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http://dx.doi.org/10.3961/jpmph.16.035

The Association Among Individual and Contextual Factors and Unmet Healthcare Needs in South Korea: A Multilevel Study Using National Data  

Lee, Seung Eun (Graduate School of Public Health, Seoul National University)
Yeon, Miyeon (Department of Statistics, Graduate School, Chungnam National University)
Kim, Chul-Woung (Department of Preventive Medicine, Chungnam National University School of Medicine)
Yoon, Tae-Ho (Department of Preventive Medicine, Busan National University School of Medicine)
Publication Information
Journal of Preventive Medicine and Public Health / v.49, no.5, 2016 , pp. 308-322 More about this Journal
Abstract
Objectives: The objective of this study is to investigate associations between contextual characteristics and unmet healthcare needs in South Korea after accounting for individual factors. Methods: 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. Results: 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." Conclusions: 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.
Keywords
Health services accessibility; Utilization; Residence characteristics; Multilevel analysis; Health surveys;
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1 Anderson RM, Davidson PL. Improving access to care in America. In: Rice TM, Kominski GF, Afifi AA, Rosenstock L, Andersen R, editors. Changing the US health care system: key issues in health services policy and management. 3rd ed. San Francisco: Jossey-Bass; 2007, p. 3-31.
2 Litaker D, Love TE. Health care resource allocation and individuals’ health care needs: examining the degree of fit. Health Policy 2005;73(2):183-193.   DOI
3 Peterson LE, Litaker DG. County-level poverty is equally associated with unmet health care needs in rural and urban settings. J Rural Health 2010;26(4):373-382.   DOI
4 Pampalon R, Hamel D, Gamache P. Health inequalities in urban and rural Canada: comparing inequalities in survival according to an individual and area-based deprivation index. Health Place 2010;16(2):416-420.   DOI
5 Jordan H, Roderick P, Martin D. The index of multiple deprivation 2000 and accessibility effects on health. J Epidemiol Community Health 2004;58(3):250-257.   DOI
6 Gunnell DJ, Peters TJ, Kammerling RM, Brooks J. Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation. BMJ 1995;311(6999):226-230.   DOI
7 Reijneveld SA, Schene AH. Higher prevalence of mental disorders in socioeconomically deprived urban areas in the Netherlands: community or personal disadvantage? J Epidemiol Community Health 1998;52(1):2-7.   DOI
8 Stafford M, Marmot M. Neighbourhood deprivation and health: does it affect us all equally? Int J Epidemiol 2003;32(3): 357-366.   DOI
9 Eibner C, Sturm R. US-based indices of area-level deprivation: results from HealthCare for Communities. Soc Sci Med 2006; 62(2):348-359.   DOI
10 Lang IA, Gibbs SJ, Steel N, Melzer D. Neighbourhood deprivation and dental service use: a cross-sectional analysis of older people in England. J Public Health (Oxf) 2008;30(4):472-478.   DOI
11 Curtis S, Copeland A, Fagg J, Congdon P, Almog M, Fitzpatrick J. The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: a comparison of London and New York City. Health Place 2006;12(1):19-37.   DOI
12 Hillemeier MM, Lynch J, Harper S, Casper M. Measuring contextual characteristics for community health. Health Serv Res 2003;38(6 Pt 2):1645-1717.   DOI
13 Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995;36(1):1-10.   DOI
14 Korea Centers for Disease Control and Prevention. Community health survey [cited 2016 Sep 9]. Available from: https://chs.cdc.go.kr/chs/index.do (Korean).
15 Kang YW, Ko YS, Kim YJ, Sung KM, Kim HJ, Choi HY, et al. Korea community health survey data profiles. Osong Public Health Res Perspect 2015;6(3):211-217.   DOI
16 Kim CS, Han SY, Lee SE, Kang JH, Kim CW. Dental care utilization for examination and regional deprivation. J Prev Med Public Health 2015;48(4):195-202.   DOI
17 Baggett TP, O'Connell JJ, Singer DE, Rigotti NA. The unmet health care needs of homeless adults: a national study. Am J Public Health 2010;100(7):1326-1333.   DOI
18 Marshall EG. Do young adults have unmet healthcare needs? J Adolesc Health 2011;49(5):490-497.   DOI
19 Kim D, Lee S, Ki M, Kim M, Kim S, Kim Y, et al. Developing health inequalities indicators and monitoring the status of health inequalities in Korea. Seoul: Korea Institute for Health and Social Affairs; 2013, p. 166-179 (Korean).
