Measure database
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Measures assessing the demand-side factors driving health need/unmet need that can be assessed by publicly available surveys conducted both nationally and cross-nationally
Cross-national surveys
European Union Statistics on Income and Living Conditions (EU-SILC)
INSTRUMENT NOT ACCESSIBLE (OWNED BY THE EUROPEAN UNION)
The aim of the European Union Statistics on Income and Living Conditions (EU-SILC) survey is to collect cross-sectional and longitudinal data on income, poverty, social exclusion and living conditions. The EU-SILC project was launched in 2003 now and covers all EU member countries, Iceland, Norway and Switzerland. EU-SILC data are collected by National Statistical Institutes and could come from different sources, with the information needed extracted either from registers or collected from interviews. Information on social exclusion and housing conditions is collected mainly at household level, while labour, education and health information is obtained from individuals aged 16 and over.
EU-SILC surveys included two distinct questions on unmet need for medical examination or treatment for a health problem and dental care. These are: 1) “Was there any time during the last 12 months when you personally, really needed a medical examination or treatment for a health problem but you did not receive it?”; and 2) “Was there any time during the last 12 months when you personally, really needed a dental examination or treatment but did not receive it?”. Both questions were followed-up with an additional question that offered a number of response categories for the main reason for unmet care needs, including reasons related to the health system (too expensive, waiting times and distance to services) and more personal reasons (fear of treatment, could not take time off work/caring responsibilities, waiting to see if the problem resolved); however, only the main reason for not receiving care was reported. The ordering of the questions in EU-SILC first assessed whether the respondent had any incidence of not receiving care, with the follow-up question exploring the reason why, only asked if indicated. This may lead to under-reporting of the true extent of unmet need. Due to the wording of the questions in EU-SILC, unmet needs only referred to foregone care, with no questions asked to assess delayed care. Based on this survey, unmet needs for medical or dental care was defined as having at least one incident in the last 12 months when the person did not receive a medical or dental examination or treatment for a health problem when they really needed it.
European Health Interview Survey (EHIS)
WAVE 2&3 INSTRUMENTS NOT ACCESSIBLE
The European Health Interview Survey (EHIS) consists of four modules on health status, health care use, health determinants and socio-economic background variables. EHIS targets the population aged at least 15 and living in private households and is run every 5 years. The first wave, EHIS 1 was conducted between 2006 and 2009 with the second wave, EHIS 2 conducted between 2013 and 2015 (14).
EHIS targets the population aged 15+ years and living in private households, and allows for differentiation between those who did and did not have health care needs in any given year (15). The way the questions were formulated means that respondents were asked a number of questions to assess their specific needs for care and the level of care received. These questions were, “Was there any time in the past 12 months when you needed the following kinds of health care, but could not afford it?”, followed by questions about the type of services/care “Yes [for …]”, “No [for …]” or “No need [for …]” for the following: a) medical care, b) dental care, c) prescribed medicines, and d) mental health care.
Respondents were then asked subsequent questions about barriers to ‘health care’ in general which may include any type of care. These could be further explored and mapped to the WHO PAHO efforts looking at barriers to care as part of the wider WHO effort looking at unmet need and foregone care. Three questions asked specifically about the three main barriers to health care: waiting times, distance/transport and cost. The first two questions asked about “experiencing a delay” due to waiting times or distance to the facility/service that the interviewer instructions defined as “episodes where care was not received soon enough or at all”. The third question related to not receiving care because of the cost. The term “health care” was not further defined in the first two questions, while, in the third question cost was explored by type of care, namely, medical care, dental care, prescribed medicines or mental health care.
The questions in EHIS included both delayed and foregone care due to waiting time and distance, and foregone care due to cost. Questions about delayed care were, “Have you experienced delay in getting health care in the past 12 months because the time needed to obtain an appointment was too long?” and “Have you experienced delay in getting health care in the past 12 months due to distance or transport problems?”.
Unmet need was defined as having had at least one instance in the last 12 months when the person did not receive care soon enough or at all because: (i) the time needed to obtain an appointment was too long, (ii) due to distance or transport problems, or (iii) when they did not receive care due to cost.
Study of global AGEing and adult health (SAGE)
WHO SAGE is part of an ongoing program of work to compile comprehensive longitudinal information on the health and well-being of adult populations and the ageing process. The core SAGE collects data on adults aged 18+ years, with an emphasis on populations aged 50+ years, from nationally representative samples in six countries: China, Ghana, India, Mexico, Russian Federation and South Africa. Wave 1 total sample size is over 40,000 individuals. Wave 2 data collection was completed in 2014/15 in five countries. Wave 2 data will be released in the public domain end 2020. Wave 3 data collection was completed in March 2020.
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Survey items that explore unmet need in the Mongolia (2018) survey
Q5002: The last time you needed health care, did you get health care?
Survey items that explore unmet need in the Wave 1 (Ghana, India, China, Mexico, Russia, South Africa) and Wave 2 (Ghana, Mexico, South Africa) 2007-2019 surveys
Q5001: When was the last time that you needed health care?
Q5002: The last time you needed health care, did you get health care?"
Q5003a. What was the main reason you needed care, even if you did not get care?
Q4067: During the last 12 months, have you had any problems with your mouth and/or teeth, including problems with swallowing?
Q4068a: Have you received any medications or treatment from a dentist or other oral health specialist during the last 2 weeks?
Q4068b: Have you received any medications or treatment from a dentist or other oral health specialist during the last 12 months?
Survey on Health, Well-Being, and Aging (SABE)
A major health study of old people in Latin America and the Caribbean (LAC) is the SABE study Survey on Health, Well-Being, and Aging in Latin America and the Caribbean; SABE (from initials in Spanish: SAlud, Bienestar & Envejecimiento) is a multicenter project originally conducted by the Pan-American Health Organization (PAHO). The study included 10,891 individuals, 60+ years of age, living in seven big cities of the region (Bridgetown, Buenos Aires, Havana, Mexico City, Montevideo, Santiago, and Sao Paulo) and was based on a probabilistic, stratified, multistage, cluster-sampling design of noninstitutionalized elderly population of the seven participating cities.
After the SABE study was conducted in Latin America, several cross-sectional studies have been carried out in the region. Between 2009 and 2010 in Ecuador, a similar study with emphasis on Aborigine population (10.4% of the total population) was conducted: SABE Ecuador. Recently, with a similar methodology to the SABE study, a cross-sectional survey was conducted in the urban zone of Bogotá (Colombia) including 2000 people of 60+ years. In Peru a SABE study is ongoing by 2016.
More than 40 papers from SABE study have been published during the last decade including different topics like gender, chronic conditions, hypertension, diabetes mellitus, obesity, anaemia, cancer, anthropometric measures, oral health, mobility, frailty and sarcopenia, disability, falls, depression, cognitive function, and caregivers.
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Survey items that explore unmet need in the Colombia (2015) survey
P902: During the last 30 days, have you had any health problems?
P903: For any of the health problems you have had in the last 30 days, have you consulted or sought help?
P904: What was the main reason for NOT consulting or seeking help?
P905: Did you receive the requested care from your health service for the problems that you have experienced?
Survey items that explore unmet need in the Ecuador (2009) survey
E9: In the last year – did not take medication
F3_2: In the last year - did not consult even if needed it
F20aL: These exams (radiographies) were performed (for people who need medical attention)
C.17 In the last year have you been cared for by a dentist?
