{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:59:47Z","timestamp":1792004387178,"version":"4.4.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Unmet healthcare needs indicate gaps between healthcare services considered necessary and those actually received, reflecting the accessibility of the health system. This study aimed to examine the frequency of unmet healthcare needs and identify Andersen model predictors of unmet needs due to financial and other objective reasons among older adults in Serbia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This cross-sectional study used data from the 2019 Serbian National Health Survey, conducted from October to December 2019 by the Institute of Public Health of Serbia \u201cDr Milan Jovanovi\u0107 Batut\u201d and the Ministry of Health. The analysis included a representative sample of respondents aged 65\u202fyears and older.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1,116 older adults with unmet healthcare needs, 40.5% reported financial reasons, while 59.5% reported other objective reasons. Most respondents had chronic health conditions, and 39.0% of them reported financial barriers to necessary healthcare (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f5.39, df\u202f=\u202f1,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). Respondents with poor self-rated health were more likely to report financial barriers than those with good self-rated health (OR\u202f=\u202f1.492). Financial barriers were also more frequently reported by respondents who had visited their chosen physician (OR\u202f=\u202f1.863), used emergency services (OR\u202f=\u202f1.869), or used private healthcare services (OR\u202f=\u202f2.069).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Financial constraints represent an important barrier to healthcare access among older adults in Serbia. Designing more accessible healthcare models requires a transparent and comprehensive analysis of the economic position of older people and its impact on obtaining necessary healthcare services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1912324","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T04:26:38Z","timestamp":1788236798000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Healthcare accessibility and financial risks for unmet health needs of the older adult population in the republic of Serbia"],"prefix":"10.3389","volume":"14","author":[{"given":"Nikola","family":"Savi\u0107","sequence":"first","affiliation":[{"name":"Singidunum University","place":["Belgrade, Serbia"]},{"name":"Institute of Public Health of Serbia \u201cDr Milan Jovanovi\u0107 Batut\u201d","place":["Belgrade, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Slobodanka","family":"Bogdanovi\u0107 Vasi\u0107","sequence":"additional","affiliation":[{"name":"University of Bijeljina, Faculty of Health Studies","place":["Bijeljina, Bosnia and Herzegovina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branimirka","family":"Aran\u0111elovi\u0107","sequence":"additional","affiliation":[{"name":"University of Novi Sad, Faculty of Medicine, Department of Nursing","place":["Novi Sad, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Pavi\u0107","sequence":"additional","affiliation":[{"name":"Academy of Vocational Studies \u0160abac","place":["\u0160abac, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanja","family":"Koci\u0107","sequence":"additional","affiliation":[{"name":"University of Kragujevac, Faculty of Medical Sciences","place":["Kragujevac, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Arnaut","sequence":"additional","affiliation":[{"name":"University of Kragujevac, Faculty of Medical Sciences","place":["Kragujevac, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milena","family":"Zlatanovi\u0107","sequence":"additional","affiliation":[{"name":"Academy of Vocational Studies \u0106uprija","place":["\u0106uprija, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelena","family":"Stoj\u010devi\u0107-Maleti\u0107","sequence":"additional","affiliation":[{"name":"University of Novi Sad, Faculty of Medicine, Department of Biochemistry","place":["Novi Sad, Serbia"]},{"name":"University Clinical Center of Vojvodina, Center for Laboratory Diagnostics and Nuclear Medicine","place":["Novi Sad, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svetlana","family":"Risti\u0107","sequence":"additional","affiliation":[{"name":"Institute of Oncology and Radiology of Serbia","place":["Belgrade, Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"ref1","volume-title":"Municipalities and Regions of the Republic of Serbia, 2023","author":"Gavrilovi\u0107","year":"2023"},{"key":"ref2","volume-title":"Old-Age Dependency Ratio in Europe by Country","year":""},{"key":"ref3","doi-asserted-by":"publisher","first-page":"115660","DOI":"10.1016\/j.socscimed.2023.115660","article-title":"Health for all? Pasts, presents and futures of aspirations for universal healthcare","volume":"319","author":"Kehr","year":"2023","journal-title":"Soc Sci Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"114838","DOI":"10.1016\/j.socscimed.2022.114838","article-title":"Health systems performance or performing health systems? Anthropological engagement with health systems research","volume":"300","author":"Kielmann","year":"2022","journal-title":"Soc Sci Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"50","DOI":"10.3389\/fphar.2017.00050","article-title":"Satisfaction with health services among the citizens of Serbia","volume":"8","author":"Mihailovic","year":"2017","journal-title":"Front Pharmacol"},{"key":"ref6","volume-title":"Izmene i Dopune: