IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v70y2010i3p465-472.html
   My bibliography  Save this article

Subjective unmet need and utilization of health care services in Canada: What are the equity implications?

Author

Listed:
  • Allin, Sara
  • Grignon, Michel
  • Le Grand, Julian

Abstract

This study aimed to evaluate whether subjective assessments of unmet need may complement conventional methods of measuring socioeconomic inequity in health care utilization. This study draws on the 2003 Canadian Community Health Survey to develop a conceptual framework for understanding how unmet need arises, to empirically assess the association between utilization and the different types of unmet need (due to waiting times, barriers and personal reasons), and to investigate the effect of adjusting for unmet need on estimates of income-related inequity. The study's findings suggest that a disaggregated approach to analyzing unmet need is required, since the three different subgroups of unmet need that we identify in Canada have different associations with utilization, along with different equity implications. People who report unmet need due to waiting times use more health services than would be expected based on their observable characteristics. However, there is no consistent pattern of utilization among people who report unmet need due to access barriers, or for reasons related to personal choice. Estimates of inequity remain unchanged when we incorporate information on unmet need in the analysis. Subjective assessments of unmet need, namely those that relate to barriers to access, provide additional policy-relevant information that can be used to complement conventional methods of measuring inequity, to better understand inequity, and to guide policy action.