Commonwealth Fund International Health Policy Survey (Commonwealth Study)
INSTRUMENT NOT ACCESSIBLE (OWNED BY THE COMMONWEALTH FUND)
In collaboration with international partners, The Commonwealth Fund's international program conducts annual surveys of patients and clinicians in 11 high-income countries. The surveys delve into financial barriers to care, chronic disease management, and satisfaction with care, among other topics. The section of the survey related to access to care contains a series of questions related to financial barriers to accessing care. Specifically, the Commonwealth Study survey includes four individual questions on financial barriers to doctor consultations, medical tests or treatments, prescribed medicines, and dental care. The Commonwealth Study survey questions only focused on unmet need for health care due to cost, with questions on waiting times not explicitly related to unmet needs.
The ordering of the questions in the Commonwealth study first assessed whether the respondent had any incidence of not receiving care, “During the past 12 months, was there a time when you had a medical problem but did not consult with a doctor because of the cost?”, with the follow-up question exploring the reason(s) behind why care was not received only asked if indicated: a) “During the past 12 months, was there a time when you skipped a medical test, treatment, or follow-up that was recommended by a doctor because of the cost?; b) “During the past 12 months, was there a time when you did not fill a prescription for medicine, or you skipped doses of your medicine because of the cost?”; and, c)” During the past 12 months, was there a time when you skipped dental care or dental check-ups because of the cost?”. Like the EU-SILC survey, this could potentially lead to some under-reporting, and similarly, unmet need only referred to foregone care, with no questions asked to assess whether or not delayed care was received.
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Survey items to explore unmet need in the Commonwealth Fund International Health Policy Survey (CMWF) (2017)
QN810: During the past 12 months, was there a time when you:
qn810_a1: Did not fill/collect a prescription for medicine, or you skipped doses of your medicine because of the cost
QN810_a2: Had a medical problem but did not consult with/visit a doctor because of the cost
QN810_a3: Skipped a medical test, treatment, or follow-up that was recommended by a doctor because of the cost
QN810_a4: Did not visit a dentist when you needed to because of the cost
Demographic and Health Surveys (DHS)
The Demographic and Health Surveys (DHS) Program has collected, analysed, and disseminated data on population, health, HIV, and nutrition through more than 400 surveys in over 90 countries. The DHS surveys usually have large, nationally-representative sample sizes with 5,000-30,000 households typically included, surveys collect primary data using various model questionnaires. The target population for the DHS survey is all women age 15-49 and children under five years of age living in residential households. Most surveys also include all men age 15-59. A household questionnaire is used to collect information on characteristics of the household's dwelling unit and characteristics of usual residents and visitors, it is also used to identify members of the household who are eligible for an individual interview, eligible respondents are then interviewed using an individual woman's or man's questionnaire along with the biomarker questionnaire, which is used to collect biomarker data (anthropometry, anaemia and HIV status) on children, women, and men.
The DHS Phase 5 questionnaires asked if there were any members of the household that were very sick for at least 3 of the last 12 months and if any support was received for the person that was sick, such as medical care, supplies or medicine for which they did not have to pay and if any regular (at least once a month) support was received. In subsequent phases, questions only pertained to specific health conditions (diarrhoea, illness/fever) and any associated advice or treatments received for household children. Similarly, there are specific questions on non-communicable diseases, disability, malaria, HIV, family planning and contraception. As a result, it is possible to assess potential levels of specific health need; however, it is difficult to ascertain overall health need. Additionally, the absence of questions specifically exploring unmet needs means that delayed or foregone care cannot be directly assessed from the DHS, and any results are limited to adults aged 15-59 years.
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Published studies and reports using DHS health data from SEAR countries have focused on fertility, family planning and contraception, maternal and child health and mortality and health inequalities.
Multiple Indicator Cluster Surveys (MICS)
The UNICEF Multiple Indicator Cluster Surveys (MICS) programme conducts household surveys in diverse settings. MICS was designed to collect statistically sound, internationally comparable estimates of about 130 indicators to assess the situation of children, women and men in the areas of health, education, and child protection. A household questionnaire is used to collect information on characteristics of the household's dwelling unit and characteristics of usual residents and visitors, eligible members of the household are also interviewed using an individual woman's or man's questionnaire
The MICS2 women’s questionnaire included modules on maternal and newborn health, contraceptive use and HIV/AIDS; however, it did not have any questions exploring general health status. Subsequent survey rounds also contained specific modules on child mortality, contraceptive use, maternal and newborn health, post-natal health checks, HIV/AIDS, domestic violence, maternal mortality, tobacco and alcohol use. As a result, it is possible to assess potential levels of specific health need related to these areas. Additionally, in the MICS4 and 5 men’s and women’s individual questionnaires there was a question that asked respondents: “How satisfied are you with your health?”; however, it is difficult to ascertain overall health need. The MICS6 questionnaire further explores health need with questions relating to sight, hearing, the ability to walk and climb stairs, memory and concentration, self-care such as washing and dressing and the ability to communicate and be understood. The range of questions means that a multi-dimensional definition of unmet need could be constructed including, for example, unmet need for assistive products such as glasses or hearing aids (that might accompany questions about functioning and disability (particularly related to activities of daily living (ADLs)); however, the absence of questions specifically asking about unmet health needs, delayed or foregone health care means that these cannot be directly assessed from MICS.
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Published studies and reports using MICS health data from SEAR member states have primarily focused on child health and welfare, maternal health, antenatal care, environmental exposures, nutrition, and immunisation.
Living Standard and Measurement Study (LSMS)
INSTRUMENT NOT ACCESSIBLE (OWNED BY THE WORLD BANK)
The Living Standards Measurement Study (LSMS) is a multi-purpose household survey that collects information on dimensions of household and individual well-being to understand household behaviours and evaluate government policies affecting the living conditions of people in low and middle-income countries.
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This study includes two surveys in SEAR member states: Nepal Living Standards Survey (Surveys 2 and 3), and Timor-Leste Survey of Living Standards.
World Values Survey (WVS)
The World Values Survey (WVS) is an international research program devoted to the scientific and academic study of social, political, economic, religious and cultural values of people in the world. The project’s goal is to assess which impact values stability or change over time has on the social, political and economic development of countries and societies. The project grew out of the European Values Study and was started in 1981. Since then has been operating in more than 120 world societies. The main research instrument of the project is a representative comparative social survey which is conducted globally every 5 years. The project’s overall aim is to analyze people’s values, beliefs and norms in a comparative cross-national and over-time perspective. To reach this aim, the project covers a broad scope of topics from the fields of Sociology, Political Science, International Relations, Economics, Public Health, Demography, Anthropology, Social Psychology etc.
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Survey items to explore unmet need in Wave 6 (2010-2014)
V190: In the last 12 month, how often have you or your family gone without medicine or medical treatment that you needed?
Survey items to explore unmet need in Wave 7 (2017-2021)
Q53: In the last 12 months, how often have your or your family…gone without medicine or medical treatment that you needed?
National surveys
South-East Asian Region
Summary of SEAR surveys
Provides a brief overview of the key variables included in each survey used in the South-East Asian Region with the inclusion of key variables for unmet need
NOTE: There are no publicly available surveys for the Democratic People’s Republic of Korea (DPRK). MICS6 was conducted in DPRK in 2017. However, this dataset is restricted and no secondary analyses have been published.
