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Résumé (français)

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Résumé (anglais)

The measurement of socio-economic inequity in health care utilization is mostly based on an indirect approach, comparing actual to “necessary” (needs-adjusted) utilization. As we show in this paper, this indirect approach can be misleading when preferences over health and health care vary along socio-economic status. An alternative approach to assessing in-equity is to measure the existence of barriers to access directly, through self-assessment of unmet need, and then estimate how it co-varies with socio-economic status. Questions on unmet need are asked in many health surveys but have not been much used in analyses of health inequity. The subjective nature of responses to unmet need may explain this neglect. In this paper we test the external validity of self-assessed unmet need, based on longitudinal Canadian data. We find that reporting unmet need statistically predicts deterioration in health status, suggesting that responses to the question on unmet need capture some actual barriers to access to care, and that responses are not only the result of subjective perceptions.