Fjær Erlend L, Stornes Per, Borisova Liubov V, McNamara Courtney L, Eikemo Terje A
Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Sociology, Uppsala University, Uppsala, Sweden.
Eur J Public Health. 2017 Feb 1;27(suppl_1):82-89. doi: 10.1093/eurpub/ckw219.
Unmet need can be defined as the individually perceived subjective differences between services judged necessary to deal with health problems and the services actually received. This study examines what factors are associated with unmet need, as well as how reasons for unmet need are distributed across socioeconomic and demographic groups in Europe.
Multilevel logistic regression models were employed using data from the 7th round of the European Social Survey, on people aged 25–75. Self-reported unmet need measured whether respondents had been unable to get medical consultation or treatment in the last 12 months. Reasons for unmet need were grouped into three categories: availability, accessibility and acceptability. Health status was measured by self-reported health, non-communicable diseases and depressive symptoms.
Two-thirds of all unmet need were due waiting lists and appointment availability. Females and young age groups reported more unmet need. We found no educational inequalities, while financial strain was found to be an important factor for all types of unmet need for health care in Europe. All types of health care use and poor health were associated with unmet need. Low physician density and high out-of-pocket payments were found to be associated with unmet need due to availability.
Even though health care coverage is universal in many European welfare states, financial strain appeared as a major determinant for European citizens’ access to health care. This may suggest that higher income groups are able to bypass waiting lists. European welfare states should, therefore, intensify their efforts in reducing barriers for receiving care.
未满足的需求可定义为个体所感知到的，在应对健康问题所需的服务与实际获得的服务之间的主观差异。本研究考察了哪些因素与未满足的需求相关，以及未满足需求的原因在欧洲社会经济和人口群体中是如何分布的。
采用多层次逻辑回归模型，使用来自第七轮欧洲社会调查的数据，调查对象为25至75岁的人群。自我报告的未满足需求衡量了受访者在过去12个月内是否无法获得医疗咨询或治疗。未满足需求的原因分为三类：可及性、可获得性和可接受性。健康状况通过自我报告的健康状况、非传染性疾病和抑郁症状来衡量。
所有未满足需求的三分之二是由于等候名单和预约可获得性。女性和年轻年龄组报告的未满足需求更多。我们未发现教育方面的不平等，而经济压力被发现是欧洲所有类型医疗保健未满足需求的一个重要因素。所有类型的医疗保健使用和健康状况不佳都与未满足需求相关。低医生密度和高额自付费用被发现与因可获得性导致的未满足需求相关。
尽管在许多欧洲福利国家医疗保健覆盖是普遍的，但经济压力似乎是欧洲公民获得医疗保健的一个主要决定因素。这可能表明高收入群体能够绕过等候名单。因此，欧洲福利国家应加大努力减少接受医疗服务的障碍。
