Peer-reviewed article
Gendered experiences of cause-specific unmet medical need: An intersectional analysis using MAIHDA.
Hanyul Lee, Wonbin Choi, Woojoo Lee, Hongsoo Kim ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines unmet medical needs among adults in South Korea, analyzing how gender intersects with employment, household composition, and income to affect healthcare access. Using data from over 230,000 adults, researchers found that time-related unmet medical needs were highest among employed younger adults and non-employed younger females with children, while cost-related needs were highest among middle-aged, low-income adults living alone. The research highlights that different patterns of unmet need arise from gendered work and family arrangements rather than from single factors alone.
Key points
- Intersectional strata explained 27.3% of variation in cost-related unmet medical need and 18.6% in time-related unmet medical need
- Younger non-employed females living with children showed the highest time-related unmet medical needs among gender-disaggregated groups
- Non-employed middle-aged males living alone showed the strongest cost-related unmet medical need even in the highest-income group
- Time- and cost-related unmet medical needs arise through different gendered work-family configurations
- Universal health coverage alone does not eliminate unequal distribution of unmet medical needs across social groups
Limitations
This study focuses on South Korean adults and does not examine children's healthcare access or unmet medical needs. The analysis is cross-sectional and cannot establish causality or track how unmet needs change over time for individuals.
Abstract
Unmet medical needs (UMN) persist even under universal health coverage and remain unequally distributed across social groups. Although gender differences in UMN are well documented, less is known about how gender intersects with family and work roles to shape healthcare access. We analyzed data from 230,925 adults aged ≥19 years in the 2024 Korea Community Health Survey. Outcomes were overall, time-related, and cost-related UMN. Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) was applied using 144 intersectional strata defined by sex, household composition, employment status, age, and household income. We estimated variance partition coefficients, proportional change in variance, and area under the curve, along with main effects and intersectional interaction effects for each outcome. Intersectional strata explained 18.6% of variation in time-related UMN and 27.3% in cost-related UMN, compared with 4.8% in overall UMN. Time-related UMN was concentrated among younger and middle-aged employed adults, but younger non-employed females living with children also had high risks and the largest intersectional interaction effects (ORs 1.59-2.10). Cost-related UMN was concentrated among middle-aged, low-income, non-employed adults living alone. However, non-employed middle-aged males living alone showed the strongest intersectional interaction effect even in the highest-income group (OR 2.60). These patterns suggest that time- and cost-related UMN arise through different gendered work-family configurations that additive approaches may obscure, particularly among younger females living with children and non-employed middle-aged males living alone. Achieving equitable healthcare access may therefore require attention to the gendered organization of work, care, and household responsibilities.