Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T08:17:56.163Z Has data issue: false hasContentIssue false
  • English
  • Français

Re-thinking unmet need for health care: introducing a dynamic perspective

Published online by Cambridge University Press:  25 April 2019

Samantha Smith  and
Sheelah Connolly
Samantha Smith*
Affiliation:
Economic & Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin2, Ireland
Sheelah Connolly
Affiliation:
Economic & Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin2, Ireland
*
*Correspondence to. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

There is an increasing interest in assessing unmet need for health care services particularly in European countries. Despite this there has been relatively little analysis of unmet need in the European or wider international setting. It remains a challenge to pin down what types of unmet need can and should be addressed by health care policymakers, and how to go about identifying and quantifying those unmet needs. The objective of this paper is to propose a new way of thinking about unmet need for health care which can in turn guide analysis of unmet need in terms of potential data sources and analytic approaches. Unmet need is shown to be a complex multi-faceted concept that cannot be captured by a single indicator or measurement. To advance the literature in this field, this paper considers what happens to unmet need over time. By introducing a dynamic perspective, three alternative trajectories for health care needs are outlined: non-use of health care, delayed use of health care and sub-optimal use of health care. These trajectories are discussed with a view to improving the focus, and policy applicability, of empirical research in this field.

Keywords

Dynamic perspectivehealth care demandhealth care needhealth care utilisationunmet need
Type
Articles
Information
Health Economics, Policy and Law , Volume 15 , Issue 4 , October 2020 , pp. 440 - 457
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Acheson, RM (1978) The definition and identification of need for health care. Journal of Epidemiology and Community Health 32, 10–15.CrossRefGoogle ScholarPubMed
Aday, LA and Andersen, R (1974) A framework for the study of access to medical care. Health Services Research 9, 208–220.Google Scholar
Allin, S and Masseria, C (2009) Unmet Need as an Indicator of Access to Health Care in Europe. Brussels, Belgium: European Commission.Google Scholar
Allin, S, Masseria, C, Sorenson, C, Papanicolas, I and Mossialos, E (2007) Measuring Inequalities in Access to Health Care: a Review of the Indices. Brussels, Belgium: European Commission.Google Scholar
Allin, S, Grignon, M and Le Grand, J (2010) Subjective unmet need and utilization of health care services in Canada: what are the equity implications? Social Science & Medicine 70, 465–472.CrossRefGoogle ScholarPubMed
Alonso, J, Orfila, F, Ruigomez, A, Ferrer, M and Anto, JM (1997) Unmet health care needs and mortality among Spanish elderly. American Journal of Public Health 87, 365–370.CrossRefGoogle ScholarPubMed
Andersen, R (1978) Health status indices and access to medical care. American Journal of Public Health 68, 458–463.CrossRefGoogle ScholarPubMed
Andersen, R and Newman, JF (1973) Societal and individual determinants of medical care utilization in the United States. Milbank Memory Fund Quaterly Health and Social 51, 95–124.CrossRefGoogle ScholarPubMed
Andersen, RM (1995) Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior 36, 1–10.CrossRefGoogle ScholarPubMed
Andersen, RM (2008) National health surveys and the behavioral model of health services use. Medical Care 46, 647–653.CrossRefGoogle ScholarPubMed
Bernhardt, J, Indredavik, B and Langhorne, P (2013) When should rehabilitation begin after stroke? International Journal of Stroke: Official Journal of the International Stroke Society 8, 5–7.CrossRefGoogle ScholarPubMed
Bhandari, A and Wagner, T (2006) Self-reported utilization of health care services: improving measurement and accuracy. Medical Care Research and Review 63, 217–235.CrossRefGoogle ScholarPubMed
Brick, A, Normand, C, O'Hara, S and Smith, S (2015) Economic Evaluation of Palliative Care in Ireland. Dublin: Trinity College Dublin & The Atlantic Philanthropies. Available at http://www.medicine.tcd.ie/health_policy_management/assets/pdf/Final-report-July-2015.pdf (Accessed 14 August 2016).Google Scholar
Carr, W and Wolfe, S (1976) Unmet needs as sociomedical indicators. International Journal of Health Services 6, 417–430.CrossRefGoogle ScholarPubMed
Cavalieri, M (2013) Geographical variation of unmet medical needs in Italy: a multivariate logistic regression analysis. International Journal of Health Geographics 12, 1–11.CrossRefGoogle ScholarPubMed
