The study found that the risk of unmet health care needs increased with increasing disability-related limitations in daily activities, with this effect being more pronounced for men. Men with physical, brain injury-related, or mild disabilities and women with internal, facial, or severe disabilities were at risk of unmet health needs due to limitations in daily activities. For both men and women, pain due to limitations in the legs and feet increased the risk of unmet health needs. Regarding the reasons for unmet needs, women were more likely to attribute them to the burden of medical care costs, while men were more likely to attribute them to other factors.
We found that people are at higher risk of having unmet needs if their disability severely impacts their daily activities and limits their ability to carry out daily activities, similar to previous findings that unmet needs increase with age and limitations in daily activities due to illnesses such as cancer, dementia, asthma and osteoarthritis. [16,17,18,19,20,21,22]Our findings, together with those of previous studies, support the relationship between unmet needs and chronic or terminal illnesses, including disabilities. Furthermore, this study is significant in that it is generalizable by conducting a national survey and provides a general, detailed look at the impact of disabilities on unmet needs based on severity.
The study found that limitations in daily activities due to disability increase the risk of having unmet needs. When daily activities were moderately limited, women were at higher risk of having unmet needs. However, when daily activities were severely limited, men were at higher risk of having unmet needs. Previous studies have found that women with disabilities are at higher risk of having unmet needs than men. [6, 23, 24]However, when care is lacking, men with disabilities are more vulnerable to unmet needs than women. [25]However, the absolute number of women in this study who fell into the group with greater limitations in daily life was small, so the results may be uncertain.
To investigate in detail the impact of daily life limitations on unmet needs, this study used the following subdivisions: type of disability, severity, health aspects limiting daily life, and cause of unmet needs. With regard to type of disability, the impact differed by gender. Men with physical disabilities or brain injuries were 2.77 times more likely to have unmet needs than men without limitations when their daily life limitations were high. In South Korea, physical disabilities among men in 2017 were due to (1) joint injury (60.0%), (2) amputation (19.1%), (3) paralysis (16.2%), and (4) deformity (4.6%). [26]Of the joint injuries, 25.7% were intervertebral disc injuries and 12.4% were knee joint injuries. [26]Furthermore, one in four people with physical disabilities receives no assistance in daily living. [27]Having a physical disability can make it difficult to access healthcare facilities and can lead to unmet medical needs.
Brain lesion-related disorders are characterized by overlapping disorders. In 2017, the main comorbidities among men with brain lesions in South Korea were (1) language (45.7%), (2) intelligence (24.3%), (3) vision (21.9%), and (4) hearing (17.3%). [26]Among people with brain injury, 9 in 10 had a caregiver to carry out activities of daily living, but 44.6% of respondents reported a lack of help from others, due to (1) limited help from family members (54.9%), (2) lack of caregiver time (23.7%), and (3) severe disability (16.0%). [26]Brain injury can make it difficult for people to seek medical care independently because of communication and intellectual disabilities, and people with brain injuries may have insufficient support from others to get their needs met.
Meanwhile, women with internal or facial disabilities that severely limit their daily activities are 7.45 times more likely to have unmet needs. Internal disabilities include kidney, heart, respiratory, liver, stoma, urinary stoma, and epilepsy disorders. External physical disabilities usually occur when the pathology caused by injury or disease first stops, after which the disability and functional impairment persist. However, internal organ disorders require ongoing medical care, including treatment, diagnosis, and testing, as the disability and disease are present at the same time and usually worsen over time. [28]In South Korea, where national health insurance is available, the average monthly additional costs due to internal disorders were higher than the 2017 average (mean: $144.8; liver: $405.4; kidney: $257.5; stoma or urinary stoma: $205.9). [26].
Facial impairments had the second highest mean monthly disability costs ($288.8, behind autism at $533.7). [26]Furthermore, people with facial disabilities were the group most likely to report being unable to go to a hospital or clinic even if they wanted to for financial reasons. [26]The economic burden of internal and facial disabilities can create a gap between the need for and utilization of health care services.
In terms of limitations of daily life due to disability, difficulty using one’s legs or feet had the greatest impact on the presence of unmet needs, regardless of gender. Mobility problems are a major concern for adults with disabilities. [29, 30]With the exception of non-face-to-face care and home care, discomfort in the legs and feet is directly related to unmet need as it makes physical movement difficult.
The main reason women’s needs go unmet is the cost of healthcare. Women with disabilities face double barriers: being a woman and being disabled. [31]The employment rate for women with disabilities is just 49.8% of that for men. [26]The main reasons why women with disabilities are not working are cited as difficulties in finding work due to their disability (34.0%) and health problems (20.5%), which leads to the conclusion that the constraints imposed by disabilities and unmet needs due to difficulties at home are closely related.
This study has certain limitations. First, the data used in this study does not include institutionalized people, people with unknown addresses, and deceased people. However, these people account for 2.6% of the registered disabled people surveyed (institutionalized people 0.6% and deleted or deceased people 2.0%). [32]which would not have had a significant impact on the overall results. Second, unmet needs based on time-series changes in the degree of limitation in daily life were not analyzed. However, the disability is considered to be chronic and of relatively stable severity. Third, although various covariates that may affect hypothesis testing were adjusted, some variables were not included in the study. The presence or absence of congenital disabilities, acceptance of disabilities, and support situation due to disabilities were not considered as covariates. Therefore, follow-up studies that take these factors into account are necessary. Fourth, because the number of participants was limited, it was difficult to analyze each disability type separately. However, this study attempted to distinguish between disability types by categorizing them.