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Abstract
Objectives South Korea grapples with a disproportionately high incidence of unmet medical needs, a concern that is particularly acute among police officers, who are exposed to significant occupational risks. Given the pivotal role of police officers in upholding democratic values and public safety, their well-being holds critical societal implications. This study aims to determine the incidence of unmet medical needs among police officers and identify the influencing factors.
Design This is a retrospective and cross-sectional study. Applying the Andersen behavioural model and multiple logistic regression analysis, we explored factors impacting unmet medical needs.
Setting The study took place in South Korea and involved its total force of police officers.
Participants Our analysis encompassed data from 6591 participants, representing 5.2% of South Korea’s total police officers.
Outcome measures Unmet medical needs.
Results Our findings revealed several influencing factors. First, predisposing factors included sex, with women experiencing a higher incidence of unmet medical needs. Second, enabling factors highlighted the significance of job positions and reduced annual leave guarantees in influencing unmet medical needs. Finally, need factors demonstrated the substantial impact of chronic diseases, heightened levels of depression, reduced subjective health assessments, increased stress levels and exposure to rough physical activity on driving unmet medical needs.
Conclusions To mitigate and pre-empt the long-term health repercussions associated with unmet medical needs, intervention strategies should prioritise these identified factors. An integrated healthcare programme emerges as a critical necessity for addressing the healthcare challenges faced by police officers.
- risk factors
- health services accessibility
- behavior
Data availability statement
Data are available on reasonable request. The data supporting the findings of this study are available from the Korean National Police Agency; however, restrictions apply to the availability of these data and they are not publicly available.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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STRENGTHS AND LIMITATIONS OF THIS STUDY
This study examined the unmet medical needs (UMNs) of a relatively large group of police officers and identified diverse influencing factors.
This is a retrospective and cross-sectional study, and data were collected online from research participants on the internal internet network of the police officers.
The Andersen behavioural model was employed as the research model, and the model explains the utilisation of medical services by categorising them into predisposing, enabling and need factors.
It was established that all need factors had a significant influence on UMN, which directly impacts medical service utilisation.
Owing to the constraints of cross-sectional research, the possibility of reverse causation cannot be ruled out, and the detailed professional characteristics of police officers were not considered.
Background
Unmet medical needs (UMNs) serve as indicators of problems related to healthcare service utilisation,1 indicating a lack of access to medical services despite the need for medical treatment and healthcare.2 The persistent incidence of UMN exacerbates diseases, leading to increased disease severity and a decline in the health status of specific groups experiencing these needs.3 From a public health perspective, it is essential to address this issue as it can adversely affect healthcare equity.
According to Statistics South Korea, the incidence of UMN has been showing a decreasing trend from 2016 (9.3%) to 2021 (6.7%) compared with the total population in South Korea.4 Nevertheless, compared with the Organization for Economic Cooperation and Development (OECD) 2016 incidence of UMN rate of 2.5%, it is still reported to be high relative to the overall population.5 Examining the domestic welfare system related to health, various regular health services are provided to the general population by the National Health Insurance Corporation to prevent and early detect diseases.6 Nonetheless, the need for research is emphasised by the high UMN. In addition, it varies significantly based on occupational characteristics, with a notable prevalence in occupational groups characterised by shift work, extended working hours and high levels of stress.7 8 This study focuses on police officers with various types of job duties. It was conducted on all police officers without group-specific restrictions. There are several ways to become a police officer. Typically, the two things that make up the largest percentage are as follows.9 First, individuals are selected as police officers through an open examination. Second, becoming a police officer requires 4 years of study at the National Police University. The first accounts for the largest proportion and the second corresponds to a considerably small number of people. Compared with other occupations, police officers are exposed to multiple risks owing to demanding physical activity, shift work and diverse job tasks.10 11 Several other work-related risk factors have also been identified, including accident hazards such as car accidents, fractures and musculoskeletal disorders. Additionally, chemical hazards involving excessive exposure to substances like carbon monoxide and 2-chloroacetophenone, as well as psychological hazards like witnessing emotional trauma and traumatic events, contribute to the unique risks faced by police officers. Consequently, police officers are reported to have a shorter lifespan compared with the general population.12 Given their crucial role in upholding law and order in a democratic society, the health of police officers has far-reaching effects, impacting not only their well-being but also that of their communities. Thus, addressing their healthcare needs is a social problem that cannot be overlooked. It is crucial to identify, prevent and manage the healthcare needs of police officers.
