Most OECD countries aim to provide
equal access to health care for people in equal need. One method of gauging equity of
access to services is through assessing reports of unmet needs for health care for some
reason. The problems that patients report in getting care when they are ill or injured
often reflect significant barriers to care.
Some common reasons that people give
for not receiving care include excessive treatment costs, long waiting times, not being
able to take time off work or needing to look after children or others, or that they had
to travel too far to receive care. Differences in the reporting of unmet care needs
across countries could be due to differences in
survey questions, because of socio-cultural reasons, or because of reactions to current
national health care debates. However, these factors play a lesser role in explaining any
differences among population groups within each
country. It is also important to consider self-reported unmet care needs in conjunction
with other indicators of potential barriers to access, such as the extent of health
insurance coverage and the amount out-of-pocket payments (see Indicator 6.2
"Coverage for health care" Indicator 6.3 "Burden of out-of-pocket health
In most OECD countries, a majority of
the population report no unmet care needs. However, in a European survey undertaken in
2009, significant proportions in some countries reported having unmet needs. Generally, it
is women, and people in low-income groups who report not getting the care they need.
Three possible reasons that might lead
to access problems are presented in Figure 6.1.1. In Greece, Italy, Poland and
Portugal, the most common reason is treatment cost. Although fewer than five per cent of
survey respondents in these countries indicated that they were affected, the burden fell
heaviest on low income earners. Waiting times were an issue for some in Poland, Finland
and Estonia. Travelling distance did not feature as a major problem except in Norway,
where one-third of the small number of persons indicating that they had an unmet care need
said that it was because of the distance they had to travel to receive care.
A larger proportion of the population
indicates unmet needs for dental care than for medical care. Portugal (14.5%) and a group
of countries including Iceland, Sweden, Norway, Italy and Poland (all around 10%) reported
the highest rates in 2009 (Figure 6.1.2). Large inequalities in unmet
dental care needs were evident between high and low income groups in Portugal and Norway,
as well as in Estonia and Germany, although in the latter two countries, average levels of
unmet dental care were low.
Inequalities in self-reported unmet
medical care needs are also evident in non-European countries (Figure 6.1.3). Again, foregone care due to cost is more prevalent among lower
income groups. There are large differences in the size of these inequalities across
countries, as shown by much lower levels in the United Kingdom than in the United States.
In the United States, more than one-third of the adult population with below-average
incomes reported having some type of unmet care need due to cost in 2010 (Commonwealth
Fund, 2010). Adults with below-average incomes who have health insurance report
significantly less access problems than do their uninsured counterparts (Blendon et al., 2002). The proportion of the population reporting
cost-related access problems declined markedly between 2007 and 2010 in New Zealand, and
to a lesser extent in the United States and Australia (Commonwealth Fund, 2008, 2010).
Definition and comparability
Questions on unmet health care
needs are a feature of a number of national and cross-national health interview
surveys, including the European Union Statistics on Income and Living Conditions
survey (EU-SILC) and the international health policy surveys conducted by the
Commonwealth Fund. No single survey or study on unmet care needs has been conducted
across all OECD countries.
To determine unmet medical care,
individuals are typically asked whether there was a time in the previous 12 months
when they felt they needed health care services but did not receive them, followed by
a question as to why the need for care was unmet. Common reasons include that care was
too expensive, the waiting time was too long, or the travelling distance to receive
care was too far.
Information on both unmet care and
socio-economic status are derived from the same survey, although question and answer
categories, age groups surveyed and measures to grade socio-economic status can vary.
Cultural factors and policy debates may also affect attitudes to unmet care. Caution
is needed in comparing the magnitude of inequalities across countries.
|Indicator in PDF
|6.1.1 Unmet need for a medical examination, selected reasons
by income quintile, European countries, 2009
|6.1.2 Unmet need for a dental examination, by income
quintile, European countries, 2009
|6.1.3 Unmet care need due to costs in
eleven OECD countries, by income group, 2010