Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice BMC Health Serv Res . 2026 Mar 5;26:513. doi: 10.1186/s12913-026-14276-w Search in PMC Search in PubMed View in NLM Catalog Add to search Association between diabetic patients’ satisfaction with local medical services and experiences of unmet healthcare needs Woorim Kim Woorim Kim 1 Cancer Knowledge & Information Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do Republic of Korea Find articles by Woorim Kim 1 , Kyujin Chang Kyujin Chang 2 Graduate School of Public Health, Ajou University, Suwon-si, Gyeonggi-do Republic of Korea Find articles by Kyujin Chang 2 , Soon Young Lee Soon Young Lee 2 Graduate School of Public Health, Ajou University, Suwon-si, Gyeonggi-do Republic of Korea 3 Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 16499 Republic of Korea 4 Gyeonggi Center for Hypertension and Diabetes, Ajou University, Suwon-si, Gyeonggi-do Republic of Korea Find articles by Soon Young Lee 2, 3, 4 , Yeong Jun Ju Yeong Jun Ju 2 Graduate School of Public Health, Ajou University, Suwon-si, Gyeonggi-do Republic of Korea 3 Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 16499 Republic of Korea Find articles by Yeong Jun Ju 2, 3, ✉ Author information Article notes Copyright and License information 1 Cancer Knowledge & Information Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do Republic of Korea 2 Graduate School of Public Health, Ajou University, Suwon-si, Gyeonggi-do Republic of Korea 3 Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 16499 Republic of Korea 4 Gyeonggi Center for Hypertension and Diabetes, Ajou University, Suwon-si, Gyeonggi-do Republic of Korea ✉ Corresponding author. Received 2025 Jul 1; Accepted 2026 Feb 25; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13077801 PMID: 41787420 Abstract Background Unmet healthcare needs reflect timely access to medical care perceived to be required by an individual. This study investigated the association between the unmet healthcare needs and satisfaction with local medical services in patients with diabetes. Methods Data from the 2023 Korea Community Health Survey were used. Descriptive statistics were measured using a chi-squared test. The association between the likelihood of unmet healthcare needs and patient satisfaction with local medical services was analyzed using a multivariable logistic regression analysis. Results Of the 23,822 participants diagnosed with diabetes, 1,141 (4.7%) reported unmet healthcare needs. A total of 18,198 (80.6%) individuals were satisfied with local medical services. Compared to those satisfied with local medical services, those unsatisfied were more likely to experience unmet needs (OR 1.65, 95% CI 1.41–1.94). Conclusions Unmet healthcare needs were associated with patient satisfaction with local medical services. This suggests the importance of addressing this association, considering its potential correlation with health outcomes and disease burden. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-026-14276-w. Keywords: Unmet medical need, Patient satisfaction, Healthcare access, Diabetes mellitus Introduction Unmet healthcare needs are defined as when medical needs subjectively perceived as being required by individuals or considered to be needed by medical professionals are not met in a timely manner [ 1 ]. The latter measures unmet healthcare needs in a clinical perspective and can be described based on the appropriate provision of clinical guidelines under specific conditions. In contrast, the subjective measure of unmet healthcare needs reflects whether patients subjectively perceive that they have received appropriate medical care [ 2 ]. The subjective aspect of unmet healthcare needs may be beneficial in that in addition to the clinical definition of whether a set of treatments have been provided in a defined set of conditions, it can reflect whether patients assess that they have received the care they need [ 3 , 4 ]. Such measure is important as communication of symptoms between the patient and provider is important in making treatment decisions, which can lead to a specific group of individuals such as minority groups receiving fewer effective services [ 4 , 5 ]. Subjective measure of unmet healthcare needs may also be useful in that in some ways individuals may be better able to predict their health conditions [ 6 ]. Experiences of unmet healthcare needs have been related to a variety of individual characteristics, including income and educational level [ 7 ]. In addition, experiences of unmet healthcare needs can also arise from various aspects in the healthcare system, such as accessibility to services regarding costs or proximity to healthcare institutions [ 8 ]. Furthermore, unmet healthcare needs have been associated with individual satisfaction with medical care [ 9 ]. Such an association is probable considering that patient satisfaction with healthcare services have been linked to long waiting times, when a factor constituting unmet healthcare needs is untimely access [ 10 ]. The subject of unmet healthcare needs and satisfaction with local medical services is particularly important in patients with diabetes because they require a regular and constant provision of treatment or care [ 11 , 12 ]. Moreover, diabetes is a highly prevalent disease worldwide, which affected approximately 463 million people in 2019 [ 13 , 14 ]. Diabetes is also prevalent in South Korea, with an estimated prevalence of approximately 14% and 30% in individuals aged ≥ 19 and ≥ 65 years, respectively [ 15 ]. Considering that unmet healthcare needs correlate with different health outcomes, including poorer self-rated health, the factors related to unmet healthcare needs in patients with diabetes should be explored [ 16 ]. This study aimed to investigate the association between unmet healthcare needs and satisfaction with local medical services in patients with diabetes. We hypothesized that patients who were unsatisfied with the healthcare services accessible in their neighborhood would be more likely to report unmet needs. The analysis suggests important health policy implications because unmet healthcare needs reflect timely access to healthcare services, which is related to disease awareness and management and can lead to worse health outcomes [ 17 ]. Methods Data and study population The Korea Community Health Survey (KCHS) is an annual, nationally representative, cross-sectional survey administered by the Korea Disease Control and Prevention Agency (KDCA). Participants aged 19 years or older are selected using a stratified, multistage, probability-cluster sampling design to represent the Korean adult population [ 18 ]. Data on sociodemographic, economic, and health-related characteristics are collected through face-to-face interviews using a computer-assisted interviewing system. The study population comprised 23,822 individuals aged ≥ 19 years diagnosed with diabetes mellitus by a physician. Regarding missing data, no additional imputation was performed because the KCHS does not provide an imputed dataset, Participants with missing information on the key variables were excluded from the analysis and a complete-case analysis was conducted, resulting in a final sample of 23,822 participants out of 31,725 eligible participants (Fig. 1 ). Fig. 1. Open in a new tab Flow-chart of study participants selection process Outcome measure Unmet healthcare needs were measured using the official KCHS-derived binary indicator for annual unmet need for clinic or hospital care, excluding dental care. The variable was coded as “yes” for respondents who reported that they had needed medical care (examination or treatment) during the past 12 months but had been unable to receive it, and as “no” otherwise. Independent variables The main independent variable was satisfaction with local healthcare service conditions in the respondent’s residential community, encompassing public health centers, clinics or hospitals, traditional Korean medical clinics or hospitals, and pharmacies. Participants were categorized as either satisfied or unsatisfied based on self-report. Apart from the variable of interest, the analysis also incorporated various sociodemographic, economic, and health-related factors as covariates. These included sex, age, education, income, occupation, BMI, subjective health status, perceived stress, depressive symptoms, smoking status, monthly drinking, moderate-to-vigorous physical activity, and current treatment status for diabetes. A Body Mass Index (BMI) of < 25.0, and ≥ 25.0 indicated being underweight, normal weight or overweight, and obese, respectively. The cutoff values were based on the diagnostic criteria of obesity