Abstract
AIM: Need-based access to health care and social welfare services is an element of health promotion, and it endorses equity and the principles of universalism in society. To explore access to services, this study analyses unmet need for services, barriers that impede access and whether individual characteristics are associated with service access. The study period coincided with the COVID-19-pandemic and health and social services reform in Finland. METHOD: The prevalence of subjective unmet need was used as an indicator of service access. Inconvenient opening hours, a difficult journey to the service unit and high user fees were barriers to receiving services. A nationally representative FinSote survey 2018 and 2020 was used in the analyses. Data were examined with multivariate logistic regression models using SPSS. RESULTS: A high prevalence of unmet need for health care and especially for social welfare services was observed. The prevalence of unmet need increased from 2018 to 2020, but in health care only, and access to social welfare services deteriorated. In particular, women, younger people, those who need income support and those with poor health or quality of life forgo care. CONCLUSIONS: A considerable share of the Finnish population do not receive essential services according to need and face barriers in accessing services. Individual characteristics are associated with perceived unmet need and access barriers despite the ethos of equal opportunities. COVID-19 measures are likely to have worsened the situation. Actions to improve access must urgently be implemented to achieve the policy goals of health promotion, equity in health and universalism.