Bangladesh DHS and MICS
Since 2000, three rounds of the DHS (Phase 5 in 2007, Phase 6 in 2011 and Phase 7 in 2017-18) and two rounds of the MICS (MICS5 in 2012-13 and MICS6 in 2019) have been completed in Bangladesh. While there are no questions that directly assess unmet need, delayed and/or foregone care, data from these surveys have been used in published studies focused on various aspects of health including maternal and child health indicators, low birth weight, antenatal care and social well-being, arsenic contamination and adolescent fertility. Again, additionally, the sample is restricted to women and men aged 15-59 years.
Bangladesh Household Income and Expenditure Survey (HIES)
INSTRUMENT NOT ACCESSIBLE (OWNED BY THE WORLD BANK)
Bangladesh Bureau of Statistics (BBS) has been conducting the Household Income and Expenditure Survey (HIES) on a regular basis as the core survey to provide important data on income, expenditure, education, health consumption and poverty, with the most recent surveys conducted in 2010 and 2016. The 2010 and 2016 HIES collected data from 12,240 and 46,076 households respectively across rural and urban settings. The health section of the HIES questionnaire included questions on chronic and acute illness/injury, cost of healthcare and reasons for hospitalisation and outpatient treatment.
The HIES questionnaire included questions on the provision of medical treatment and the reasons for not seeking treatment; however, these were specifically related to symptoms/diseases suffered in the past 30 days. In the section of the questionnaire related to illness/injury, respondents were first asked, “Have you suffered from any symptoms of illness/injury in the last 30 days?”, if they answer ‘yes’, they were subsequently asked, “What symptoms/diseases did you suffer from?” and if they had “Sought any type of medical treatment related to your health problems mentioned [in the previous question]”. If the respondent answered ‘no’, they were asked to indicate why they did not seek treatment. The overall rate of not seeking treatment was not presented in the report following the 2010 survey; however, of those who did not seek treatment, 56.5% did not perceive the problem as being serious enough to warrant treatment, 15.6% did not seek treatment because the cost was too high and 3.9% were not supported by family members to do so. Analysis of the questions relating to the provision of medical treatment and the reasons behind not seeking treatment are not reported from the 2016 survey. While these questions are not worded in a way to specifically assess unmet need, together they can be used to assess if the individual did have a health need and if this need was met.
Bangladesh Health Facility Survey
The 2017 Bangladesh Health Facility Survey (2017 BHFS) is a national health facility survey implemented in Bangladesh by the National Institute of Population Research and Training (NIPORT) with technical assistance from ICF, USA (i.e. DHS). The survey collected information on the availability of basic and essential health care services and the readiness of health facilities to provide quality services in child health, maternal and newborn care, family planning, tuberculosis, and non-communicable diseases with survey data collected from 1,524 health care facilities and 5,400 health care providers nationwide. While the survey does not specifically measure population health or unmet need, it does provide important information on the general preparedness of the country’s health facilities in terms of the availability of basic amenities, equipment, laboratory services, essential medicines, standard precautions for infection control, and human resources. Service-specific readiness of health facilities was also measured in terms of the WHO recommended minimum conditions required to provide quality services for maternal, newborn, and child health care; family planning services; and treatment of diabetes, cardiovascular disease, and tuberculosis.
Bangladesh Urban Health Survey
The Urban Health Survey (UHS) 2013, was designed to examine the conditions of the urban population of Bangladesh with explicit attention to differences between slum and non-slum groups. The UHS consisted of five (household, women’s, verbal autopsy, men’s and community) questionnaires and sampled households from:
slum populations in the nine City Corporations;
non-slum populations in the nine City Corporations; and,
other urban areas, which included all District Municipalities and large towns/Paurasavas with a population of over 45,000 habitants as listed in the 2011 Population Census.
Both the Men’s and Women’s questionnaires included questions on general health, HIV/AIDS and other sexually transmitted diseases, physical measurements, mental health, violence, smoking, alcohol and drug use and crime. The Women’s questionnaire also included questions on birth history, antenatal care, postnatal care and breastfeeding. The Community questionnaire also asked questions regarding health service availability.
The UHS did not include any questions that can be used to assess an individual’s unmet needs generally; however, when individuals were asked if they had high blood pressure and diabetes, they were subsequently asked if they had accessed any treatment. Additionally, women were asked if they received any ante- and/or post-natal care. A majority of women living in non-slum and other urban areas received antenatal care (ANC) from medically trained providers (83% and 76%, respectively. Regarding the availability of health services, it was reported that 95% of communities in slum and non-slum and about 90% in other urban areas have a health facility available within two kilometres with NGO facilities are the most commonly available health service providers in both slum and non-slum areas.
Bangladesh Unmet Needs and Use of Assistive Products
Pryor et al. reported findings from a cross-sectional, population-based household survey conducted in the Kurigram and Narsingdi districts in Bangladesh examining unmet needs directly related to assistive products. The survey used the ‘Assistive Technology Assessment-Needs (ATA-Needs)’ tool consisting of four parts:
respondent & household demographics;
self-reported functional difficulties and self-reported needs for assistive products;
assistive products in use; and,
abandonment of and barriers to assistive products.
The ATA-Needs instrument directly examines two main dimensions of unmet need:
the proportion of people who have unmet needs or self-identify a need for an assistive product (AP) that they do not already have, and
the extent to which possession of current APs satisfies needs.
This ‘category’ of unmet need was not covered in the benchmark surveys – but this type of need stemming from age-related disability might be more relevant to the older adult population of interest in SEAR countries. A brief summary of the results is pasted below:
The mean age of the study population was 37.9 (95% CI: 37.3–38.5) years. As expected, the presence of disability was associated with increasing age, and older people were more likely to report functional difficulties.
Of people with any functional difficulty, 74.7% reported a need for AP they do not already have. This comprised both 65.3% of people who have any difficulties but no current AP, and 87.5% of people currently using AP. Logistic regression predicting self-reported unmet needs for AP suggested that all else being equal, people already using AP were more likely to report an unmet need than people not using AP (OR = 4.95, p < 0.01). People who were working were 5.5 times more likely to report unmet need for AP (OR = 5.55, p < 0.05) than those who were not working.
Bhutan Living Standards Survey
The Bhutan Living Standards Survey (BLSS) is a nationally representative survey conducted by the National Statistics Bureau of Bhutan in 2007, 2012, 2017 and 2022 with data collected from 10,000, 8,968, 11,660, and 13,340 households, respectively. The BLSS collects information on education, health, employment, income and expenditure, housing, access to public facilities and services, assets, social capital and non-traditional measures such as self-rated poverty and happiness. The 2012 questionnaire contained an expanded health module and a separate module on fertility and the 2017 questionnaire was further expanded to include questions on disability and expenses related to diagnostic services for women at reproductive ages.
All three rounds of the BLSS contained questions related to access to health care. In the 2007 survey, respondents were asked if, “In the last 4 weeks [they] have suffer[ed] from sickness or injury” - if they answer ‘yes’, they were subsequently asked, “who did [they] consult first?” with the instruction to just consider the last sickness or injury. If they did not consult anyone, they were asked the reason why. It was reported that about 15% of those surveyed reported suffering from sickness or injury in the four weeks preceding the survey with higher rates among the population aged 60 years or older. Of those who reported suffering sickness or injury, only 10% did not consult health care providers with most of this group (61%) citing that it was “not necessary”, 29% indicated they had “no time”, 25% indicated they had “no transport/too far”, and an additional 25% listed other reasons for not consulting a health care provider.