reported by the Korean Society for the Study of Obesity [ 19 ]. The KDCA also defines obesity based on a BMI cutoff value of ≥ 25.0 [ 20 ]. Depressive symptoms were assessed using the Korean version of the Patient Health Questionnaire-9 (PHQ-9), which asks about the frequency of nine symptoms over the past two weeks with four response options ranging from “not at all” to “nearly every day.” A cutoff score of 10 or higher was applied, and participants with PHQ-9 scores ≥ 10 were coded as having depressive symptoms [ 21 ]. Smoking status included those who responded to smoke every day or sometimes and with an experience of smoking over 100 cigarettes in their lifetime. Monthly drinking status included individuals who responded to drink alcohol at least once a month in the recent years. Moderate-to-vigorous physical activity included individuals who performed vigorous physical activity at least 20 min per day for 3 days or more per week in the past week; individuals who performed moderate level activity at least 30 min per day for 5 days or more per week in the past week. Current treatment status for diabetes was classified based on the question enquired to individuals diagnosed with diabetes by a physician, “Are you currently receiving treatment to manage your blood glucose level?” The responses included either received insulin or other pharmacological treatments (oral drugs) to control their blood glucose levels. Statistical analysis A chi-squared test was used to examine the participants’ general characteristics and differences between the groups. The association between unmet healthcare needs and satisfaction with local medical services was analyzed using a multivariable logistic regression adjusting for all covariates. To account for the complex survey design of the KCHS, all analyses incorporated sampling weights, stratification, and clustering to ensure nationally representative estimates and valid statistical inference. The overall model fit was assessed using the Hosmer-Lemeshow goodness-of fit test, which indicated an adequate fit ( p = 0.2935, Supplementary Table 1 ). Multicollinearity among covariates was examined and all tolerance values were greater than 0.1 while all variance inflation factors (VIFs) were below 10, indicating no multicollinearity issues excluding the age groups 60 to 69 years and 70 + years (Supplementary Table 2 ). Results are presented as OR with 95% CIs for each variable of interest. Statistical significance was defined as a two-sided p-value < 0.05. All analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). Results The participants’ general characteristics are shown in Table 2 . Of the 23,822 participants diagnosed with diabetes, 1,141 (4.7%) reported unmet healthcare needs. Unmet healthcare needs were more commonly reported by participants who were not satisfied with the medical services available in their neighborhood (7.3%) compared to by those who were satisfied (4.0%). Table 2. The association between unmet healthcare needs and satisfaction with available medical services available Variables Unmet healthcare needs Adjusted-Odds Ratio* 95% Confidence Interval Satisfaction with available medical services at neighborhood Yes 1.00 No 1.65 1.41 - 1.94 Sex Male 1.00 Female 1.33 1.12 - 1.58 Age 19 ~ 39 1.00 40 ~ 59 1.01 0.65 - 1.59 60 ~ 69 0.62 0.38 - 1.00 70+ 0.52 0.32 - 0.85 Education Elementary school or below 1.00 Middle school 0.85 0.67 - 1.07 High school 0.75 0.60 - 0.94 College or above 0.60 0.45 - 0.80 Income Low 1.00 Middle-low 0.66 0.54 - 0.81 Middle-high 0.61 0.48 - 0.77 High 0.65 0.51 - 0.83 Body Mass Index Normal weight (BMI < 25) 1.00 Obesity (BMI ≥ 25) 0.90 0.77 - 1.05 Subjective health status Fair 1.00 Poor 1.35 1.08 - 1.68 Perceived stress Yes 1.00 No 0.63 0.53 - 0.74 Depressive symptoms Yes (PHQ-9 ≥ 10) 1.00 No (PHQ-9 < 10) 0.32 0.26 - 0.39 Smoking Yes 1.00 No 0.85 0.69 - 1.05 Monthly drinking Yes 1.00 No 0.97 0.81 - 1.16 Moderate-to-vigorous physical activity No 1.00 Yes 1.27 1.01 - 1.59 Receiving treatment for diabetes No 1.00 Yes 0.39 0.28 - 0.53 Open in a new tab *Adjusted for all covariates Table 1. General characteristics of the study participants Variables Total Unmet healthcare needs p -value** Yes No N %* N %* N %* Satisfaction with available medical services at neighborhood < 0.001 Yes 18,198 80.6 728 4.0 17,470 96.0 No 5,624 19.4 413 7.3 