UMN can affect a wide range of individuals, and the factors contributing to these needs vary considerably. Previous studies have shown that factors such as sex, age, educational level, income, presence of chronic diseases, subjective health status, stress levels, working hours and autonomy during vacation time are closely associated with UMN.7 10 11 13–16 Specifically, among police officers, research has indicated that as individuals grow older, they tend to have more chronic diseases, lower subjective health ratings, higher levels of depression, increased obesity and a greater likelihood of seeking health services.7 10 11 Notably, in a study examining risk factors related to the occupational characteristics of police officers, working environment and job status were identified as primary risk factors.13
In studies involving the general population, women were found to have an increased incidence of UMN if they were unemployed or in poor health, while workers in higher-income groups reported a higher incidence of UMN than low-income individuals, often due to difficulties accessing medical centres when needed.8 14 An association between long working hours and the incidence of UMN was also identified, with those working more than 52 hours per week being 1.58 times more likely to experience UMN than those working 30–51 hours per week.15 Additionally, individuals working in shifts had a higher demand for healthcare but were less likely to use it.16
To date, some studies have explored various factors affecting the health of police officers. However, most studies have been limited to identifying a list of factors that affect health. Specifically, the literature is scarce on studies on the incidence of unmet medical care among police officers. Most studies of UMN have been conducted in the general population, with a few studies focusing on various types of occupations, such as firefighters and military personnel.17 18 Consequently, it has been challenging to generalise the findings to the population of police officers. In this study, we applied the Andersen behavioural model to determine the level of UMN of police officers and systematically identify the factors that influence the incidence of UMN. Through this study, we aim to provide fundamental data for the development of an integrated health management programme aimed at preventing and addressing the UMN of police officers.
Study methods
Study design and participants
This retrospective and cross-sectional study aimed to analyse the levels of UMN and related factors among police officers. Data were collected online from 6 October 2921 to 7 November 2021, from research participants who met the selection criteria. The participants were recruited through a pop-up recruitment notice on the internal internet network of the police officers and were sent an online survey if they expressed a voluntary interest in participating. To participate in the research, individuals had to provide their consent after reviewing a research explanation that included relevant details such as research methods, procedures and risks. This explanation was placed on the first page of the questionnaire, and only participants who selected ‘consent’ online were allowed to proceed with the survey. Since the participants are Korean, a questionnaire was composed in Korean to determine the accuracy of the responses, and detailed explanations were written for each question.
For this study, individuals aged 21 years and above who were employed as police officers were considered eligible participants. As of 2021, the total number of police officials working in target locations, such as the National Police Agency, local police offices, police stations and city/provincial offices, was 126 746; the goal was to conduct a comprehensive survey. The survey was conducted online over a period of 31 days, from 6 October 2021 to 7 November 2021, resulting in 6616 responses, approximately 5.2% of the total police officer population. 25 responses were excluded as follows: four cases, including only one person response from a subject who filled out the questionnaire in duplicate; 21 participants because they did not respond to the key variable UMN. Finally, 6591 data points were used for the study (figure 1).
The study participants.
Conceptual model and variables
Conceptual model
The Andersen behavioural model was employed as the research model. This model has demonstrated its validity in factor classification in numerous prior studies and was deemed suitable for this research owing to its comprehensive consideration of both internal and external factors influencing an individual’s utilisation of medical services. The model explains the utilisation of medical services by categorising them into predisposing, enabling and need factors.19 Predisposing factors encompass characteristics that an individual already possesses, irrespective of their will, that existed prior to the need for medical services and include sociodemographic attributes such as age, sex and education level. Enabling factors comprise the means and capabilities that either facilitate or impede the utilisation of services and encompass variables such as income, overtime hours and job position. Need factors correspond to health-related characteristics such as an individual’s disability or illness, which necessitate the utilisation of services (figure 2).
Conceptual model.
Dependent variable
UMN means through which an individual desires to receive medical services or a medical professional’s diagnosis that necessitates medical services but has not primarily received them.8 Although no official concept of UMN exists, previous studies primarily used the medical service needs evaluated by individuals themselves to examine the fundamental problems of UMN.20 In this study, the medical service needs were evaluated based on the concept of UMN. UMN was assessed through the question, ‘In the past year, have you ever had the experience of not receiving treatment or examination at a hospital or hospital when you needed it?’ with the response options ‘yes (experience of not receiving it at least once)’ and ‘no (no experience of not receiving it)’. Instances where the response was ‘yes’ were classified as having UMN (table 1).
