Gendered experiences of cause-specific unmet medical need: An intersectional analysis using MAIHDA

Unmet medical needs (UMN) persist even under universal health coverage and remain unequally distributed across social groups. Although gender differences in UMN are well documented, less is known about how gender intersects with family and work roles to shape healthcare access. We analyzed data from 230,925 adults aged ≥19 years in the 2024 Korea Community Health Survey. Outcomes were overall, time-related, and cost-related UMN. Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) was applied using 144 intersectional strata defined by sex, household composition, employment status, age, and household income. We estimated variance partition coefficients, proportional change in variance, and area under the curve, along with main effects and intersectional interaction effects for each outcome. Intersectional strata explained 18.6% of variation in time-related UMN and 27.3% in cost-related UMN, compared with 4.8% in overall UMN. Time-related UMN was concentrated among younger and middle-aged employed adults, but younger non-employed females living with children also had high risks and the largest intersectional interaction effects (ORs 1.59-2.10). Cost-related UMN was concentrated among middle-aged, low-income, non-employed adults living alone. However, non-employed middle-aged males living alone showed the strongest intersectional interaction effect even in the highest-income group (OR 2.60). These patterns suggest that time- and cost-related UMN arise through different gendered work-family configurations that additive approaches may obscure, particularly among younger females living with children and non-employed middle-aged males living alone. Achieving equitable healthcare access may therefore require attention to the gendered organization of work, care, and household responsibilities.