In the 2012 and 2017 surveys, respondents were asked the same question regarding sickness or injury in the last four weeks; however, it was followed by a more specific question asking if they “visit[ed]/consult[ed] a health provider without staying overnight in the health facility (referral hospital/hospital/BHU)” and if so, they were asked to report the total number of visits and the main reason before they were asked to indicate “why [they] didn’t consult anyone” (if applicable). From both the 2012 and 2017 surveys, about 30% of those who reported being sick or injured either did not consult a health provider or stayed overnight at a health facility (5%). The main reasons for seeking health care were outlined in the reports for both surveys, however, the reasons for not consulting anyone were not reported.
While questions asked in all four rounds of the BLSS were not worded in a way to specifically assess unmet need, together they could be used to assess if individuals had a health need and if a health provider was consulted regarding this need.
Bhutan National Health Survey
The National Health Survey (NHS) is a nationally representative household survey conducted by the Ministry of Health, Bhutan. The 2012 survey consisted of five main questionnaires: Household questionnaire, Individual questionnaire, Women’s questionnaire, Immunization questionnaire, and Violence against women questionnaire, and collected information from 13,256 households across urban and rural areas.
The household questionnaire included a question that asked if, “Any usual member of the household suffer[ed] from any illness during the past 1 month?” and also included questions regarding access to health services including the details of the nearest health facility, how household members usually get to the facility and the time it takes to get to the facility. The individual questionnaire included sections on: Knowledge of HIV/AIDS, tobacco use, alcohol consumption, physical activity, diabetes, hypertension oral health breast and cervical cancer, mental health, and drug and substance abuse. This questionnaire also included a section on the sources of health-related information and utilization of health services which included the question “Have you visited a health facility for any health concern during the last 12 months?”. These questions can be used to determine a potential level of health need and what health services have been accessed by the respondents. However, in the absence of a question that can be used to determine the need for health care, this question alone is not suitable for determining levels of unmet need.
India SAGE
The World Health Organization’s (WHO) Study on global AGEing and adult health (SAGE) has collected comprehensive health data in India across four survey waves. SAGE survey instruments assessed health status and health systems at the household and individual level and included perceptions of health and more objective measures of health, as well as questions about interactions with the health care system. The SAGE individual questionnaire includes sections on health state, risk factors and preventative health behaviours, chronic conditions and health service coverage, health care utilisation, social cohesion, well-being and quality of life and caregiving. The SAGE questionnaire includes two questions that can be used to directly assess unmet need, respondents are first asked “The last time you needed health care, did you get health care?” if they indicate they did not receive the health care they are asked “Which reason(s) best explains why you did not get health care?” with multiple responses able to be noted including: “1) Could not afford the cost of the visit; 2) No transport available; 3) could not afford the cost of transport; 4) You were previously badly treated; 5) Could not take time off work or had other commitments; 6) The health care provider's drugs or equipment were inadequate; 7) The health care provider's skills were inadequate; 8) You did not know where to go; 9) You tried but were denied health care; 10) You thought you were not sick enough; 11) Other”.
Unmet need could also be generated from the gap between those who reported having any of eight high-burden chronic conditions and whether or not they were on treatment. The presence of a chronic condition was assessed through a variety of mechanisms – either by a health care professional, “Have you ever been told by a health professional/doctor that you have (disease name)?” – and/or via a set of symptomatic questions plus diagnostic algorithms – and/or direct measurement of risk factors (for example, blood pressure, measured weight and height). The use of treatment/medication received in the 2 weeks and 12 months prior to interview was asked. Those who reported having a condition and not on treatment could signify an unmet need.
Data from SAGE India Wave 1 is presented in a study report – where unmet need (as presented in the report) was defined as the proportion of respondents who were diagnosed with a condition but had not received any medication or treatment for it in the previous 12 months.
However, results from the direct questions about unmet need (including “The last time you needed health care, did you get health care?”) were not presented in the report – instead, the report focused on characteristics of those who reported needing care and received it. An analysis of unmet need could be done by inpatient and outpatient setting, related to: 1) “Which reason(s) best explains why you did not get health care?”; and, 2) “What was the main reason you needed care, but did not get care?”. The first question is related to a barriers to care, while the second provides an understanding of the perceptions about why care was not received.
An analysis of information about unmet need for oral health services from SAGE India Wave 1 data was based on self-reported answers to two survey questions: 1) “Have you had any problems with your mouth/teeth during the last 12 months?” and 2) “Have you received any medication or treatment from a dentist or any other oral health specialist during the last two weeks or 12 months?”.
The prevalence of unmet need was 62% in India. The adjusted RII for education was statistically significant in India (1.5, 95% CI:1.2–2.0). Male sex was significantly associated with self-reported unmet need for oral health services in India.
India National Family Health Survey
The National Family Health Survey (NFHS), provides information on population, health, and nutrition across all districts of India and consists of four questionnaires; Household Questionnaire, Woman’s Questionnaire, Man’s Questionnaire, and Biomarker Questionnaire. NFHS-4 collected data from 601,509 households with a similar response rate expected for the most recent round of the survey. The household questionnaire contains questions to assess the incidence of specific health conditions (including tuberculosis) and behaviours (such as smoking, use of mosquito nets). Additionally, it also included questions asking, “When members of your household get sick, where do they generally go for treatment?” and “Why don't members of your household generally go to a government facility when they are sick? Any other reason?”. The Men’s and Women’s questionnaires contain sections on reproduction, contraception, sexual health, other health issues, attitudes to gender roles and HIV/AIDS. These questionnaires also ask respondents, “In the last three months, have you visited a health facility or camp for any reason for yourself (or for your children)?” and “What service did you go for?” While there are no questions the directly assess unmet need, together these sections can be used to determine a potential level of health need and the type of health services accessed by the respondents.
India National Sample Survey - Surveys of Social Consumption
The surveys on social consumption conducted by the National Sample Survey (NSS) Office collect information on morbidity, hospitalisation, pre- and post-natal care and health care expenditure. Recent rounds of the survey, the 71st and 75th NSS conducted in 2014 and 2017-18, collected data from 65,932 and 113,823 households respectively across every district in India. In both rounds of the survey respondents were asked during the last 365 days whether they suffered from a communicable disease or a chronic ailment and if they have suffered or are suffering from any other ailment during the last 15 days, they are subsequently asked about the medical services received/not received including the type of service, treatment, and the cost of treatment. While there is no question that assesses the overall level of unmet need, together these sections can be used to determine a potential level of health need and the type of health services accessed by the respondents, and the barriers for not seeking treatment.
The report following the 71st Survey presented data on the reported levels of specific ailments and the proportions of ailing persons treated on medical advice. Moreover, analysis of the reasons for treatment without medical advice was also reported, with “financial constraint” cited as the most common (55% and 60% in rural and urban areas respectively) reason for not seeking medical advice. The report following the 75th Survey also presented data on the reported incidence of specific ailments, however, while the same questions were asked in the survey the report only presents data on the types of services utilised not the reasons behind not seeking medical advice.
India Annual Health Survey (AHS)
The first Annual Health Survey (AHS) was conducted in 2010-11 with subsequent surveys completed in 2011-12 and 2012-13 across nine states in India. While the questionnaires for these surveys are not publicly available, reports are available that present information on fertility and family planning, maternal health and health care, maternal mortality, child health and health care, neonatal, infant and under-five mortality, acute and chronic illness, and disability and injury. AHS could be used to estimate levels of health need and care provided in relation to specific conditions, however, no data is presented on unmet need and the barriers to seeking/receiving health care.
