Measuring unmet healthcare needs - findings from a tribal district in the Chhattisgarh State of India

Abstract Background There are many indicators and methods in use for measuring access to healthcare, much of which relate to physical access or utilization of services. This study measures unmet healthcare needs in a district with relatively good physical access and insurance coverage and discusses the relevance of our findings for the design and monitoring of progress towards achieving universal health coverage (UHC). Methods A multi-stage sampling survey identified and interviewed a sample of 3153 individuals from 598 households drawn from 13 villages and seven urban wards. In-depth qualitative interviews of five purposively chosen individuals from each village and urban ward, was also undertaken. The study examined access in terms of perceived healthcare needs and unperceived or latent healthcare needs and the proportion of such needs that utilized effective health care and the proportion that did not. Estimation of unperceived healthcare needs was limited to five tracer conditions- hypertension, diabetes, depression, rheumatic conditions and dependence in activities of daily living in the elderly. Bivariate, multivariate (logistic regression), and thematic analyses were used for this study. Results Out of the total population, 10.47% reported perceived healthcare needs for acute ailments in the last 15 days, and 10.62% of the population self-reported suffering from chronic conditions. 12.75% of those with acute ailment and 18.40% of those with chronic ailment received no treatment, while 27.83% and 9.07% respectively took care from informal care provider. Unperceived healthcare needs were high in all five-tracer conditions studied. Incomplete treatment was another form of unmet need. Inappropriate care conceals unmet healthcare needs. Unperceived healthcare needs were significantly higher for poor and marginalized population subgroup, whereas perceived healthcare needs were higher among upper socioeconomic and less marginalized population. Conclusion The measurement of unmet healthcare needs should include both perceived and latent needs, as well as incomplete care and care from informal providers. Further, inappropriate care conceals a lot of unmet healthcare needs, and its measurement is not easy. In a context of information asymmetry and prevailing health markets, the measurement of unmet healthcare needs in all its complexity, becomes essential for measuring progress towards UHC. Trial registration: Not Applicable