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


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


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.

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  • 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

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    References listed on IDEAS

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    Cited by:

    1. 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.
    2. Röttger, Julia & Blümel, Miriam & Köppen, Julia & Busse, Reinhard, 2016. "Forgone care among chronically ill patients in Germany—Results from a cross-sectional survey with 15,565 individuals," Health Policy, Elsevier, vol. 120(2), pages 170-178.
    3. Maria Jose Aragon Aragon & Martin Chalkley & Maria Goddard, 2017. "Defining and measuring unmet need to guide healthcare funding:identifying and filling the gaps," Working Papers 141cherp, Centre for Health Economics, University of York.
    4. Fiorillo, Damiano, 2017. "Reasons for unmet needs for health care: the role of social capital and social support in some Western EU countries," MPRA Paper 82680, University Library of Munich, Germany.
    5. Hana Bataineh & Rose Anne Devlin & Vicky Barham, 2018. "Does unmet health care lead to poorer health outcomes?," Working Papers 1803E, University of Ottawa, Department of Economics.
    6. García-Gómez, Pilar & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores & Oliva-Moreno, Juan, 2015. "Inequity in long-term care use and unmet need: Two sides of the same coin," Journal of Health Economics, Elsevier, vol. 39(C), pages 147-158.
    7. Dourgnon, Paul, 2013. "Evaluation des politiques publiques et inégalités sociales d'accès aux services de santé," Economics Thesis from University Paris Dauphine, Paris Dauphine University, number 123456789/12221 edited by Wittwer, Jérôme, March.
    8. Ko, Hansoo, 2016. "Unmet healthcare needs and health status: Panel evidence from Korea," Health Policy, Elsevier, vol. 120(6), pages 646-653.
    9. Garcia-Subirats, Irene & Vargas, Ingrid & Mogollón-Pérez, Amparo Susana & De Paepe, Pierre & da Silva, Maria Rejane Ferreira & Unger, Jean Pierre & Vázquez, María Luisa, 2014. "Barriers in access to healthcare in countries with different health systems. A cross-sectional study in municipalities of central Colombia and north-eastern Brazil," Social Science & Medicine, Elsevier, vol. 106(C), pages 204-213.
    10. Vicky Barham & Hana Bataineh & Rose Anne Devlin, 2017. "Unmet Health Care and Health Care Utilization," Working Papers 1716E, University of Ottawa, Department of Economics.
    11. Abu-Zaineh, Mohammad & Mataria, Awad & Moatti, Jean-Paul & Ventelou, Bruno, 2011. "Measuring and decomposing socioeconomic inequality in healthcare delivery: A microsimulation approach with application to the Palestinian conflict-affected fragile setting," Social Science & Medicine, Elsevier, vol. 72(2), pages 133-141, January.
    12. repec:spr:soinre:v:135:y:2018:i:1:d:10.1007_s11205-016-1483-2 is not listed on IDEAS
    13. Brackbill, Robert M. & Stellman, Steven D. & Perlman, Sharon E. & Walker, Deborah J. & Farfel, Mark R., 2013. "Mental health of those directly exposed to the World Trade Center disaster: Unmet mental health care need, mental health treatment service use, and quality of life," Social Science & Medicine, Elsevier, vol. 81(C), pages 110-114.
    14. Kim, Tae Jun & Vonneilich, Nico & Lüdecke, Daniel & von dem Knesebeck, Olaf, 2017. "Income, financial barriers to health care and public health expenditure: A multilevel analysis of 28 countries," Social Science & Medicine, Elsevier, vol. 176(C), pages 158-165.


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