India District Level Household Survey (DLHS)
District Level Household and Facility Survey (DLHS) is a nationwide survey covering 601 districts from 34 states and union territories of India. The third round of the DLHS was conducted in 2007-2008 and consisted of eight separate questionnaires for households, individuals, villages and health care centres. The household and individual questionnaires collected information on socio-economic characteristics, assets, number of marriages and deaths, maternal care, immunization and childcare, contraception and fertility preferences, reproductive health including knowledge about RTI/STI and HIV/AIDS. The village questionnaire collected information on the availability of health, education and other facilities in the village, and whether the facilities are accessible throughout the year. The health facility questionnaires contained information on human resources, infrastructure and services. While there were no questions that asked individuals to report their personal levels of health need or asked directly about unmet need/foregone care, these surveys provided a comprehensive overview of the health care services available in the regions sampled.
Indonesia DHS and MICS
Since 2000, three rounds of the DHS (Phase 5 in 2007, Phase 6 in 2012 and Phase 7 in 2017) and two rounds of the MICS (MICS2 in 2000 and MICS4 in 2011 for selected districts) have been completed in Indonesia. While there were no questions that directly assess unmet need, delayed and/or foregone care, data from these surveys could be used to assess various aspects of health need.
Indonesia National Socio-Economic Household Survey (SUSENAS)
The National Socioeconomic Survey (SUSENAS) of Indonesia is a series of large-scale multi-purpose socioeconomic surveys initiated in 1963-1964. Since 1993, SUSENAS annually (or almost annually) includes a nationally representative sample typically composed of 200,000 households. Each survey included a core household questionnaire which collected information on the sex, age, marital status, and educational attainment of all household members, along with supplementary modules that collected additional information on health care and nutrition, household income and expenditure, and labour force experience. The questionnaire included questions related to health conditions/complaints and the kind of treatment received, and how the treatment was financed; however, there were no questions that directly assess unmet need, delayed and/or foregone care.
Indonesia The Indonesia Family Life Survey (IFLS)
The Indonesia Family Life Survey (IFLS) is a longitudinal socioeconomic and health survey based on a sample of households representing about 83% of the Indonesian population living in 13 of the nation’s 26 provinces in 1993. The survey collected data on individual respondents, their families, their households, the communities in which they lived, and the health and education facilities they used. The fifth wave of the IFLS (IFSL5) was conducted in 2014-15 with 16,204 households interviewed. Along with questions related to the presence of specific health conditions, the questionnaire included a question to assess general health with respondents asked “In general, how is your health?” where they are able to indicate if they are “Very healthy, Somewhat healthy, Somewhat unhealthy, or Unhealthy.” Additionally, responds are also asked "Concerning your healthcare, which of the following is true?” With five options to choose as their response: “It is less than adequate for my needs, It is just adequate for my needs, It is more than adequate for my needs, Don’t know”. Together, these questions can be used to assess general health need and also the adequacy of healthcare available. Data from the IFLS has been used to determine the prevalence of multimorbidity as well as unmet need in relation to specific health conditions including cardiovascular disease.
Maldives DHS and MICS
Since 2000, two rounds of the DHS (Phase 5 in 2009 and Phase 7 in 2016-17) and one round of the MICS (MICS2 in 2001) have been completed in the Maldives. While there were no questions that directly assessed unmet need, delayed and/or foregone care, data from these surveys could be used to assess various aspects of health need.
Myanmar DHS and MICS
Since 2000, one round of the DHS (Phase 7 in 2015-16) and two rounds of the MICS (MICS2 in 2000 and MICS3 in 2009-10) have been completed in Myanmar. While there were no questions that directly assessed unmet need, delayed and/or foregone care, data from these surveys could be used to assess various aspects of health need.
Myanmar Survey on Accessing Healthcare to Older Persons in Myanmar
The Survey on Accessing Healthcare by the Older Population (2016) in Myanmar was conducted by HelpAge International and included a survey to assess access to healthcare by older people from both the supply and demand perspectives, examine health-seeking behaviour of older persons with limited access to healthcare services and identify challenges and barriers in accessing quality health services for the older adult population. Five townships were selected for sampling by HelpAge across rural and urban areas with 808 households successfully interviewed for the study. The following questions can be used to determine the level of health need, with respondents asked if they had; “Ever been diagnosed by health personal with/ told you have any of the following illnesses?” with a variety of options provided and the additional option to list any other illness. Additionally, respondents were asked if they had experienced any of the following conditions in the last month; headache, vomiting, fever, diarrhoea, skin problems, chest pain, pain in your joints, dizziness, back or hip pain, shoulder pain, trembling hands, stomach ache, problems breathing, coughing, feeling weak, constipation, loss of bladder control, loss of bowel control. Respondents were also asked, “During the past 12 months, were there any times that you were sick or injured and needed health care?” and if “The last time you needed health care, did you get health care?” if they responded ‘no’ they were asked a further question, “Which reason best explains why you did not get health care?”. The wording and order of these questions allows health need, unmet need for health care and the barriers related to unmet need to be determined for respondents of this survey.
Survey items that explore unmet need in the 2016 survey
C1: During the past 12 months, were there any time that you were sick or injured and needed health care?
C3: The last time you needed health care, did you get health care?
Myanmar Myanmar Poverty and Living Conditions Survey (MPLCS) and Myanmar Living Conditions Survey (MLCS)
The Myanmar Poverty and Living Conditions Survey (MPLCS) and Myanmar Living Conditions Survey (MLCS) were conducted in 2015 and 2017, respectively, on a nationally representative sample of households. Both surveys were undertaken through collaboration between the Ministry of Planning and Finance in Myanmar and World Bank to collect information on living conditions and socio-economic indicators in the country. The respective survey questionnaires included sections on health where respondents were asked, “During the past 30 days did [NAME] suffer from any injury or health complaints? For example a cold, cough, diarrhoea, back pain, fever, stomach ache, headache etc.” and “What action did [NAME] take to find relief for the MOST SERIOUS illness or injury in the last 30 days?” with options including; did nothing, used medicine had in stock, sought treatment with a traditional healer, consulted a quack, went to a local store to buy drugs, went to local pharmacy/drug store, went to a medical facility/consulted a health practitioner. If they reported attending a medical facility or consulting a health practitioner, respondents were asked where the consultation occurred. Together these questions can be used to assess health need and the health services accessed; however, there is not a question that directly assesses unmet need, delayed and/or foregone care. While this health data was collected in both surveys, it was not presented in the reports available.
Myanmar Myanmar Aging Study 2012
The Myanmar Aging Study was conducted in 2012 by HelpAge International and UNFPA at the request of the Department of Social Welfare of Myanmar to assess the situation of older people in multiple regions of the country by gathering information on the needs and contributions of older people particularly in relation to their livelihoods/work, health, care, and social participation. The survey included 4,080 households, and the questionnaire included a section on health with questions on general health, memory, chronic illness, acute conditions, physical functioning, activities of daily living, health behaviours, nutrition and health service use. Specifically, respondents were asked “How would you rate your physical health at the present time? Would you say it is very good, good, fair, poor or very poor?” and if they, “have any chronic illness?” they were also asked “Did you receive any professional treatment for these illnesses or injuries?” and if they responded ‘no’, “Do you think that you needed treatment?”. Respondents were also asked “What was the main reason that you did not receive this treatment?” and “Did you need additional treatment but could not afford to pay for it?”. Together, these questions can be used to assess the level of health need, unmet need for health care and the barriers related to unmet need for respondents of this survey.
Only 33% of older persons reported their health as good or very good and 44% reported their health as fair. Among those who experienced illness or injury in the past year, 95% said they had received some form of treatment, around 1% reported that they did not need treatment, and just over 3% said that they needed but did not receive treatment. Interestingly, 27% of those who went for treatment reported that they did not receive all the treatment they felt they needed.
