Is subjective unmet need for mental health care a valid measure compared to a more 'objective' metric?
Jemimah Ride, University of Melbourne
General Research Seminars
Wednesday, 21 April 2021, 10am to 11am
Hosted by HERC
Date and Time: Wednesday 21st April 2021, 10:00 am (UK BST - UTC+1))
To Join: This is a free event, which will be taking place online via Zoom. To register your interest in attending this talk please click HERE.
Reducing unmet need for mental health care is a policy goal in many health systems since most people with mental disorders receive less than adequate or no care. However, the measurement of unmet mental healthcare needs is complex, with no agreed-upon best measure and little attention paid to the implications of choice of measure. Subjective measures of unmet need are more often used to measure health system performance and inequalities. These prioritise the patient perspective but may be subject to reporting biases with socioeconomic gradients. Alternatives include normative (or more ‘objective’) assessment of unmet need using clinical interview or validated symptom measures paired with administrative data on healthcare use. However, variation in the level of care required for a given disorder make it difficult to determine whether someone’s needs have been met. Self-reporting allows for differing preferences for health and health care, while the normative approach may reflect a more deterministic definition of need. Self-reported unmet need for health care in adults predicts later deterioration in physical health, but this has not been examined for mental health, nor in children, where the reporter is usually the parent. To investigate the validity of each approach, we explore how well they predict later outcomes, since the principle reason to address unmet needs is to reduce health burden.
We analyse panel data (N=5,118) from the nationally representative Longitudinal Study of Australian Children for children aged 4-18, using the Arellano-Bond approach to estimate dynamic panel data models. Subjective unmet need is less prevalent but shows higher relative income inequality. Our results suggest that the normative measure of unmet needs for children’s mental health care predicts health outcomes while parent-reported subjective unmet needs are not predictive of future health. Measuring unmet needs in this way is more laborious for national surveys but may be more useful in assessing how well a healthcare system addresses unmet needs that are important to long-term health. However, subjective unmet needs may be important to capture patient experience of care. In Australia, access to most community-based mental health services requires out-of-pocket payments even if publicly subsidised, which may contribute to income gradients in unmet need. Differences in inequality between self-reported and measured unmet need could reflect a socioeconomic gradient in reporting bias or could represent an important recognition of differences in experience.
Jemimah Ride is a medically qualified health economist and Research Fellow at the Health Economics Unit, Centre for Health Policy at the University of Melbourne. Her research addresses mental health and mental health care, including preferences for and distribution of care. Jemimah completed her PhD in health economics at Monash University, and was a research fellow in the Centre for Health Economics at the University of York. Before her research career, Jemimah worked as a medical practitioner in emergency medicine, and in mental health policy and public health.