Access denied: financial, structural, and personal barriers to health service use in a universal health system

Despite Australia's universal health coverage framework, a substantial proportion of Australians, particularly those from marginalised populations, continue to report unmet healthcare needs. Barriers to accessing care are complex and multifactorial, particularly for marginalised groups. This study aimed to identify the prevalence and reasons for not accessing health services in Australia despite perceiving a need to do so, and to explore variations by service type and demographic characteristics.

A secondary analysis was conducted using data from a cross-sectional survey on healthcare experiences. Participants (N = 636) were recruited via social media and an online panel. Respondents were asked whether they had foregone needed health care in the past 12 months and to indicate the types of services and reasons. Descriptive statistics and chi-squared tests were used to examine associations between reported barriers and participant characteristics.

Over one-third (38.5%) of participants reported an unmet healthcare need in the past year. Cost was the most commonly cited barrier (54.9%), followed by the belief the issue would resolve itself (44.7%), time constraints (32.8%), and appointment difficulties (25.3%). Significant gender differences emerged, with women more likely to cite cost (P = 0.031). LGBTIQA+ participants were more likely to report fear of the outcome (P = 0.046) and concerns about privacy (P = 0.013). No significant differences were observed by Indigenous status or country of birth.

Unmet healthcare needs remain prevalent in Australia, driven by financial, structural, and personal barriers. The findings underscore the importance of targeted reforms to address cost and capacity issues, and suggest a continued need to improve culturally safe, accessible care - particularly for marginalised populations, though further targeted research is needed to fully capture these groups' experiences.