Survey items that explore unmet need in the 2012 survey
J41: During the past 12 months, were there any times that you were sick or injured that prevented you from performing your usual activities?
J42: Because of illnesses or injuries during the last 12 months, how many days were you unable to perform your usual activities because of these?
J43: Did you receive any professional treatment for these illnesses or injuries?
J44: Do you think that you needed treatment?
Nepal DHS and MICS
Since 2000, three rounds of the DHS (Phase 5 in 2006, Phase 6 in 2011 and Phase 7 in 2016) and two rounds of the MICS (MICS4 in 2010 for the Mid- and Far-Western Regions and MICS5 in 2014) have been completed in Nepal. While there were no questions that directly assessed unmet need, delayed and/or foregone care, data from these surveys could be used to assess various aspects of health need.
Nepal Nepal Living Standards Survey
The Nepal Living Standards Survey (NLSS) is a national household survey conducted by the Central Bureau of Statistics with surveys 2 and 3 collecting data from over 8,000 households. The NLSS questionnaire included questions on chronic and acute illness/injury, HIV/AIDS, immunisations, pre- and post-natal care and family planning. As a result, it is possible to assess potential levels of specific health need at the level of the individual related to these areas.
The NLSS questionnaire did include two questions on unmet need; however, these were specifically related to acute illness/injury in the past 30 days. In the section of the questionnaire related to illness/injury, respondents were first asked if they, “had any health problem or been injured during the past 30 days, for example diarrhoea, respiratory problems, fever, burns, etc?”, if they answered ‘yes’, they are asked, “was anyone consulted (e.g. a doctor, nurse, pharmacist or other healers) for the illness or injury in the last month?”, and if they answer ‘no’, they were asked the main reason why with options including “1) Illness/injury not serious enough 2) Heath facility too far 3) No transport 4) Health care too expensive 5) Transport too expensive 6) Health workers unfriendly 7) Health workers not present 8) Healthcare not good quality 9) Other (specify)”. In the statistical report from the most recent survey, approximately 30% of people with an acute illness reported that they did not consult with some kind of medical practitioner. While the data on the reason why was not presented in this report, it was noted that the proportion of individuals who did not consult a medical practitioner increased with the age of the patient; however, it was consistent in all consumption quintiles.
Nepal Surgeons OverSeas Surgical Assessment Survey
The Surgeons OverSeas Assessment of Surgical need (SOSAS) is a household survey tool used to determine the prevalence of surgical conditions and access to health care services in low and middle-income countries, the survey has been used in a number of African countries as well as Nepal. The questionnaire included questions on transport to health facilities, household deaths, education, general health, women’s health, disability as well as the presence of and treatments received for a number of specific health conditions. The section on general health included a question that asked respondents, “Are you generally healthy?”, in relation to specific health conditions, respondents were asked, “Did you go to a health facility or see a doctor/nurse for this problem?” and “What was the main reason not to go to a health facility to see a doctor/nurse or not to have an operation or dressings?” with options including; no money for health care, no (money for) transportation, no time, fear / no trust, not available (facility/personnel/equipment), or no need.
Stewart et al. reported the findings from a survey of 1350 households using the SOSAS: surgical need is largely unmet among older individuals in Nepal with literacy and distance from a capable health facility reported as the greatest barriers to accessing care.
Sri Lanka DHS
Since 2000, one round of the DHS (Phase 4 in 2006-07) has been completed in Sri Lanka. Data from this survey is not available.
Sri Lanka National Survey on Self-reported Health
The National Survey on Self-reported Health was a survey module attached to the Sri Lanka Labour Force Survey (LFS) conducted in 2014 to collect data from approximately 25,000 households on health conditions. While an English language version of the questionnaire is not available, the report produced included sections outlining the findings on: the distribution and prevalence of chronic illness, health status of the working age population, distribution of acute illnesses, accidents and required treatment, and health behaviours including smoking, alcohol use, health screening and insurance. There appear to be questions asked related to the place of treatments for specific acute and chronic illnesses, however, there were no reported findings on unmet need and/or foregone care or the barriers to treatment.
Sri Lanka Sri Lanka Demographic and Health Survey
The Sri Lanka Demographic and Health Survey (SLDHS) 2016 was carried out by the Department of Census and Statistics (DCS) in collaboration with the World Bank to gather data to monitor and evaluate the impact of population, health and nutrition programmes implemented by different government agencies. The survey was conducted among a nationally representative sample of 28,720 households, detailed information was collected from all ever-married women aged 15- 49 years and about their children born after January 2011 with data collected on; fertility, family planning, infant and child mortality, maternal and child health, nutrition, HIV/AIDS, domestic violence, malaria, women’s empowerment, non-communicable diseases, and health behaviours.
The SLDHS includes a series of questions related to the presence/absence of specific health conditions such as heart disease, high blood pressure, asthma, paralysis, diabetes, cancer and any treatment received for these conditions. This information is useful in determining the potential level of health need and access to health services, yet there are no questions that can be used to directly determine levels of unmet need and/or foregone care or the barriers to treatment across the population.
Thailand MICS
Since 2000, four rounds of the MICS (MICS3 in 2005-6, MICS4 in 2012-13, MICS5 in 2015-16, and MICS6 in 2019) have been completed in Thailand. While there were no questions that directly assessed unmet need, delayed and/or foregone care, data from these surveys could be used to assess various aspects of health need.
Thailand National Survey of Older Persons in Thailand
Thailand’s National Survey of Older Persons was conducted by the National Statistical Office in 2011 and 2017 to provide an assessment of the situation of older persons in Thailand. The 2011 survey questionnaire included a question, “During 7 days before the interview, how does (name) feel about (his/her) physical health? Very good, Good, Fair, Bad, Very bad” respondents were also asked a number of questions related to their access to and need for healthcare. Specifically, “Last time (name) was ill, did (name) seek care through government health service (for example, elderly card, health card, social security card, government/pensioner welfare, state enterprise welfare)?”, if they did not use a government health service they were asked why and to identify the main reason from the options provided including: 1) Unaware of rights; 2) Free of charge; 3) Not residing in the area where services are given; 4) Minor illness; 5) Accident/emergency case; 6) Did not have transportation fare; 7) No one to take me; 8) The site of service is too far and inconvenient; 9) Lack of trust in quality of service; or, 10) Other. For respondents with at least one chronic disease, that were asked if “During 6 months before the interview did (name) receive care from health personnel continuously?” if ‘no’ they were asked “Why did (name) not receive care continuously? 1) Thought that the disease is uncurable; 2) Lack of trust/good impression re health service/personnel; 3) Unaffordable cost; 4) No one to take me; 5) Did not have transportation fee; 6) Inconvenient to go; 7) Did not have time; and, 8) Other”.
Thailand Panel Socio-Economic Survey (Panel SES) 2010
An English language version of questionnaire was not available, however, a publication from the survey provided some of the questions used, including the direct questions used by EU-SILC. Using the EU-SILC survey as a basis, a standard set of questions on unmet need was added in the fourth wave of the Panel SES in 2010 to assess the prevalence and profile of unmet need across respondents with different socio-economic characteristics. According to the authors, this was the first attempt to assess unmet healthcare need in Thailand. The authors also stated that this approach was to be used to maintain prospective monitoring of unmet healthcare need in Thailand in the future. The questions were:
“Was there any time during the last 12 months when you personally, really needed a medical examination or treatment for a health problem but you did not receive it?”, with Yes/No as response options.