Variables used in the study and their coding
Independent variables
Independent variables were categorised into predisposing, enabling and need factors, following Andersen’s behavioural model. Predisposing factors included sex, age, educational level and marital status. Specifically, sex was categorised as either men or women, and age was divided into four groups: 21–30 years, 31–40 years, 41–50 years and 51–60 years. Educational attainment was categorised as high school graduate or lower, college graduate, or university or higher. Marital status was categorised as married or single (table 1). Enabling factors included income, overtime hours, job position and level of annual leave guarantee. In South Korea, the occupational environment is important for access to healthcare. In this study, we selected representative barriers to healthcare utilisation based on the occupational characteristics of police officers.21 Income was categorised as low, medium low, medium high or high in response to the question, ‘How would you describe your income subjectively?’. This is because objective indicators alone do not reflect individual life patterns and comprehensive attitudes toward life according to income levels. In particular, in the case of police officers in South Korea, there is little variation in wages within a given rank and experience level.22 Therefore, we attempted to examine the income difference in detail through subjective income evaluation. Job position was measured using the question ‘What is your current job position?’ with responses categorised as constable (grade 1), senior policeman (grade 2), assistant inspector (grade 3), inspector (grade 4) and over senior inspector (grade 5). Overtime hours were defined as work conducted outside regular working hours by the question, ‘How long do you work outside regular working hours?’. The response indicated long working hours corresponding with increased workload. The level of annual leave guarantee was assessed on a 5-point Likert scale to the question, ‘Does your job allow you to freely take annual leave?’ The higher the score, the greater the flexibility in using annual leave.
Finally, need factors included chronic diseases, depression level, experiences of rough physical activity, subjective health status and stress level. Chronic disease was defined as the use of medication for more than 6 months23 and categorised as present or absent. Depression levels were measured using the Patient Health Questionnaire-9 Scale,24 comprising physical decline (two items), depressed mood (four items) and interpersonal failure (three items). Responses ranged from 0 (extremely rare) to 3 (almost every day), with higher scores indicating a higher level of depression. The reliability of the depression level was assessed using Cronbach’s ɑ=0.88. Subjective health was rated on a 5-point Likert scale through the question, ‘How do you think about your health in general?’ Higher scores indicated more positive subjective health awareness. Stress level was measured with the question ‘How do you feel about stress in your daily life?’ using a 4-point Likert scale, where higher scores indicated lower stress levels. Rough physical activity was evaluated based on a yes or no answer to the question ‘Have you experienced rough physical activity in the past year while doing your job’. Rough physical activity used in this study means dangerous activities (eg, struggling with criminals, being hit by a car while dealing with a car accident) with the potential to cause physical trauma. In other words, it refers to a scenario that involves vulnerability to injury from risky activities.
Statistical analysis
In this study, data analysis was performed by using SAS V.9.4. The specific analysis methods employed are as follows:
Frequency analysis, t-test and one-way analysis of variance were conducted to assess the differences in sociodemographic factors and UMN among study participants.
Descriptive statistics were used to determine the means and SD of the variables.
To investigate the factors influencing UMN, multiple logistic regression was employed. This analysis provided ORs and 95% CI were calculated. The significance level for all statistical analyses was set at p<0.05.
Patient and public involvement
The number of participants in this study was 6591, which is 5.2% of the total Korean police population. In cooperation with the Korean National Police Agency (KNPA), the survey was conducted online. The online survey used KNPA’s intranet and only those who agreed to the survey after explanation of it participated.
