Klein Jens, Lüdecke Daniel, von dem Knesebeck Olaf
Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Int J Equity Health. 2025 May 6;24(1):122. doi: 10.1186/s12939-025-02483-6.
Subjective unmet need is an established indicator of unequal access to medical care and is often measured by delaying and forgoing medically necessary treatment. Research on delayed and forgone care among the general population in Germany including different reasons, social deprivation measures, and the perceived health risk of unmet need is sparse. This study aims to examine reasons, inequalities, and health-related consequences of unmet need in terms of delayed and forgone care.
A cross-sectional online survey was carried out based on a randomly drawn sample of the German adult population in December 2022 (N = 2,201). Respondents were asked whether medical treatments were delayed or forgone in the past 12 months due to different reasons (waiting time, travel distance, financial costs). If unmet need was indicated, the respondents were subsequently asked about their perception of related health risks. Associations with individual social (sex, age, migration history, education, income) and regional factors (social deprivation) as well as insurance status were examined using multilevel logistic regressions analyses.
Among N = 1,955 respondents who indicated need for medical care, 30% reported at least one reason for forgone care (waiting time 23%, financial costs 11%, travel distance 9%). In terms of delayed care, highest rate was found for waiting time (34%). Multilevel analyses revealed significant associations of unmet need with female sex, younger age, lower education, lower income, and statutory health insurance. Associations varied depending on the reason for unmet need. Differences in regional social deprivation were particularly found for forgone care due to distance. Between half and nearly two-thirds of the participants reported worsening of symptoms in case of unmet need. Associations with social characteristics were inconsistent.
Unmet need is a prevailing issue in Germany and associated with perceived worsening of health, various indicators of social inequality, and health insurance. Reducing waiting times (e.g. through the further development of appointment service centres) and private co-payments as well as ensuring health care provision in deprived areas can contribute to a decrease of barrier-related unmet need and health risks. However, more in-depth studies are required to account for the complex nature of health care access.
主观未满足需求是医疗服务获取不平等的既定指标，通常通过延迟和放弃必要的医疗治疗来衡量。关于德国普通人群中延迟和放弃医疗护理的研究，包括不同原因、社会剥夺措施以及未满足需求的感知健康风险，较为稀少。本研究旨在探讨延迟和放弃医疗护理方面未满足需求的原因、不平等现象以及与健康相关的后果。
2022年12月，基于随机抽取的德国成年人群样本（N = 2201）开展了一项横断面在线调查。询问受访者在过去12个月内是否因不同原因（等待时间、出行距离、经济成本）而延迟或放弃了医疗治疗。如果表明存在未满足需求，随后询问受访者对相关健康风险的看法。使用多水平逻辑回归分析研究与个体社会因素（性别、年龄、移民史、教育程度、收入）、区域因素（社会剥夺）以及保险状况之间的关联。
在表明有医疗护理需求的N = 1955名受访者中，30%报告了至少一个放弃医疗护理的原因（等待时间23%、经济成本11%、出行距离9%）。在延迟医疗护理方面，等待时间的比例最高（34%）。多水平分析显示，未满足需求与女性、较年轻年龄、较低教育程度、较低收入以及法定医疗保险之间存在显著关联。关联因未满足需求的原因而异。在因距离而放弃医疗护理方面，特别发现了区域社会剥夺的差异。一半至近三分之二的参与者报告称，在未满足需求的情况下症状会加重。与社会特征的关联不一致。
未满足需求在德国是一个普遍存在的问题，与感知到的健康恶化、各种社会不平等指标以及医疗保险相关。减少等待时间（例如通过进一步发展预约服务中心）和私人自付费用，以及确保贫困地区的医疗服务提供，有助于减少与障碍相关的未满足需求和健康风险。然而，需要更深入的研究来解释医疗服务获取的复杂性。
