Research Projects

Background

As the trend toward global population ageing continues, defining and measuring unmet needs for health and social care among older people will be important elements of assessing progress and achievements toward Sustainable Development Goal (SDG) 3.8., Universal Health Coverage (UHC), and WHO’s 13th Global Programme of Work. In the global context, two common challenges exist: lack of a common metric for measuring needs for health and social care among older adult populations; and, little or no access to quality health data in many countries. Populations with care needs that remain unmet or that have foregone needed care will fail to meet the goal of UHC. However, the magnitude of this problem is unclear, even in countries that have taken major strides toward the progressive achievement of UHC, in part because of a lack of standard definitions for the concept of unmet needs and corresponding lack of data.

• To develop an analytical model of unmet needs for health and social care among older people using a theory-based, data-driven approach and a systems perspective that incorporates demand and supply factors.
• To generate empirical estimates of unmet needs among older people by applying the model to existing national-level health survey data from several countries across WHO regions.

• Build on existing theoretical models of health service coverage and access (e.g. Tanahashi and Levesque models) and a synthesis model being developed through research supported by the WHO Kobe Centre that specifically considers equity in service coverage of older people to develop a comprehensive analytical model of unmet needs among older people.
• Identify datasets suitable for analysis from a diverse set of countries at different income levels across different regions, and harmonize and analyze the datasets through local partnerships, especially in low- and middle-income countries. 
• Apply statistical methods informed by existing guidelines and previous research to test the analytical model and produce a composite metric for unmet need.  
• Apply multilevel regression analysis to examine the predisposing, enabling and need factors at individual, group or area, and system level that affect unmet need.

1. Prevalence estimates for unmet health care need and unmet social care need in older adults were generated through secondary analysis of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. (*Additional analysis of the European Health Interview Survey (EHIS) Wave 3 collected in 29 countries in 2019 was performed at a later time in 2023. The methods and results of this analysis are reported separately - see Technical Notes and Evidence Summary below). 
2. Large variation was seen in question wording and response categories related to the measurement of unmet need across the different surveys that were analyzed.
3. Based on the responses to direct questions asking about self-reported unmet need, current estimates range from low levels of less than 2% of unmet health care need in adults 60 years and older in some countries to much higher rates of over 50% in others. Similarly, estimates for unmet social care need range from less than 4% to over 40% across countries. Both increasing and decreasing trends in unmet health care need were observed among the few countries where longitudinal data were available. A statistically significant correlation was observed in which the prevalence of unmet health care need among older people was generally lower in countries scoring higher on the UHC Service Coverage Index. 
4. To better quantify unmet health and social care need, a data-driven latent measure of unmet health need among older people was also pursued, using a theoretical model to inform analytical approaches. Each of the models provided some signal on country-specific structures for unmet health need, but the models did not sufficiently converge to develop a universal structure for unmet health need.

Global Implications

An agreed definition of unmet need for health and social care and standardized survey questions would improve current prevalence estimates and their comparability across place and time. The dimensions and determinants of unmet health need are contextual and may be highly localized. Thus, efforts to define and measure unmet need in a way that comprehensively captures their multifactorial nature may be needed before standardization is attempted. Further advancements in defining and measuring unmet need would be required to incorporate this element into monitoring progress towards universal health coverage.

Implications for Kansai

This study identified several ways in which survey questions have been designed around the world to measure unmet need for health and social care among older persons. These could be adapted for use in local surveys. They could also inform debates about how unmet need should be measured in the local context. The prevalence estimates of unmet need produced by this study could also provide comparison data for locally derived estimates of unmet need for health and social care among the older population.

Publications

WHO reports

• Preliminary results were described in Tracking Universal Health Coverage: 2021 Global Monitoring Report (section 1.3.2 Inequalities in unmet health care needs, paragraph 2, page 13). 
• Updated results were featured in Tracking Universal Health Coverage: 2023 Global Monitoring Report (Box 3.2 Aging population and unmet needs, page 56).

Journal articles

• Kowal P, Corso B, Anindya K et al. Prevalence of unmet health care need in older adults in 83 countries: measuring progressing towards universal health coverage in the context of global population ageing. Popul Health Metrics. 2023;21:15. https://doi.org/10.1186/s12963-023-00308-8
• Corso B, Anindya K, Ng N, Minicuci N, Rosenberg M, Kowal P, Byles J. Unmet need for older adults in low-, middle- and high-income countries – lessons in theoretical and analytical model building for monitoring universal health coverage. (submission in progress).

Technical notes 

• Technical Notes: Unmet needs direct survey question analysis - PDF download
• Technical Notes: Unmet social care needs direct survey question analysis - PDF download
• Technical Notes: Prevalence of and reasons for unmet needs for health and social care in the European region - PDF download

Working papers

• Working paper: Prevalence of unmet health care need in older adults in 83 countries - PDF download
• Working paper: Measuring unmet need for older adults: theoretical and analytical model building - PDF download

Evidence summary

• Evidence summary: Inequality in unmet healthcare and social care needs in Europe - PDF download