5,211 92.7 Sex < 0.001 Male 11,733 54.2 458 3.9 11,275 96.1 Female 12,089 45.8 683 5.6 11,406 94.4 Age < 0.001 19 ~ 39 428 3.4 30 6.9 398 93.1 40 ~ 59 4,732 27.9 280 5.7 4.452 94.3 60 ~ 69 7,458 30.1 305 3.9 7,153 96.1 70+ 11,204 38.6 526 4.3 10,678 95.7 Education < 0.001 Elementary school or below 9,225 28.5 547 5.7 8,678 94.3 Middle school 4,306 17.3 186 4.8 4,120 95.2 High school 6,410 30.7 264 4.5 6,146 95.5 College or above 3,881 23.5 144 3.6 3,737 96.4 Income < 0.001 Low 7,666 23.4 528 6.9 7,138 93.1 Middle-low 5,488 21.0 200 4.0 5,288 96.0 Middle-high 5,679 26.0 218 3.9 5,461 96.1 High 4,989 29.7 195 4.1 4,794 95.9 Body Mass Index 0.480 Normal weight (BMI < 25) 14,672 59.0 719 4.8 13,953 95.2 Obesity (BMI ≥ 25) 9,150 41.0 422 4.5 8,728 95.5 Subjective health status < 0.001 Fair 3,767 17.4 98 2.8 3,669 97.2 Poor 20,055 82.6 1043 5.1 19,012 94.9 Perceived stress < 0.001 Yes 5,336 24.3 485 8.2 4,851 91.8 No 18,486 75.7 656 3.5 17,830 96.5 Depressive symptoms < 0.001 No (PHQ-9 < 10) 22,399 93.6 898 3.9 21,501 96.1 Yes (PHQ-9 ≥ 10) 1,423 6.4 243 16.6 1,180 83.4 Smoking 0.007 Yes 3,904 19.2 220 5.6 3,684 94.4 No 19,918 80.8 921 4.5 18,997 95.5 Monthly drinking 0.152 Yes 7,824 37.9 325 4.4 7,499 95.6 No 15,998 62.1 816 4.9 15,182 95.1 Moderate-to-vigorous physical activity 0.678 No 21,087 87.7 1,009 4.7 20,078 95.3 Yes 2,735 12.3 132 4.9 2,603 95.1 Receiving treatment for diabetes < 0.001 No 620 2.9 67 12.3 553 87.7 Yes 23,202 97.1 1,074 4.5 22,128 95.5 Total 23 , 822 100.0 1 , 141 4.7 22 , 681 95.3 Open in a new tab *Weighted estimates of proportions were calculated ** p-value were calculated using the Rao-Scott chis-square test The results of the regression analysis on the association between unmet healthcare needs and satisfaction with local medical services are shown in Table 2 . Compared to individuals satisfied with the medical services in their neighborhood, participants who were not satisfied were more likely to experience unmet needs (OR 1.65, 95% CI 1.41–1.94). Additionally, those who currently received treatment for diabetes had lower odds of reporting unmet healthcare needs (OR 0.39, 95% CI 0.28–0.53). Other noticeably related factors were education (high school OR 0.75, 95% CI 0.60–0.94; college or above OR 0.60, 95% CI 0.45–0.80) and income (middle-low OR 0.66, 95% CI 0.54–0.81; middle-high OR 0.61, 95% CI 0.48–0.77; high OR 0.65, 95% CI 0.51–0.83). Discussion This study investigated the association between the experiences of unmet healthcare needs and satisfaction with local medical services in individuals diagnosed with diabetes. The findings revealed that those unsatisfied with available local healthcare services were more likely to have unmet healthcare needs. Patient satisfaction with healthcare services encompasses personal expectations and thoughts on the care received by an individual [ 22 ]. As such, low satisfaction may reflect experiences of barriers to accessing healthcare, including long waits, which is an aspect of unmet healthcare needs [ 23 ]. In other words, satisfaction with local medical services may be a subjective reflection of easy accessibility to healthcare, recognized as a determinant of unmet healthcare needs [ 24 ]. Such tendencies may be particularly important for patients with diabetes because standard treatment for diabetes includes medications and lifestyle changes, inferring that patients with diabetes require long-term, regular care [ 25 ]. Dissatisfaction with local medical services at a proximal distance may act as a significant burden to patients with diabetes who require regular care [ 26 ]. This study is unique in that it suggests a relationship between unmet medical need and satisfaction with local healthcare services in patients with diabetes who require regular medical visits for disease management and prevention of potential complications [ 27 ]. The findings are in accordance with studies that have examined this topic in patients with other diseases or the general population. For instance, a study in Korea concluded that unmet medical need was more common in households that were unsatisfied with local healthcare services [ 28 ]. Since a notable proportion of patients with diabetes are known to report experiences of unmet healthcare need, this study offers important insights by suggesting the potential importance of patient satisfaction with