Measurement of self-reported forgone health care and its reasons: towards tackling unmet health care need

Access to needed health services remains a central challenge for achieving universal health coverage, with unmet health care need reflecting gaps in service delivery, equity and health system performance. This working paper examines the measurement of self-reported forgone health care and its underlying reasons, contributing to WHO’s efforts to standardize approaches to measuring unmet health care need, in response to World Health Assembly resolution WHA76.4 and within the framework of the Fourteenth General Programme of Work (2025–2028).

The document reviews conceptual definitions and existing measurement frameworks, and analyses survey questions used to capture self-reported forgone care across multiple countries and data sources. It explores variations in question wording, response categories and disaggregation approaches, and assesses their implications for comparability and interpretation. The paper also examines the range of barriers influencing forgone care, drawing on the Tanahashi framework to categorize factors related to availability, accessibility, acceptability and effective coverage. A proposed survey module and question set are presented for further testing and refinement. The report highlights methodological and analytical challenges, identifies research gaps and outlines priorities for future work. Intended for policymakers, researchers and technical experts, it supports the development of standardized, evidence-informed approaches to strengthen universal health coverage monitoring and equity analysis.