The Influence of Perceptions of Regional Transportation and Healthcare Environments on Unmet Healthcare Needs: A Multi-Level Analysis by Fiscal Independence Levels

Abstract

The purpose of this study is to determine the effect of regional environmental perceptions (specifically, satisfaction with transportation and healthcare environments) on an individual's experience with unmet healthcare needs, and to examine whether healthcare accessibility, measured by distance, moderates this effect based on the level of local financial independence. We used data from the Korea Community Health Survey and National Geographic Indicators for our analysis, which involved a multi-level logistic regression of 225,501 adults aged 19 and older residing in 249 si-gun-gu districts. The analysis revealed that positive perception of the local transportation and healthcare environment significantly reduced the probability of experiencing unmet healthcare needs, compared to a negative perception. In addition, subgroup analysis based on financial independence levels found that the probability of experiencing unmet healthcare was significantly lower in all subgroups where participants had a positive perception of the local transportation and healthcare environments. Interaction analysis showed no significant interactions in regions with low fiscal independence. However, in regions with medium fiscal independence, a significant interaction was found between general hospital accessibility and perceptions of the transportation environment. In regions with high fiscal independence, a significant interaction was observed between general hospital accessibility and perceptions of the healthcare environment. This study contributes to the existing literature by empirically analyzing the effects of perceived environments, which have been relatively less discussed compared to objective environments, on unmet healthcare needs on a national scale.