20 Yoon TH, Kim SY, Yun MS, Moon KJ. Relationship between local authority deprivation and activity limitation in adults aged 50 or over. Korean J Health Educ Promot 2015;32(2):27-37 (Korean).   DOI
21 Kang BS, Lee CW. A study on development strategies for jurisdictional change of local metropolitan governments. J Soc Sci 2005;16:1-23 (Korean).
22 Raudenbush SW, Bryk AS. Hierarchical linear models: applications and data analysis methods. 2nd ed. Thousand Oaks: Sage Publications; 2002, p. 68-98.
23 Heeringa SG, Liu J. Complex sample design effects and inference for mental health survey data. Int J Methods Psychiatr Res 1998;7(1):56-65.   DOI
24 Shin YJ, Shon JI The prevalence and association factors of unmet medical need-using the 1st and 2nd Korea welfare panel data. Health Soc Welf Rev 2009;29(1):111-142 (Korean).
25 Lee SY, Kim CW, Kang JH, Seo NK. Unmet healthcare needs depending on employment status. Health Policy 2015;119(7): 899-906.   DOI
26 Ko H. Unmet healthcare needs and health status: panel evidence from Korea. Health Policy 2016;120(6):646-653.   DOI
27 Robert SA. Socioeconomic position and health: the independent contribution of community socioeconomic context. Annu Rev Sociol 1999;25:489-516.   DOI
28 Organization for Economic Cooperation and Development. Health at a glance 2013: OECD indicators [cited 2016 Sep 9]. Available from: http://apps.who.int/medicinedocs/documents/s21725en/s21725en.pdf.
29 Choi SH. Unmet health care needs among adults in Korea. Public Health Wkly Rep 2014;7:197-200 (Korean).
30 Bae KS. What sustains the working time regime of long hours in South Korea? Econ Soc 2012;95:128-162 (Korean).
31 Zhang P, Tao G, Anderson LA. Differences in access to health care services among adults in rural America by rural classification categories and age. Aust J Rural Health 2003;11(2):64-72.   DOI
32 Heo J, Oh J, Kim J, Lee M, Lee JS, Kwon S, et al. Poverty in the midst of plenty: unmet needs and distribution of health care resources in South Korea. PLoS One 2012;7(11):e51004.   DOI
33 Ministry of Health and Welfare. Health data OECD 2012 [cited 2016 Sep 9]. Available from: file:///C:/Users/user/Downloads/OECD+Health+Data+2012.pdf (Korean).
34 Organization for Economic Cooperation and Development. Health at a glance: Europe 2014; 2014 [cited 2016 Sep 9]. Available from: http://www.oecd.org/health/health-at-a-glance- europe-23056088.htm.
35 Allin S, Grignon M, Le Grand J. Subjective unmet need and utilization of health care services in Canada: what are the equity implications? Soc Sci Med 2010;70(3):465-472.   DOI
36 Diamant AL, Hays RD, Morales LS, Ford W, Calmes D, Asch S, et al. Delays and unmet need for health care among adult primary care patients in a restructured urban public health system. Am J Public Health 2004;94(5):783-789.   DOI
37 Kirby JB, Kaneda T. Neighborhood socioeconomic disadvantage and access to health care. J Health Soc Behav 2005;46(1): 15-31.   DOI
38 Koolman X. Unmet need for health care in Europe. In: Comparative EU statistics on income and living conditions: issues and challenges; Proceedings of the EU-SILC Conference (Helsinki, Nov 6-8, 2006). Luxembourg: Office for Official Publications of the European Communities; 2007, p. 181-191.
39 Law M, Wilson K, Eyles J, Elliott S, Jerrett M, Moffat T, et al. Meeting health need, accessing health care: the role of neighbourhood. Health Place 2005;11(4):367-377.   DOI
40 Ahn YH, Kim NH, Kim CB, Ham OK. Factors affecting unmet healthcare needs of older people in Korea. Int Nurs Rev 2013;60(4):510-519.   DOI