Suggested Citation

  • Allin, Sara & Grignon, Michel & Le Grand, Julian, 2010. "Subjective unmet need and utilization of health care services in Canada: What are the equity implications?," Social Science & Medicine, Elsevier, vol. 70(3), pages 465-472, February.
    • Handle: RePEc:eee:socmed:v:70:y:2010:i:3:p:465-472
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(09)00717-5
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Nelson, Connie Holmes & Park, Jungwee, 2006. "The nature and correlates of unmet health care needs in Ontario, Canada," Social Science & Medicine, Elsevier, vol. 62(9), pages 2291-2300, May.
    2. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896, December.
    3. Balsa, Ana I. & McGuire, Thomas G., 2003. "Prejudice, clinical uncertainty and stereotyping as sources of health disparities," Journal of Health Economics, Elsevier, vol. 22(1), pages 89-116, January.
    4. Westin, Marcus & Ahs, Annika & Brand Persson, Kristina & Westerling, Ragnar, 2004. "A large proportion of Swedish citizens refrain from seeking medical care--lack of confidence in the medical services a plausible explanation?," Health Policy, Elsevier, vol. 68(3), pages 333-344, June.
    5. Eddy van Doorslaer & Cristina Masseria, 2004. "Income-Related Inequality in the Use of Medical Care in 21 OECD Countries," OECD Health Working Papers 14, OECD Publishing.
    6. Ahs, Annika Maria Helen & Westerling, Ragnar, 2006. "Health care utilization among persons who are unemployed or outside the labour force," Health Policy, Elsevier, vol. 78(2-3), pages 178-193, October.
    7. Balsa, Ana I. & McGuire, Thomas G., 2001. "Statistical discrimination in health care," Journal of Health Economics, Elsevier, vol. 20(6), pages 881-907, November.
    8. Himmelstein, D.U. & Woolhandler, S., 1995. "Care denied: US residents who are unable to obtain needed medical services," American Journal of Public Health, American Public Health Association, vol. 85(3), pages 341-344.
    9. Dolores Jiménez‐Rubio & Peter C. Smith & Eddy Van Doorslaer, 2008. "Equity in health and health care in a decentralised context: evidence from Canada," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 377-392, March.
    10. Litaker, David & Love, Thomas Ezra, 2005. "Health care resource allocation and individuals' health care needs: examining the degree of fit," Health Policy, Elsevier, vol. 73(2), pages 183-193, August.
    11. Diamant, A.L. & Hays, R.D. & Morales, L.S. & Ford, W. & Calmes, D. & Asch, S. & Duan, N. & Fielder, E. & Kim, S. & Fielding, J. & Sumner, G. & Shapiro, M.F. & Hayes-Bautista, D. & Gelberg, L., 2004. "Delays and Unmet Need for Health Care among Adult Primary Care Patients in a Restructured Urban Public Health System," American Journal of Public Health, American Public Health Association, vol. 94(5), pages 783-789.
    12. Elofsson, Stig & Undén, Anna-Lena & Krakau, Ingvar, 1998. "Patient charges -- a hindrance to financially and psychosocially disadvantage groups seeking care," Social Science & Medicine, Elsevier, vol. 46(10), pages 1375-1380, March.
    13. Culyer, A. J. & Wagstaff, Adam, 1993. "Equity and equality in health and health care," Journal of Health Economics, Elsevier, vol. 12(4), pages 431-457, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Grant Gibson & Michel Grignon & Jeremiah Hurley & Li Wang, 2019. "Here comes the SUN: Self‐assessed unmet need, worsening health outcomes, and health care inequity," Health Economics, John Wiley & Sons, Ltd., vol. 28(6), pages 727-735, June.
    2. Erik Schokkaert & Jonas Steel & Carine Van de Voorde, 2017. "Out-of-Pocket Payments and Subjective Unmet Need of Healthcare," Applied Health Economics and Health Policy, Springer, vol. 15(5), pages 545-555, October.
    3. Evelina Pappa & Nick Kontodimopoulos & Angelos Papadopoulos & Yannis Tountas & Dimitris Niakas, 2013. "Investigating Unmet Health Needs in Primary Health Care Services in a Representative Sample of the Greek Population," IJERPH, MDPI, vol. 10(5), pages 1-11, May.
    4. Hana Bataineh & Rose Anne Devlin & Vicky Barham, 2019. "Unmet health care and health care utilization," Health Economics, John Wiley & Sons, Ltd., vol. 28(4), pages 529-542, April.
    5. Laura Hirello & Mohammad Habibullah Pulok & Mohammad Hajizadeh, 2022. "Equity in healthcare utilization in Canada’s publicly funded health system: 2000–2014," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(9), pages 1519-1533, December.
    6. Winnie W. Kung & Xiaoran Wang & Xinhua Liu & Emily Goldmann & Debbie Huang, 2019. "Unmet Mental Health Care Needs among Asian Americans 10–11 Years After Exposure to the World Trade Center Attack," IJERPH, MDPI, vol. 16(7), pages 1-15, April.
    7. Hajizadeh, Mohammad & Pandey, Sujita & Pulok, Mohammad Habibullah, 2023. "Decomposition of socioeconomic inequalities in catastrophic out-of-pocket expenditure for healthcare in Canada," Health Policy, Elsevier, vol. 127(C), pages 51-59.
    8. Jens Detollenaere & Lise Hanssens & Veerle Vyncke & Jan De Maeseneer & Sara Willems, 2017. "Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-13, January.
    9. Hai Zhong, 2010. "The impact of missing data in the estimation of concentration index: a potential source of bias," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(3), pages 255-266, June.
    10. Pulok, Mohammad Habibullah & van Gool, Kees & Hall, Jane, 2020. "Horizontal inequity in the utilisation of healthcare services in Australia," Health Policy, Elsevier, vol. 124(11), pages 1263-1271.
    11. Setti Rais Ali & Paul Dourgnon & Lise Rochaix, 2018. "Social Capital or Education: What Matters Most to Cut Time to Diagnosis?," Working Papers halshs-01703170, HAL.
    12. Sveréus, Sofia & Kjellsson, Gustav & Rehnberg, Clas, 2018. "Socioeconomic distribution of GP visits following patient choice reform and differences in reimbursement models: Evidence from Sweden," Health Policy, Elsevier, vol. 122(9), pages 949-956.
    13. Damiano Fiorillo, 2020. "Reasons for unmet needs for health care: the role of social capital and social support in some western EU countries," International Journal of Health Economics and Management, Springer, vol. 20(1), pages 79-98, March.
    14. Christine André & Philippe Batifoulier & Mariana Jansen-Ferreira, 2016. "Privatisation de la santé en Europe. Un outil de classification des réformes," CEPN Working Papers hal-01256505, HAL.
    15. Olufunke Alaba & Lumbwe Chola, 2014. "Socioeconomic Inequalities in Adult Obesity Prevalence in South Africa: A Decomposition Analysis," IJERPH, MDPI, vol. 11(3), pages 1-20, March.
    16. Antonio Abatemarco & Sergio Beraldo & Francesca Stroffolini, 2020. "Equality of opportunity in health care: access and equal access revisited," International Review of Economics, Springer;Happiness Economics and Interpersonal Relations (HEIRS), vol. 67(1), pages 13-29, March.
    17. Sato, Azusa, 2012. "Do Inequalities in Health Care Utilization in Developing Countries Change When We Take into Account Traditional Medicines?," World Development, Elsevier, vol. 40(11), pages 2275-2289.
    18. Connolly, Sheelah & Wren, Maev-Ann, 2017. "Unmet healthcare needs in Ireland: Analysis using the EU-SILC survey," Health Policy, Elsevier, vol. 121(4), pages 434-441.
    19. Westin, Marcus & Ahs, Annika & Brand Persson, Kristina & Westerling, Ragnar, 2004. "A large proportion of Swedish citizens refrain from seeking medical care--lack of confidence in the medical services a plausible explanation?," Health Policy, Elsevier, vol. 68(3), pages 333-344, June.
    20. Tavares, Lara Patrício & Zantomio, Francesca, 2017. "Inequity in healthcare use among older people after 2008: The case of southern European countries," Health Policy, Elsevier, vol. 121(10), pages 1063-1071.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:70:y:2010:i:3:p:465-472. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.