Slu\u017ebeni Glasnik RS","year":"2019"},{"key":"ref7","volume-title":"Families\u2019 Use of Health Services: A Behavioral Model of Predisposing, Enabling, and Need Components","author":"Andersen","year":"1968"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1016\/j.mpsur.2020.07.010","article-title":"Evaluating quality in clinical care","volume":"38","author":"Singh","year":"2020","journal-title":"Surgery (Oxford)"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.1111\/1475-6773.13883","article-title":"How can we make valid and useful comparisons of different health care systems?","volume":"56","author":"Street","year":"2021","journal-title":"Health Serv Res"},{"key":"ref10","volume-title":"European Health Interview Survey (EHIS Wave 2): Methodological Manual","year":"2013"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.jagp.2023.10.012","article-title":"Is behavioral activation higher ground for the silver tsunami?","volume":"32","author":"Jimenez","year":"2024","journal-title":"Am J Geriatr Psychiatry"},{"key":"ref12","volume-title":"Life Expectancy at Birth in Serbia","year":""},{"key":"ref13","volume-title":"GDP (Current US$) \u2013 Serbia","year":""},{"key":"ref14","volume-title":"Current Health Expenditure (% of GDP) \u2013 Serbia","year":""},{"key":"ref15","volume-title":"Current Health Expenditure Per Capita, PPP (Current International $)","year":""},{"key":"ref16","volume-title":"Standardi u javnom zdravstvu i EU \u2013 Poglavlje 28","author":"Vukovic","year":"2020"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"537","DOI":"10.11124\/JBIES-20-00413","article-title":"Out-of-pocket expenses related to aging in place for frail older people: a scoping review","volume":"20","author":"Moody","year":"2022","journal-title":"JBI Evid Synth"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.2147\/CIA.S396833","article-title":"Aging stigma and the health of US adults over 65: what do we know?","volume":"18","author":"Allen","year":"2023","journal-title":"Clin Interv Aging"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"104814","DOI":"10.1016\/j.healthpol.2023.104814","article-title":"A comparative overview of health and social care policy for older people in England and Scotland, United Kingdom (UK)","volume":"132","author":"Aujla","year":"2023","journal-title":"Health Policy"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity","volume":"8","author":"Skou","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"ref21","volume-title":"Healthcare Personnel Statistics \u2013 Physicians","year":""},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e1872","DOI":"10.1002\/mpr.1872","article-title":"Unmet needs of the oldest old primary care patients with common somatic and psychiatric disorders\u2014a psychometric evaluation","volume":"30","author":"Stein","year":"2021","journal-title":"Int J Methods Psychiatr Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s13561-022-00398-4","article-title":"A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people","volume":"12","author":"Rahman","year":"2022","journal-title":"Health Econ Rev"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.2147\/RMHP.S271289","article-title":"The effect of population aging on healthcare expenditure from a healthcare demand perspective among different age groups: evidence from Beijing City in the people\u2019s republic of China","volume":"13","author":"Li","year":"2020","journal-title":"Risk Manag Healthc Policy"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17082711","article-title":"Unmet healthcare needs and healthcare access gaps among uninsured U.S. adults aged 50\u201364","volume":"17","author":"Choi","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"209","DOI":"10.24171\/j.phrp.2020.11.4.10","article-title":"Predictors affecting the elderly\u2019s use of emergency medical services","volume":"11","author":"Park","year":"2021","journal-title":"Osong Public Health Res Perspect"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2304","DOI":"10.3390\/ijerph18052304","article-title":"Health investment management and healthcare quality in the public system: a gender perspective","volume":"18","author":"Valls Mart\u00ednez","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"3318","DOI":"10.3390\/ijerph16183318","article-title":"Patient satisfaction with health care services: an application of physician\u2019s behavior as a moderator","volume":"16","author":"Manzoor","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref29","volume-title":"Global Expenditure on Health: Public Spending on the Rise?","year":"2021"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.3390\/healthcare10071229","article-title":"Analysis of patient satisfaction through the effect of healthcare spending on waiting times for consultations and operations","volume":"10","author":"Santos-Ja\u00e9n","year":"2022","journal-title":"Healthcare"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"193","DOI":"10.24083\/apjhm.v16i3.295","article-title":"Dissatisfaction factors that influence customers to give low online rating to hospitals","volume":"16","author":"Raza","year":"2021","journal-title":"Asia Pac J Health Manag"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1912324\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:14:45Z","timestamp":1788369285000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1912324\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":31,"alternative-id":["10.3389\/fpubh.2026.1912324"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1912324","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]},"article-number":"1912324"}}