title: Subjective unmet need and utilization of health care services in Canada: what are the equity implications?
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.
authors.affiliation: Department of Health Policy, Management and Evaluation, University of Toranto, Canada; London School of Economics and Political Science, London, United Kingdom. Electronic address: sara.allin@utoronto.ca.
authors.forename: Sara
authors.initials: S
authors.lastname: Allin
authors.affiliation: Department of Economics, Department of Health, Aging and Society, McMaster University, Hamilton, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Grignon
authors.affiliation: London School of Economics and Political Science, London, United Kingdom.
authors.forename: Julian
authors.initials: J
authors.lastname: Le Grand
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D002170:Canada; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014850:Waiting Lists; D055815:Young Adult