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Health Econ. 2019 Apr 24. doi: 10.1002/hec.3877. [Epub ahead of print]

Here comes the SUN: Self-assessed unmet need, worsening health outcomes, and health care inequity.

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Economics, McMaster University, Hamilton, Ontario, Canada.
CHEPA, McMaster University, Hamilton, Ontario, Canada.


Utilization-based approaches have predominated the measurement of socioeconomic-related inequity in health care. This approach, however, can be misleading when preferences over health and health care are correlated with socioeconomic status, especially when the underlying focus is on equity of access. We examine the potential usefulness of an alternative approach to assessing inequity of access using a direct measure of possible barriers to access-self-reported unmet need (SUN)-which is documented to vary with socioeconomic status and is commonly asked in health surveys. Specifically, as part of an assessment of its external validity, we use Canadian longitudinal health data to test whether self-reported unmet need in one period is associated with a subsequent deterioration in health status in a future period, and find that it is. This suggests that SUN does reflect in part reduced access to needed health care, and therefore may have a role in assessing health system equity as a complement to utilization-based approaches.


Canada; access; equity; health care utilization; validation


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