Unmet need for healthcare services among unemployed people – findings from a national survey in Finland

BACKGROUND: Unemployed people have higher morbidity compared to employed people. Both the frequent use and the underutilization of healthcare services are common among unemployed people, potentially leading to unmet healthcare needs. We studied the differences in self-reported no need and unmet need for healthcare services between unemployed and employed persons and the health-related factors associated with these differences. METHODS: We used the Healthy Finland Survey of 2022-2023, which included employed and unemployed respondents of working age (20-64, N = 9841). The outcomes were (1) no need for healthcare services and (2) unmet need for healthcare services in the previous 12 months. We used logistic regression, adjusting for sociodemographic and health-related factors, including limiting long-term illness, psychological distress, limited functional ability, very weak social inclusion, poor work ability, smoking, and excessive alcohol consumption. RESULTS: Among unemployed people, 23% reported no need for a doctor or nurse, whereas 41% reported unmet needs. Compared with employed people, unemployed people were more likely to perceive no need for doctor or nurse services (OR 1.36, 95% CI 1.02-1.82). When health-related factors, especially long-term illness and work ability, were controlled for, the difference increased. In the full model, the OR was 1.87 (95% CI 1.35-2.58). Unemployed people were more likely than employed people to have unmet need for doctor or nurse (OR 2.31, 95% CI 1.78-3.00). For most of the health-related factors, especially work ability, controlling decreased the difference, whereas controlling for smoking and alcohol had little effect. In the full model the OR was 1.33 (95% CI 0.98-1.81). CONCLUSIONS: Unmet healthcare need among unemployed people was largely attributable to health-related factors, especially poor work ability. In some cases, unemployed people may not recognize their need for healthcare, highlighting the importance of low-threshold services and proactive outreach to ensure equitable access. Healthcare systems should ensure effective and timely use of services to prevent diagnostic delays or untreated illnesses and support more appropriate use of sickness benefits and rehabilitation services.