Background In Ireland, entitlement to healthcare is subject to a complex system of eligibility categories. Medical cards are awarded on income grounds with holders eligible for a range of healthcare services without significant charge. The remainder of the population pay the full cost of GP care and are entitled to subsidised public hospital care, but due to long waits for care, approximately 45% of the population have private insurance, which secures faster access. Increasingly there are concerns about financial barriers to access and unmet need for care. The objective of this analysis is to identify the individual socioeconomic and health characteristics associated with unmet need and to examine how the causes of unmet need differ across these characteristics.

Methods A secondary analysis of cross-sectional data from the 2013 Survey of Income and Living Conditions including 12,663 individuals living in private households in Ireland. Respondents were asked if they needed a medical/dental examination in the past 12 months but did not receive it. Multivariant logistic regression analysis was used to determine the factors associated with unmet need and to determine the relationship between these factors and the different causes of unmet need.

Results Almost 4% of participants reported an unmet need for medical care, while 7% reported an unmet need for dental care. Female gender, poor health status and not having a medical card or private insurance increased the likelihood of unmet needs for medical care. The most common causes of unmet need for medical care were cost (55%) and waiting lists (27%), while cost was the single most important cause of unmet need for dental care (79%). Younger people and those without a medical card were more likely to report an unmet need for medical care due to cost, while older people and those in poor health were more likely to report an unmet need due to waiting list issues.

Conclusion The reasons for unmet need for healthcare differ depending on characteristics of the individual under consideration with initial evidence suggesting that the two-tier nature of the Irish healthcare system is contributing to unmet need.