Determinants of Unmet Needs and Impact on Ambulatory Health Care Expenditures

Objectives: The objective of this study was to explore the determinants of unmet needs in elderly individuals and to evaluate the effect of unmet needs on yearly ambulatory health care expenditures. Methods: We used the cross-sectional 2012 French health, health care, and insurance survey (Enquête sur la santé et la protection sociale, ESPS) matched with National Health Insurance data, containing approximately 12000 individual data. We modeled ambulatory health care expenditures using the Heckman method implementing a double selection with a sequential biprobit model framework, based on the self-perceived health status and self-reported unmet needs, to correct for potential bias. Results: In 2012 ESPS database, 1034 elderly individuals (aged at least 65) matching with National Health Insurance data could be identified. Among these individuals, 4.4% reported unmet needs and 62.3% declared having a poor health status. After adjusting for endogeneity of self-perceived health status, we found that unmet needs is positively associated with age and difficulty paying for care, and negatively associated with possession of private health care insurance cover. Then, the model for ambulatory health care expenditure revealed that expenditures in elders declaring both poor health status and no unmet needs increase with frailty and possession of private health care insurance cover. Among elders reporting a poor health status, health care expenditures decrease, ceteri paribus, in those not reporting unmet needs. Conclusions: Using National Health Insurance and survey data, this study provides evidence to support the impact of unmet needs on an increment of health care expenditures in elders with poor self-reported health status. Hence, this suggested that health care expenditures might be shifted from preventive care to curative care in elders with poor health status and declaring unmet needs.