local medical services. The direction of the association found in this study are mostly consistent with previous research. This study extends from previous findings my using nationally representative data focusing on individuals with diabetes whereas previous studies have largely investigated the general population or those with other diseases. This study underscores the important role of patient satisfaction in addressing unmet need in individuals with diabetes. Furthermore, psychosocial and behavioral mechanisms can also help explain the studied relationship. Lower satisfaction may reflect lower levels of trust towards healthcare providers, which can influence healthcare-seeking behaviors in patients such as adherence to medical advice and perceived quality of care [ 29 , 30 ]. Quality of communication is also an important factor as it has been associated with patient confidence in providers [ 31 , 32 ]. As patient satisfaction and unmet healthcare need have been related, dissatisfaction with available local medical services may be associated with unmet healthcare needs in individuals with diabetes [ 33 ]. Such findings may be explained within Andersen’s Behavioral Model that reveals that patient satisfaction acts as an enabling factor that helps or constrains healthcare utilization [ 34 ]. Under this framework, dissatisfaction may decrease the likelihood of an individual with perceived need to utilize services, thereby escalating the risk of unmet healthcare need. The findings are also noteworthy in that it extends beyond previous literature that focused on individual-level characteristics related to unmet healthcare needs as stated above. At the same time, the analysis also incorporated individual variables, including income or educational level as covariates. The results on the association between such variables and unmet healthcare needs generally aligned to the findings of previous studies. For instance, similar to the tendencies found, being female or coming from a less educated and lower income background were related to a higher likelihood of unmet healthcare needs in previous studies [ 35 ]. Specifically, lower income was related to a higher likelihood of reporting unmet healthcare needs in this study. Likewise, income level was also cited as a factor that influenced unmet healthcare needs in Korea and other countries with universal health coverage [ 36 ]. Another factor that correlated with unmet healthcare needs in the analysis was educational level. However, previous results on this topic have been mixed, as some report no significant association on this subject while others conclude a link between higher educational level and unmet healthcare need [ 8 , 37 ]. In contrast, a study on older Korean adults revealed that lower educational attainment shows an association with unmet healthcare needs [ 38 ]. The findings together suggest the importance of considering patient satisfaction in access to local healthcare services when addressing unmet healthcare needs, which can lead to worse health outcomes and associated disease burdens. Primary care should be strengthened to satisfactorily meet the needs of individuals with diabetes as high-quality care for diabetes can be achieved in the primary care setting [ 39 ]. At the same time, patient centered care should also be stressed as it can be effective in the management and self-care of individuals with diabetes [ 40 ]. A particular emphasis should also be made on addressing patient satisfaction in rural areas because regions have predisposing features, such as the level of deprivation or the number of healthcare institutions and physicians, which are related to accessibility and unmet healthcare needs [ 41 ]. This study had some limitations. First, this was a cross-section study. Hence causality cannot be inferred. Second, the reasons behind the study participants’ satisfaction with local medical services could not be investigated due to data limitations. Moreover, we could not measure the type, duration, or severity of diabetes. Third, unmet healthcare needs were measured based on self-reports and this could have led to recall bias. However, previous studies reported that this method was appropriate to measure unmet healthcare needs in population-based national surveys [ 4 ]. Fourth, although this study was adjusted for various