Chaupain-Guillot, S and Guillot, O (2015) Health system characteristics and unmet care needs in Europe: an analysis based on EU-SILC data. The European Journal of Health Economics 16, 781–796.CrossRefGoogle ScholarPubMed
Choi, A and Cawley, J (2018) Health disparities across education: the role of differential reporting error. Health Economics 27, e1–e29.CrossRefGoogle ScholarPubMed
Collins, E and Klein, R (1980) Equity and the NHS: self-reported morbidity, access, and primary care. British Medical Journal 281, 1111–1115.CrossRefGoogle ScholarPubMed
Connolly, S and Wren, MA (2017) Unmet healthcare needs in Ireland: analysis using the EU-SILC survey. Health Policy 121, 434–441.CrossRefGoogle ScholarPubMed
Culyer, AJ and Wagstaff, A (1993) Equity and equality in health and health care. Journal of Health Economics 12, 431–457.CrossRefGoogle ScholarPubMed
Eurostat (2016) European Survey on Income and Living Conditions (EU SILC). Available at http://ec.europa.eu/eurostat/web/income-and-living-conditions/methodology/list-variables (Accessed 17 September 2016).Google Scholar
Gillam, SJ (1992) Assessing the health care needs of populations – the general practitioner's contribution. British Journal of General Practice 42, 404–405.Google ScholarPubMed
Grossman, M (1972) On the concept of health capital and the demand for health. The Journal of Political Economy 80, 223–255.CrossRefGoogle Scholar
Harrison, JD, Young, JM, Butow, PN and Solomon, MJ (2013) Needs in health care: what beast is that? International Journal of Health Services 43, 567–585.CrossRefGoogle Scholar
Koolman, X (2007) Unmet need for health care in Europe. In Proceedings of the EU-SILC Conference. Comparative EU Statistics on Income and Living Conditions: Issues and Challenges (pp. 181–19). Luxembourg: Office for Official Publications of the European Communities.Google Scholar
Koopmanschap, MA, Brouwer, WB, Hakkaart-van Roijen, L and van Exel, NJ (2005) Influence of waiting time on cost-effectiveness. Social Science & Medicine 60, 2501–2504.CrossRefGoogle ScholarPubMed
Long, SK, King, J and Coughlin, TA (2005) The implications of unmet need for future health care use: findings for a sample of disabled Medicaid beneficiaries in New York. Inquiry 42, 413–420.CrossRefGoogle ScholarPubMed
May, P, McGarrigle, C and Normand, C (2017) The End of Life Experience of Older Adults in Ireland. Dublin: The Irish Longitudinal Study on Ageing. Available at https://tilda.tcd.ie/publications/reports/pdf/Report_EndofLife.pdf (Accessed 30 June 2018).CrossRefGoogle Scholar
Nolan, A (2011) An extension in eligibility for free primary care and avoidable hospitalisations: a natural experiment. Social Science & Medicine 73, 978–985.CrossRefGoogle ScholarPubMed
Pappa, E, Kontodimopoulos, N, Papadopoulos, A, Tountas, Y and Niakas, D (2013) Investigating unmet health needs in primary health care services in a representative sample of the Greek population. International Journal of Environmental Research and Public Health 10, 2017–2027.CrossRefGoogle Scholar
Reeves, A, McKee, M and Stuckler, D (2015) The attack on universal health coverage in Europe: recession, austerity and unmet needs. European Journal of Public Health 25, 364–365.CrossRefGoogle ScholarPubMed
Ronksley, PE, Sanmartin, C, Quan, H, Ravani, P, Tonelli, M, Manns, B and Hemmelgarn, BR (2013) Association between perceived unmet health care needs and risk of adverse health outcomes among patients with chronic medical conditions. Open Medical 7, e21–e30.Google ScholarPubMed
Sanmartin, C, Houle, C, Tremblay, S and Berthelot, JM (2002) Changes in unmet health care needs. Health Reports 13, 15–21.Google ScholarPubMed
Shapiro, MF, Ware, JE Jr and Sherbourne, CD (1986) Effects of cost sharing on seeking care for serious and minor symptoms. Results of a randomized controlled trial. Annals of Internal Medicine 104, 246–251.CrossRefGoogle ScholarPubMed
Vlachantoni, A, Shaw, R, Willis, R, Evandrou, M, Falkingham, J and Luff, R (2011) Measuring unmet need for social care amongst older people. Population Trends 145, 60–76.CrossRefGoogle Scholar
Washington, DL, Bean-Mayberry, B, Riopelle, D and Yano, EM (2011) Access to care for women veterans: delayed healthcare and unmet need. Journal of General Internal Medicine, 26(suppl. 2), 655–661.CrossRefGoogle ScholarPubMed
Wren, M-A, Gillespie, P, Crichton, S, Smith, S, Kearns, K, Parkin, D, Hickey, A, Horgan, F and Wiley, M (2014) Towards Earlier Discharge, Better Outcomes, Lower Cost: Stroke Rehabilitation in Ireland. Dublin: ESRI/Irish Heart Foundation.Google Scholar
Wren, M, Connolly, S and Cunningham, N (2015) An Examination of the Potential Costs of Universal Health Insurance in Ireland. Research Series. Dublin, Ireland: Economic and Social Research Institute.Google Scholar