Unmet healthcare needs among adults with disabilities in South Korea: a nationally representative analysis using the behavioral model

BACKGROUND: Unmet healthcare needs are a critical indicator of health inequities. Despite near-universal health insurance coverage in South Korea, people with disabilities experience substantial barriers to healthcare access. This study identified factors associated with unmet healthcare needs among people with disabilities in South Korea. METHODS: This cross-sectional study used data from the 2023 Korea National Survey of People with Disabilities (KNSPD 2023), a nationally representative survey. The survey employed two-stage stratified cluster sampling, yielding an analytic sample of 6,772 adults with registered disabilities (weighted N = 2,630,374). Applying Andersen's Behavioral Model, complex-sample logistic regression examined predisposing, enabling, and vulnerability factors associated with unmet healthcare needs in the past 12 months. RESULTS: Overall, 17.3% of people with disabilities reported unmet healthcare needs. Transportation difficulties (36.5%) and financial cost (27.8%) accounted for nearly two-thirds of reported barriers. Among enabling factors, lack of health insurance emerged as the strongest predictor of unmet healthcare needs. Physical disability and poor self-rated health were also associated with substantially increased odds of unmet healthcare needs. Individuals with severe disabilities had lower odds of unmet healthcare needs than those with mild disabilities, suggesting potential gaps in support for people with less severe functional limitations. Women with physical disabilities showed particularly elevated odds of unmet healthcare needs. CONCLUSIONS: Despite universal insurance coverage, substantial unmet healthcare needs persist among people with disabilities in South Korea, driven primarily by transportation and financial barriers. Policy priorities should include expanding paratransit services, reducing out-of-pocket costs, targeting insurance enrollment assistance to the uninsured, addressing service gaps for mild disabilities, and implementing sex-specific interventions for women's compounded barriers. Healthcare access equity requires moving beyond coverage expansion to address structural accessibility barriers.