Determinants and associated costs of unmet healthcare need and their association with resource allocation. Insights from Finland

Abstract

The Finnish counties’ allocation formulae for welfare services are based on utilisation collected from national registers and do not account for unmet needs. We investigated factors associated with self-reported unmet healthcare need and associated costs of primary and total healthcare, as well as the association between regional variation in unmet needs and utilisation-based need. The 2017–2018 FinSote survey data were matched with 2017 register data (n = 13,800). Costs of healthcare visits were used as a proxy for utilisation. We applied three logit regressions to explore factors related to self-reported unmet need and eight two-part models to analyse cost data. Analysis weights were developed and used. Those reporting unmet need were female, unemployed and foreign-born, and had multiple morbidities and poor self-assessed health. The highest income quintile and good self-rated quality of life were negatively associated with self-reported unmet need. A person with unmet needs spent an additional €32.2–183.9 and €269.7–963.7 yearly on primary and total healthcare, respectively. Regional differences in self-reported unmet need were not fully correlated with the need indices used in the regional resource allocation. To account for unmet need in budget allocations, self-reported unmet need and quality of life data should be collected more extensively and routinely. Addressing unmet need should be viewed as a long-term investment in primary care to reduce avoidable health inequalities.