From Stats Canada Daily release January 24,2002

Unmet health care needs
1998/99

   About 1.5 million people, or 6.6% of those 18 or older, reported having
had health care needs in the previous 12 months that were not met, according
to the 1998/99 National Population Health Survey. That is, they felt they
needed, but did not receive, some form of health care. This was a small but
significant increase from 4.4% in 1994/95 and 5.4% in 1996/97.

   Problems relating broadly to perceived "availability," which included
waiting too long for care, accounted for 36% of cases of unmet need;
"accessibility" problems - specifically, cost or lack of transportation -
accounted for about 10%.

   In 49% of the reported cases of unmet need, the individuals chose to do
without health care, either because of competing demands on their time or
because of their attitude toward illness, health care providers or the
health care system. These situations, referred to as "acceptability"
problems, included being too busy, deciding not to bother, believing care
would be inadequate, or disliking or fearing doctors.

   Most people's unmet health care needs fell in only one group of reasons.
In just 5% of cases, the reported problems spanned more than one category of
unmet need.


Small proportion report "availability" problems


   Of the 1.5 million people who reported having had unmet health care
needs, about 588,000, or 2.6% of the population 18 and older, attributed
them to unavailability of services.

   Unmet needs of this kind reflect perceived deficiencies in health care
delivery. While there may have been concerns that recent limits on health
care budgets placed an unequal burden on less advantaged groups, the results
of this analysis showed that the likelihood of reporting unmet needs due to
a lack of services did not vary significantly by factors such as household
income, education, employment, Aboriginal status or immigrant status.
______________________________________________________________________

Note to readers

   This report features an analytical article entitled "Unmet needs for
health care," available today in Health reports, Vol. 13, no. 2. The study
examines the prevalence of unmet health care needs and the extent to which
they can be attributed to perceived problems with "availability,"
"accessibility" or "acceptability" of service.

   The data are from the 1998/99 household component of the National
Population Health Survey (NPHS) and pertain to 14,143 respondents aged 18 or
older. The NPHS has collected information about the health of the population
every two years since 1994/95.

   The data used for this study were self-reported and do not include people
on Indian reserves and in some remote areas of Quebec and Ontario, so the
prevalence of unmet health care needs may be underestimated. Furthermore,
since the survey was conducted in English or French, unmet needs due to
difficulties with these languages or lack of information about the health
care delivery system may also be underestimated.

   This analysis examines perceived unmet health care needs and the reasons
for them as perceived by the NPHS respondents. There is no way of knowing if
those perceptions reflect reality or if people are truly going without
necessary care.
______________________________________________________________________


   However, service "availability" problems were associated with an
individual's health. For example, about 7% of people in poor or fair health
cited unmet needs stemming from "availability" problems. By contrast, just
over 2% of people who rated their health as good, very good or excellent
reported such problems. Similarly, people with chronic conditions or chronic
pain were more likely than those not so afflicted to report unmet needs
arising from problems with "availability".

   People who had consulted their family doctor or a specialist in the year
before the survey were more likely than those who had not to report unmet
needs related to "availability." It could be that because individuals with
medical problems are the most likely to require health care services, they
are also more likely than those in better health to recognize deficiencies
in the delivery of those services - particularly if their medical problem
persists.


Income a major factor in "accessibility" problems


   In 1998/99, an estimated 192,000 people, or about 1% of the adult
population, reported that a health care need went unmet because of problems
related to "accessibility" - that is, cost or transportation.

   Household income was a major factor in the prevalence of unmet needs
related to "accessibility". About 3% of people in low-income households
reported such unmet needs, compared with less than one-half of one percent
of residents of upper-middle or high-income households.

   Relatively high percentages of people reporting chronic conditions,
chronic pain or distress recalled having unmet health care needs stemming
from cost or transportation concerns.

   Most unmet health care needs, however, were attributed to the
individual's own circumstances. An estimated 794,000 adults, or 3.5%,
reported that in the year before the survey they had an unmet health care
need because of problems with "acceptability". That is, they did not receive
care because of personal circumstances or their attitudes toward health care
professionals or the health care system.

   The more respondents trusted doctors' authority, the lower the prevalence
of unmet health care needs related to "acceptability". On the other hand,
the more they relied on self-care, the higher the prevalence of
"acceptability"-related unmet needs.


Provincial patterns vary


   The prevalence of unmet health care needs of all types was close to the
national figure in most provinces.

   Problems with service "availability" significantly exceeded the national
level only in Nova Scotia, ( 4.6% compared with the national average of
2.6%). In New Brunswick and Ontario, the prevalence of unmet health care
needs related to "availability" was significantly lower.

   "Accessibility"-related unmet needs were significantly higher only in
British Columbia (1.5% compared with the national average of 0.9%), and
lower only in Ontario (0.6%).

   In each province except Nova Scotia, unmet health care needs stemming
from "acceptability" problems were the most common. No province had numbers
significantly higher than the national average, and only Newfoundland and
Labrador came in significantly low; 2.2% of adults there reported
"acceptability"-related unmet needs, compared with 3.5% of all Canadians.

   For more information, or to enquire about the concepts, methods or data
quality of the article "Unmet needs for health care," contact Jiajian Chen
(613-951-5059; [log in to unmask]), Health Statistics Division, or Feng Hou
(613-951-4337; [log in to unmask]), Business and Labour Market Analysis
Division.
Full report available in Health reports, Vol. 13, no. 2 (need paid
subscription to access)
Catalogue number 82-003-XIE ($15/$44)
http://www.statcan.ca/english/indepth/82-003/hrhome.htm

> Penney Kirby
> OHPRS Intranet Facilitator
> Ontario Prevention Clearinghouse (OPC)
> 180 Dundas Street West, Suite 1900
> Toronto, Ontario  M5G 1Z8
> Tel: 416-408-2249, ext. 242
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