demographic, socioeconomic, and health-related covariates, the possibility of residual confounding cannot be completely ruled out. Last, the categorical age variable exhibited relatively higher VIF values. To address this issue, we first assessed multicollinearity by re-estimating the model with age specified as a continuous covariate, which yielded tolerance and VIF values within acceptable ranges. We additionally evaluated alternative age-grouping definitions to minimize tolerance limits and VIF values and age categorization was selected based on this assessment. Accordingly, age was retained as a covariate in the final model. Despite these limitations, this study is significant as it is the first to investigate the relationship between unmet healthcare needs and satisfaction with local medical services in patients with diabetes, using reliable nationwide data from Korea. Conclusions In conclusion, unmet healthcare needs were associated with patient satisfaction with local medical services for diabetes. The findings offer health policy implications by stressing the importance of patient satisfaction with local medical services in addressing unmet healthcare needs in patients with diabetes who require regular care in an accessible setting for adequate disease management. Strengthening primary care and stressing patient satisfaction may be important in reducing unmet healthcare needs by supporting access to local medical services. Reinforcing responsiveness to local healthcare institutions may be especially relevant in rural areas where accessibility to different services may be comparatively limited. Supplementary Information Below is the link to the electronic supplementary material. Supplementary Material 1 (20.9KB, docx) Acknowledgements None. Abbreviations BMI Body Mass Index KCHS Korea Community Health Survey KDCA Korea Disease Control and Prevention Agency PHQ-9 Patient Health Questionnaire-9 VIF Variance Inflation Factor Author contributions WK, SYL, and YJJ contributed to the concept of the study. SYL and YJJ contributed to the acquisition and analysis of data. WK, and KC drafted the work. All authors revised the final draft and approved the submitted version of the manuscript. Funding This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (Ministry of Science and ICT) (No. RS-2022-NR072242). These funding sources had no involvement in the study design, data analysis and interpretation, writing of the manuscript, or decision to submit the manuscript for publication. Data availability The dataset is available on the Korea Community Health Survey website ( https://chs.kdca.go.kr/chs/rdr/rdrInfoDownMain.do ). Please note that access to these government-hosted repositories may require a Korean network environment due to server-side security configurations managed by the respective Korean government agencies. Declarations Ethics approval and consent to participate This study used data from the Korea Community Health Survey (KCHS), which are openly published and fully anonymized prior to release. According to Article 2.2 of the Enforcement Rule of the Bioethics and Safety Act in Korea, the use of these data is exempt from institutional review board (IRB) review. This exemption was confirmed by the IRB of the Korea Disease Control and Prevention Agency (KDCA), and the requirement for informed consent was waived. All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974;9(3):208–20. [ PMC free article ] [ PubMed ] [ Google Scholar ] 2. Pappa E, Kontodimopoulos N, Papadopoulos A, Tountas Y, Niakas D. Investigating unmet health needs in primary health care services in a representative sample of the Greek population. Int J Environ Res Public Health. 2013;10(5):2017–27. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 3. Carr W, Wolfe S. Unmet needs as sociomedical indicators. Int J Health Serv. 1976;6(3):417–30. [ DOI ] [ PubMed ] [ Google Scholar ] 4. Allin S, Grignon M, Le Grand J. Subjective unmet need and utilization of health care services in Canada: what are the equity implications? Soc Sci Med. 2010;70(3):465–72. [ DOI ] [ PubMed ] [ Google Scholar ] 5. Balsa AI, McGuire TG. Statistical discrimination in health care. J Health Econ. 2001;20(6):881–907. [ DOI ] [ PubMed ] [ Google Scholar ] 6. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38(1):21–37. [ PubMed ] [ Google Scholar ] 7. Hwang J. Understanding reasons for unmet health care needs in Korea: what are health policy implications? BMC Health Serv Res. 2018;18(1):557. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 8. Fjaer EL, Stornes P, Borisova LV, McNamara CL, Eikemo TA. Subjective perceptions of unmet need for health care in Europe among social groups: Findings from the European social survey (2014) special module on the social determinants of health. Eur J Public Health. 2017;27(suppl1):82–9. [ DOI ] [ PubMed ] [ Google Scholar ] 9. Kwon Y, Sohn M, Choi M. Unmet healthcare needs and the local extinction index: an analysis of regional disparities impacting South Korea’s older adults. Front Public Health. 2024;12:1423108. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 10. Morales J, Silva-Aravena F, Saez P. Reducing Waiting Times to Improve Patient Satisfaction: A Hybrid Strategy for Decision Support Management. Mathematics. 2024;12(23):3743. [ Google Scholar ] 11. Savoy M, Faafp, Fabc, Cpe, Cmq F, et al. The Role of Primary Care Physicians in Managing Chronic Disease. Dela J Public Health. 2017;3(1):86–93. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 12. Reynolds R, Dennis S, Hasan I, Slewa J, Chen W, Tian D, et al. A systematic review of chronic disease management interventions in primary care. BMC Fam Pract. 2018;19(1):11. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 13. Raposo JF, Shestakova MV, Lu J, Court E, Mayorov AY. Identifying the unmet needs of individuals with Type 2 diabetes: an international web-based survey. J Comp Eff Res. 2021;10(7):613–24. [ DOI ] [ PubMed ] [ Google Scholar ] 14. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res Clin Pract. 2019;157:107843. [ DOI ] [ PubMed ] [ Google Scholar ] 15. Bae JH, Han KD, Ko SH, Yang YS, Choi JH, Choi KM, et al. Diabetes Fact Sheet in Korea 2021. Diabetes Metab J. 2022;46(3):417–26. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 16. Kim Y, Kim S, Jeong S, Cho SG, Hwang SS. Poor People and Poor Health: Examining the Mediating Effect of Unmet Healthcare Needs in Korea. J Prev Med Public Health. 2019;52(1):51–9. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 17. Ratnapradipa KL, Jadhav S, Kabayundo J, Wang H, Smith LC. Factors associated with delaying medical care: cross-sectional study of Nebraska adults. BMC Health Serv Res. 2023;23(1):118. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 18. Kang YW, Ko YS, Kim YJ, Sung KM, Kim HJ, Choi HY, et al. Korea Community Health Survey Data Profiles. Osong Public Health Res Perspect. 2015;6(3):211–7. [ DOI ] [ PMC free article ] [ PubMed ] 19. Haam JH, Kim BT, Kim EM, Kwon H, Kang JH, Park JH, et al. Diagnosis of Obesity: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity. J Obes Metab Syndr. 2023;32(2):121–9. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 20. Community health survey. main results by region: obesity: korea disease control and prevention agency, Available from: https://chs.kdca.go.kr/chs/recsRoom/ctprvnResultMain.do . 21. Levis B, Benedetti A, Thombs BD, Collaboration DESD. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 22. Bull C. Patient satisfaction and patient experience are not interchangeable concepts. Int J Qual Health Care. 2021;33(1). [ DOI ] [ PubMed ] 23. Metiso NF, Mboweni SH. Barriers and Enablers of Health Services Utilisation in Rural Communities of Nkomazi Sub-District in Mpumalanga Province, South Africa: A Quantitative Community Survey. Health Serv Insights. 2025;18:11786329251356931. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 24. Vahedi S, Torabipour A, Takian A, Mohammadpur S, Olyaeemanesh A, Kiani MM, et al. Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study. BMC Public Health. 2021;21(1):457. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 25. Gieroba B, Kryska A, Sroka-Bartnicka A. Type 2 diabetes mellitus – conventional therapies and future perspectives in innovative treatment. Biochem Biophys Rep. 2025;42:102037. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 26. Kieu TTM, Trinh HN, Pham HTK, Nguyen TB, Ng JYS. Direct non-medical and indirect costs of diabetes and its associated complications in Vietnam: an estimation using national health insurance claims from a cross-sectional survey. BMJ Open. 2020;10(3):e032303. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 27. Kim JY, Yang Y. Factors affecting unmet medical needs of patients with diabetes: A population-based study. Nurs Open. 2023;10(10):6845–55. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 28. Woo S, Moon H, Lee Y, Kim S. The Association between the Subjective Perception of the Regional Healthcare Environment and Unmet Medical Needs. Korea J Hosp Manage. 2023;28(4):62–72. [ Google Scholar ] 29. Zhou WJ, Wan QQ, Liu CY, Feng XL, Shang SM. Determinants of patient loyalty to healthcare providers: An integrative review. Int J Qual Health Care. 2017;29(4):442–9. [ DOI ] [ PubMed ] [ Google Scholar ] 30. Lloyd R, Munro J, Evans K, Gaskin-Williams A, Hui A, Pearson M, et al. Health service improvement using positive patient feedback: Systematic scoping review. PLoS ONE. 2023;18(10):e0275045. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 31. Lyu H, Wick EC, Housman M, Freischlag JA, Makary MA. Patient satisfaction as a possible indicator of quality surgical care. JAMA Surg. 2013;148(4):362–7. [ DOI ] [ PubMed ] [ Google Scholar ] 32. Newnham H, Barker A, Ritchie E, Hitchcock K, Gibbs H, Holton S. Discharge communication practices and healthcare provider and patient preferences, satisfaction and comprehension: A systematic review. Int J Qual Health Care. 2017;29(6):752–68. [ DOI ] [ PubMed ] [ Google Scholar ] 33. Chambers-Richards T, Chireh B, D’Arcy C. Unmet health care needs: factors predicting satisfaction with health care services among community-dwelling Canadians living with neurological conditions. BMC Health Serv Res. 2022;22(1):1256. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 34. Alkhawaldeh A, Rayan MAL, Abdalrahim A, Musa A, Eshah A. Application and Use of Andersen’s Behavioral Model as Theoretical Framework: A Systematic Literature Review from 2012–2021. Iran J Public Health. 2023;52(7):1346–54. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 35. Jang H, Han M, Park J. Factors Related to Unmet Medical Care Needs in Adult Diabetes Patients in Korea. Health Policy Manage. 2021;31(3):328–34. [ Google Scholar ] 36. Lee SE, Yeon M, Kim CW, Yoon TH. The Association Among Individual and Contextual Factors and Unmet Healthcare Needs in South Korea: A Multilevel Study Using National Data. J Prev Med Public Health. 2016;49(5):308–22. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 37. Sibley LM, Glazier RH. Reasons for self-reported unmet healthcare needs in Canada: a population-based provincial comparison. Healthc Policy. 2009;5(1):87–101. [ PMC free article ] [ PubMed ] [ Google Scholar ] 38. Eo Y-S, Um J. Unmet healthcare needs among older people in South Korea. Int J Healthc Manag. 2024:1–10. 39. Seidu S, Cos X, Brunton S, Harris SB, Jansson SPO, Mata-Cases M, et al. 2022 update to the position statement by Primary Care Diabetes Europe: a disease state approach to the pharmacological management of type 2 diabetes in primary care. Prim Care Diabetes. 2022;16(2):223–44. [ DOI ] [ PubMed ] [ Google Scholar ] 40. Asmat K, Dhamani K, Gul R, Froelicher ES. The effectiveness of patient-centered care vs. usual care in type 2 diabetes self-management: A systematic review and meta-analysis. Front Public Health. 2022;10:994766. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 41. Lee S, Yeon M, Kim C-W, Yoon T-H. The Association Among Individual and Contextual Factors and Unmet Healthcare Needs in South Korea: A Multilevel Study Using National Data. J Prev Med Public Health. 2016;49:308–22. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Supplementary Materials Supplementary Material 1 (20.9KB, docx) Data Availability Statement The dataset is available on the Korea Community Health Survey website ( https://chs.kdca.go.kr/chs/rdr/rdrInfoDownMain.do ). Please note that access to these government-hosted repositories may require a Korean network environment due to server-side security configurations managed by the respective Korean government agencies. Articles from BMC Health Services Research are provided here courtesy of BMC ACTIONS View on publisher site PDF (1.1 MB) Cite Collections Permalink PERMALINK Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM Add to Collections Create a new collection Add to an existing collection Name your collection * Choose a collection Unable to load your collection due to an error Please try again Add Cancel Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top