Quantifying unmet need for health and social care among older persons and understanding its policy drivers in the Western Pacific Region

The COVID-19 pandemic raised awareness of unmet health care needs, leading the 2023 World Health Assembly to consider including unmet health care needs as a universal health coverage indicator. However, unmet social care needs among older adults, which affect independence and health outcomes, are largely overlooked. 

Previous WKC research identified at least 15 countries in WHO’s Western Pacific Region which have data on unmet health and social care needs, allowing exploration to better understand the impact of unmet care needs policies, especially on older persons. This project examines data-policy links in Cambodia, China, and Viet Nam.

To estimate unmet health and social care needs from 2005 to 2023 and identify health and social care policies from 2000 to 2020 that may impact on unmet needs of older persons in Cambodia, China and Viet Nam.

• Use quantitative methods to describe levels and changes in unmet health and social care needs of older persons during 2005 – 2023 in each country using WHO and non-WHO surveys. 
• Undertake a desk review focusing on major policy, health system and socioeconomic changes in the past 10-20 years in the three countries. 
• Map these major policies with unmet health and social care needs over time to examine policy levers for addressing needs or to identify policies/programmes that may contribute to unmet need.
• Conduct key informant interviews with experts, WHO technical units in the selected countries, and the WHO Regional Office to leverage local knowledge about policies and context.

• Several population-based surveys exist in China, Cambodia, and Viet Nam, which can be used to estimate unmet health and social care needs in general and specifically for older populations in these countries, though there is less data on social care gaps. 
• Levels of unmet social care need generally exceeded forgone health care. Key informant interviews suggest self-reported survey data likely underestimate true levels.
• Accessibility barriers, such as financial and informational barriers, were key obstacles to health care. For social care, strong cultural and legal norms that assign primary responsibility for caregiving to families hinder the development of formal policies and systems for providing care. Changing social dynamics also make it difficult for some family members to provide care, contributing to unmet need.
• Policies and laws which may have influenced unmet health and social care needs especially of older people include Cambodia’s National Ageing Policy (2017–2023) and Social Protection Framework (2016); China’s 2009 health care reforms; and Viet Nam’s Health Insurance Law, Law on Older Persons (2009/2010), and National Programme on Older Persons (2012-2020). Key informants noted uneven implementation and impact of these policies at the subnational level.

Cambodia, China, and Vietnam’s population growth and ageing, coupled with the health transition across much of the WHO Western Pacific Region, will sharply increase demand for health and social care. Policy data, expert insights, and survey-based estimates from this study suggest current assessments underestimate these needs. Without system reforms, more older adults will face declining health and well-being due to unmet care needs, with major implications for health planning and for social care structures.

Journal articles and other publications from this project are expected in (or after) 2026.