This was followed by, “What was the main reason for not consulting a medical specialist?”, with responses” 1) Could not afford to (too expensive); 2) Waiting list; 3) Could not take time off work (or could not take time off from caring for children or others); 4) Too far to travel or no means of transport; 5) Fear of doctor, examination, treatment; 6) Wanted to wait and see if problem got better on its own; 7) Didn’t know any good doctor or specialist; 8) Other reason.
The annual prevalence of unmet outpatient and inpatient healthcare need was broken down by various socio-economic strata – where common patterns emerged: prevalence of unmet need was higher in females for both services than males; an age gradient of unmet need for both services--increased need with age; and, rural populations reported higher levels of unmet need for ambulatory services, but lower unmet need for hospital admission compared with their urban counterparts. Geographic and cost issues were the main reasons behind unmet need.
Thailand Used and foregone health services among a cohort of university students
Yiengprugsawan et al. presented findings from a survey of 87,134 students from the Sukhothai Thammathirat Open University (STOU). The questionnaire used for this survey collected information on demographic-socioeconomic-geographic information on health status, health risk behaviours, social networks, and family background. The questionnaire includes two questions specifically related to unmet health care need with respondents asked “In the past 12 months, have you considered using health services but did not use them?” and “If yes, why did you not use health services? 1) Do not like health provider; 2) Could not get away from family; 3) Scared of going; 4) Too expensive; 5) Not satisfied with services; 6) Too difficult to travel; 7) Could not get time off work; and, 8) Had to wait for too long”. The authors reported that 42.1% of respondents reported having foregone health service use in the past year with professionals and office workers frequently citing ‘long waiting time’ (17.1%) and ‘could not get time off work’ (13.7%) as the reason for not using health services, whereas manual workers frequently noted it was ‘difficult to travel’ (11.6%).
Thailand Health and Welfare Study
The 2019 Health Welfare Survey (HWS) was a nationwide biennial survey jointly conducted by the National Statistical Office (NSO) and the International Health Policy Programme (IHPP) of the MOPH. This study included a number of direct questions on unmet need:
Was there any time during the last 12 months when you personally, really needed a medical examination or treatment for a health problem, but you did not receive it? (Yes or No). Followed by questions about reasons: “What was the main reason for not consulting a medical specialist?” with the response categories: 1) Could not afford to (too expensive); 2) Could not afford travel costs to receive treatment; 3) Long waiting list /time; 4) Difficulty travelling / Living far away from facilities; 5) No time to go get treatment/ Could not take time off work; 6) Don’t trust or feel confident with facilities or providers; 7) Did not know where to go receive treatment: 8) No one was able to take me to get treatment; and, 9)Other.
“Was there any time during the last 12 months when you needed to/ were recommended by a doctor or nurse to admit in health care facilities but did not receive it?” (Yes or No) Followed again by reasons behind the decision: “What was the main reason for not receiving the treatment? 1) Could not afford treatment; 2) Could not afford travel costs to receive treatment; 3) Long waiting list /time; 4) Difficulty travelling / Living far away from facilities; 5) No time to go get treatment/ Could not take time off work; 6) Don’t trust or feel confident with facilities or providers; 7) Did not know where to go receive treatment; 8) No one was able to take me to get treatment; 9) The provider was unable to provide in-patient treatment, such as no bed availability or facility has no in-patient facilities; and, 10) Other.
“Was there any time during the last 12 months when you had dental health problems and needed treatment but did not receive it?” (Yes or No). Followed by questions about the reasons: “What was the main reason for not receiving treatment?” 1) Could not afford treatment; 2) Could not afford travel costs to receive treatment; 3) Long waiting list /time; 4) Difficulty travelling / Living far away from facilities; and 5) No time to go get treatment; 6) Don’t trust or feel confident with facilities or providers; 7) Did not know where to go receive treatment; 8) No one was able to take me to get treatment; 9) The provider was unable to provide in-patient treatment, such as no dental personnel or facility has no dental facilities; and, 10) Other.
Results from the 2019 HWS were examined for a specific population group (urban refugees and asylum seekers) and found the prevalence of unmet need was higher than the prevalence in the general Thai population. Factors correlated with unmet need included advanced age, lower educational achievement, and, most evidently, being uninsured.
Survey items that explore unmet need in the 2011, 2013, 2015 & 2017 surveys
UN1 (out-patient): Was there any time during the last 12 months when you were sick and needed a medical treatment but you did not receive it?
UN3 (in-patient): Was there any time during the last 12 months when you needed or were recommended by medical doctor to admit to a health facility but you did not receive it?
Thailand Thai National Health Examination Survey
English language version of the survey and report is not available. Examining available reports and questionnaires indicated that there were no direct questions about unmet need included in these studies. However, indirect methods were used to examine unmet need related to alignment with cascades of care for diabetes. Using the 2014 Thai National Health Examination Survey, unmet need was defined as total loss across national and regional care cascades across diabetes screening, diagnosis, treatment, and control. Total unmet need was 74.0% (95% CI 70.9% to 77.1%), with regional variation ranging from 58.4% (95% CI 45.0% to 71.8%) in South to 78.0% (95% CI 73.0% to 83.0%) in Northeast.
Timor-Leste DHS
Since 2000, two rounds of the DHS (Phase 6 on 2009-10 and Phase 7 in 2016) have been completed in Timor-Leste. While there were no questions that directly assessed unmet need, delayed and/or foregone care, data from these surveys could be used to assess various aspects of health need.
Timor-Leste Timor-Leste Survey of Living Standards
The 2007 Timor-Leste Survey of Living Standards (TLSLS 2) is the second national survey of living standards for Timor-Leste that collected data from close to 4,500 households. The TLSLS 2 questionnaire included questions on health care use, immunisation and care of children’s illnesses, access to health care providers, and fertility. The TLSLS questionnaire included two questions on unmet need; however, these were specifically related to “health complaints in the past 30 days”. In the section of the questionnaire related to health care use, respondents were first asked if they “had any health complaints in the past 30 days, for example, a cold/cough diarrhoea, back pain, fever, stomach ache headache, etc?”, if they answered ‘yes’, they were asked “In the past 30 days did you seek treatment at a health facility or health provider for your health problems?” and if they answered ‘no’, they were asked the main reason why. In the statistical report, it was reported that approximately 25% of people that reported a health complaint in the last 30 days did not seek treatment. Of those who reported not seeking treatment, the primary reasons were due to distance to the health facility being too far (42.3%) and their illness not being serious enough (42.3%).
Timor-Leste Household Income and Expenditure Survey 2011
The Timor-Leste Household Income and Expenditure Survey 2011 was the first survey of this type ever conducted in the country to assess the economic situation of households. Two questions were included about health need: “Has anybody in the household been seriously ill in the last year?”, and if yes, “Did any patient receive medical attention?”. No follow-up questions were asked about a ‘no’ response – so health need could generally be ascertained, but not unmet need.
Timor-Leste Determinants of health care utilisation study
In their 2018 paper published in International Health, Guinness et al. reported the findings from a nationally representative cross-sectional survey of healthcare utilisation. This survey included two questions to directly assess unmet need, respondents were asked if “In the last 12 months a household member has been ill but not sought health care?” and if they answered ‘yes’ they were asked “What was the reason for not seeking care?”. The authors reported that this data was measured at the household level and was found to be low with only 149/1712 households reporting a member who was ill but did not seek care and in most cases (59.7%) the reason for not seeking care was that there was ‘no need’ due to the person not being sick enough.
