Performance comparison and socio-economic inequalities in unmet need for medical treatment and dental care in the European Union

Ensuring adequate access to healthcare services is a priority across European countries. The EU has developed performance indicators to compare access using self-reported unmet need. Cross-country comparisons require adjustment for factors outside the health systems’ control. We address two research questions to improve the comparability of unmet need for medical and dental care across the EU and the comparability of socio-economic inequalities in unmet need across the EU. First, we explore the role of risk adjustment for demographic and socio-economic factors, which are outside health systems’ control, for both overall unmet need and unmet need due to affordability, waiting lists and distance. Second, we compare differences in unmet need by socio-economic status, and investigate whether different forms of risk adjustment affect such comparison. We show that adjusting for age, gender and chronic conditions reduces dispersion of unmet need for medical care across the EU. Controlling for income further reduces the dispersion, mostly due to affordability. When comparing socio-economic inequalities across countries, risk adjustment for age, gender and chronic conditions play a limited role. Socio-economic inequalities by income and education vary by reason of unmet need: the income gradient, even controlling for education, is mostly due to affordability rather than waiting list or distance. For dental care, the main reason for unmet need is affordability. Risk adjustment for age, gender, chronic conditions and education plays a limited role. The income and education gradients are more pronounced for dental than medical care.