Lee Seung Eun, Yeon Miyeon, Kim Chul-Woung, Yoon Tae-Ho
Graduate School of Public Health, Seoul National University, Seoul, Korea.
Department of Statistics, Graduate School, Chungnam National University, Daejeon, Korea.
J Prev Med Public Health. 2016 Sep;49(5):308-322. doi: 10.3961/jpmph.16.035. Epub 2016 Sep 7.
The objective of this study is to investigate associations between contextual characteristics and unmet healthcare needs in South Korea after accounting for individual factors.
The present study used data from the 2012 Korean Community Health Survey (KCHS) of 228 902 adults residing within 253 municipal districts in South Korea. A multilevel analysis was conducted to investigate how contextual characteristics, defined by variables that describe the regional deprivation, degree of urbanity, and healthcare supply, are associated with unmet needs after controlling for individual-level variables.
Of the surveyed Korean adults, 12.1% reported experiencing unmet healthcare needs in the past. This figure varied with the 253 districts surveyed, ranging from 2.6% to 26.2%. A multilevel analysis found that the association between contextual characteristics and unmet needs varied according to the factors that caused the unmet needs. The degree of urbanity was associated with unmet need due to "financial burden" (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.42 to 0.66 for rural vs. metropolitan), but not unmet need due to "service not available when needed." There were no significant associations between these unmet need measures and regional deprivation. Among individual-level variables, income level showed the highest association with unmet need due to "financial burden" (OR, 5.63; 95% CI, 4.76 to 6.66), while employment status showed a strong association with unmet need due to "service not available when needed."
Our finding suggests that different policy interventions should be considered for each at-risk population group to address the root cause of unmet healthcare needs.
本研究的目的是在考虑个体因素后，调查韩国背景特征与未满足的医疗保健需求之间的关联。
本研究使用了2012年韩国社区健康调查（KCHS）的数据，该调查涉及居住在韩国253个市辖区的228902名成年人。进行了多层次分析，以研究在控制个体层面变量后，由描述区域贫困、城市化程度和医疗保健供应的变量所定义的背景特征如何与未满足的需求相关联。
在接受调查的韩国成年人中，12.1%报告在过去经历过未满足的医疗保健需求。这一数字因所调查的253个地区而异，范围从2.6%到26.2%。多层次分析发现，背景特征与未满足需求之间的关联因导致未满足需求的因素而异。城市化程度与因“经济负担”导致的未满足需求相关（比值比[OR]，0.53；95%置信区间[CI]，农村与大城市相比为0.42至0.66），但与因 “需要时无服务” 导致的未满足需求无关。这些未满足需求指标与区域贫困之间没有显著关联。在个体层面变量中，收入水平与因“经济负担”导致的未满足需求关联最高（OR，5.63；9%置信区间，4.76至6.66），而就业状况与因“需要时无服务”导致的未满足需求有很强的关联。
我们的研究结果表明，应针对每个高危人群组考虑不同的政策干预措施，以解决未满足的医疗保健需求的根本原因。