Western Pacific Region
Cambodia Cambodia Elderly Survey (CES)
Survey items that explore unmet need in the 2004 survey
G20: During the past year, were there any times that you were sick or injured?
G21: For how many days, if any, during the last year would you say you were unable to perform your usual activities because of these illnesses or injuries?
G22: Did you receive any professional treatment or take any medicines for these illnesses or injuries over the past year?
G23: Do you think that you needed such treatment or medicines?
G24: What were the reasons that you did not receive this treatment?
New Zealand New Zealand Health Survey (NZHS)
Survey items that explore unmet need in the 2015, 2016, 2017, 2018 & 2019 surveys
A2.06: In the past 12 months, has there been a time when you wanted to see a GP, nurse or other health care worker at your usual medical centre within the next 24 hours, but they were unable to see you?
Viet Nam Viet Nam National Aging Survey (VNAS)
Survey items that explore unmet need in the 2011 survey
I18: During the last 12 months, were there any times that you were sick or injured that prevented you from performing your usual activities?
I20: Did you receive any professional treatment for these illnesses or injuries over the last 12 months?
I21: Do you think that you needed treatment?
Viet Nam Survey on Older persons & Social Health Insurance (OP&SHI)
Survey items that explore unmet need in the 2019 survey
Q0604: During the last 12 months, were there any times that you were sick or injured that prevented you from performing your usual activities?
Q0606: Did you receive any professional treatment for these illnesses or injuries?
Q0610: Do you think that you needed treatment?
African Region
Gambia Integrated Household Survey (IHS), The Gambia
Survey items that explore unmet need in the 2016 survey
S2aq3_1: During the last 2 weeks, what symptoms has [name] suffered from?
S2aq4_1: Did [NAME] consult a health provider for this illness/injury last 2 weeks for MAIN illness?
S2aq5_1: What was the main reason that [NAME] did not visit a health practitioner during his/her illness?
S2aq3_2: During the last 2 weeks, what symptoms has [name] suffered from?
S2aq4_2: Did [NAME] consult a health provider for this illness/injury last 2 weeks for SECONDARY illness?
Tunisa Tunisia World Health Survey (WHS)
Survey items that explore unmet need in the 2003 survey
Q7004: The last time you [your child] needed health care, did you get health care?
A4045: During the last 12 months, have you had any problems with your mouth and/or teeth (this includes problems with swallowing)?
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Region of the Americas
Brazil Brazilian Longitudinal Study of Aging (ELSI-Brazil)
Survey items that explore unmet need in the 2015 survey
U32: Have you looked for a health service to get an appointment related to your health, in the PAST 2 WEEKS,
U34: Were you immediately taken care of on the first time you sought care in this health service in the PAST 2 WEEKS?
U35: What was the reason for not being taken care of on the first time you sought care in this health service in the PAST 2 WEEKS?
U36: In this latest appointment, within the PAST 2 WEEKS, were you prescribed any medication?
U37: Were you able to get all the medication that was prescribed to you on your latest appointment within the PAST 2 WEEKS?
U38: Why didn’t you get all the medication that was prescribed to you on your latest appointment within the PAST 2 WEEKS?
T6: In the PAST 30 DAYS, due to financial issues, you:
(1) Had no financial issues to buy the medication(s)
(2) Did not take a medication that was prescribed by a doctor or a dentist
(3) Decrease the number of pills of the medication(s) that were prescribed by the doctor
(4) Decreased the dose of the medication, breaking the pills or taking less drops
(5) Didn’t use medication(s)
(9) Didn’t know/didn’t answer
Mexico Mexican Health and Aging Study (MHAS)
Survey items that explore unmet need in the 2001 & 2003 survey
D15: In the last five years, was there at least one instance when you had a serious health problem but you did not go to the doctor?
Survey items that explore unmet need in the 2012, 2015 & 2018 survey
d15_15: Last 2 years: Did respondent have a serious health problem but not seek a doctor?
Puerto Rica Puerto Rican Elderly: Health Conditions (PREHCO)
Survey items that explore unmet need in the 2003 & 2007 surveys
J1/WJ1 Could you tell me how many medications, prescribed by a doctor, you have been taking regularly in the last year?
J12/WJ12 During the last year, have you stopped taking or have you taken less of any medication that was prescribed because you could not afford it?
K48/WK48 In the last twelve months, were you ever told you should get an x-ray or have laboratory tests done, not including those for a hospitalization? K49/WK49 Did you have those tests done?
K60/WK60 In the last two years, have you needed medical attention that you could not get?
Mexico Mexican Health and Aging Study (MHAS)
Survey items that explore unmet need in the 2001 & 2003 survey
D15: In the last five years, was there at least one instance when you had a serious health problem but you did not go to the doctor?
Survey items that explore unmet need in the 2012, 2015 & 2018 survey
d15_15: Last 2 years: Did respondent have a serious health problem but not seek a doctor?
European Region
United Kingdom Integrated Household Survey (IHS)
The Integrated Household Survey (IHS) is the largest social survey collected by the Office for National Statistics (ONS), providing estimates from approximately 325,000 individual respondents − the biggest pool of UK social data after the census.
The Integrated Household Survey (IHS) was previously formed from "core" questions asked by a number of our household surveys. Currently, the IHS is based solely upon the Annual Population Survey (APS), following the removal of IHS questions on the Living Costs and Food (LCF) survey in January 2014. Topics covered by the IHS include sexual identity, perceived general health, smoking prevalence, education, housing and employment.
At present, IHS statistics are designated as experimental.
Survey items that explore unmet need
82 QHealth1 How is your health in general; would you say it was...(Likert scale)
83 LSIll (And) do you have any long-standing illness, disability or infirmity – by long-standing I mean anything that has troubled you over a period of time or that is likely to affect you over a period of time?
84 IllLim Does this illness or disability (Do any of these illnesses or disabilities) limit your activities in any way?
Belgium Generations and Gender Programme (GGP Belgium)
Changing families and populations are presenting growing challenges for industrialized societies. As a result of low fertility levels prevailing for a long time, many countries are now expected to face labour shortages simultaneously with the demand to support a rapidly growing number of retired persons. At the same time, younger generations tend to postpone marriage and parenting. Increased prevalence of consensual unions, decreasing stability of co-residential partnerships and the emergence of non-residential partnerships are other trends that can be seen in many countries. Multifaceted family change requires that governments and other social partners monitor and, when necessary, step in to help families preserve and strengthen the ties that bind their members. To successfully meet these and other challenges, the UNECE Population Activity Unit launched the Generations & Gender Programme (GGP) to equip policymakers with a better understanding of the causes underlying recent developments and their consequences, with particular attention given to the relationships between children and parents (generations) and between partners (gender).
The Generations and Gender Programme consists of two parts: on the one hand, a large-scale survey, the Generations and Gender Survey (GGS) with micro-level data, and, on the other hand, a contextual database with macro-level data.
The Generations and Gender Survey (GGS) is a panel survey of a representative sample of the 18 to 79-year-old population of every participating country. The GGS is planned with at least three successive waves with an interval of three years between waves. The GGS collects very detailed information on a wide range of social demographic topics which can be summarized in two words: generations and gender. On the other hand, particular attention is given to relationships between grandparents, parents, children and grandchildren, including related topics like ageing and denatality, and intergenerational assistance,… (‘Generations’). On the other hand, the many forms of relationships (marriage, cohabitation…), in current and previous relationships, as well as the typical gender themes such as the division of household tasks are analyzed (‘Gender’).