Results
The sociodemographic characteristics of the study participants, categorised by their experience with UMN, are presented in table 2. Regarding sex, 5464 (82.9%) were identified as ‘men’ and 1127 (17.1%) were categorised as ‘women’, indicating a higher proportion of men in the study. In terms of age distribution, the largest group was ‘31–40 years old’, comprising 2038 individuals (30.9%), followed by ‘41–50 years old’, with 1682 participants (25.5%), ‘51–61 years old’, with 2020 individuals (30.6%) and ‘21–30 years old’, with 351 people (12.9%). Educational levels were distributed as follows: 4429 participants (67.2%) were ‘college graduates’, and 327 (5.0%) were ‘university graduates or higher’, indicating a significant proportion of highly educated participants. Regarding marital status, 4881 individuals (74.1%) indicated that they were ‘married’, with the majority being confirmed as married. Income levels were predominantly categorised as ‘low middle’, accounting for more than half of the participants, totalling 3593 individuals (54.5%). Job positions were distributed as follows: ‘inspector’ with 2813 participants (42.7%), ‘assistant inspector’ with 1071 participants (16.2%), ‘senior policeman’ with 1064 participants (16.1%), ‘over senior inspector’ with 843 participants (12.8%) and ‘constable’ with 800 participants (8.5%). Regarding the presence of chronic diseases, ‘none’ was the most common category with 4055 participants (61.5%). Among the study participants, 1065 individuals (16.2%) reported having experienced rough physical activity. Additionally, it was found that 16.7% of the participants had encountered UMN.
General characteristics of the participants and their unmet medical needs
The general characteristics and UMN of the study participants showed significant differences in terms of sex, age, educational level, marital status, income, job position, chronic disease and experience of rough physical activity. Regarding sex, women were found to have a higher incidence of UMN compared with men. In terms of age, individuals aged 41–50 had the highest frequency of UMN. Higher education levels were associated with a greater likelihood of experiencing UMN. Marital status revealed that ‘married’ individuals reported more experiences with UMN than ‘single’ individuals. Concerning income, those with ‘low’ income levels had the highest incidence of UMN. Job position analysis indicated that individuals in ‘constable’ positions appeared to have the lowest frequency of UMN. Regarding chronic diseases and experiences of rough physical activity, individuals responding ‘yes’ to these factors were confirmed to have a higher incidence of UMN than those responding ‘no’ (table 2).
Descriptive statistics of the continuous variables, categorised by UMN, are presented in table 3. First, it was observed that police officers put in an average of 43 more hours of overtime per month, which is notably high in comparison to general occupations.25 Additionally, concerning the availability of vacation days (level of annual leave guarantee) within the work environment, the average score was 3.6 points. Subjective health also displayed a commonality, with an average score of 3.0 points. Depression levels were relatively low, averaging 13.3 points, while stress levels were around an average of 2.4 points. Furthermore, individuals with UMN were found to work more overtime, have a lower ‘level of annual leave guarantee’, exhibit higher levels of depression, report lower levels of subjective health and experience higher stress levels.
Descriptive analysis of continuous variables by unmet medical needs
The results of the logistic regression analysis aimed at identifying factors associated with the incidence of UMN among police officers are presented in table 4. Among the predisposing factors, ‘sex and education level’ were identified as influencing factors while the enabling factors were ‘job position’ and ‘level of annual leave guarantee’. Finally, concerning the need factors, all factors such as chronic illness, depression, perceived health, stress and rough physical activity appeared to exert an influence on UMN. Additionally, women were found to be 1.48 times more likely than men (95% CI 1.217 to 1.804) to experience UMN. With each increase in education level, the probability of experiencing UMN increased by 1.21 times (95% CI 0.1.063 to 0.1.333). Similarly, as the job position level increased by one, the likelihood of UMN occurring increased by 1.24 times (95% CI 1.125 to 1.357), and an increase in the level of annual leave guarantee was associated with a decreased likelihood of UMN occurring. Finally, individuals with chronic diseases had 1.32 times the odds (95% CI 1.133 to 1.539) of experiencing UMN compared with those without chronic diseases. Those who had experienced rough physical activity were 1.635 times more likely (95% CI 1.382 to 1.936) to have UMN compared with those without such experiences. Additionally, for each level of increase in depression and stress, the probability of experiencing UMN increased by 1.06 times (95% CI 1.039 to 1.073) and 1.736 times (95% CI 1.594 to 1.891), respectively. In the case of subjective health, for each level of increase, the probability of experiencing UMN decreased by 0.80 times (95% CI 0.725 to 0.886).
Factors influencing the unmet medical needs of police officers
Discussion
This study aimed to assess the extent of UMN among South Korean police officers and identify associated factors. The findings have highlighted key factors requiring intervention to reduce UMN. The study revealed various factors influencing the incidence of UMN among police officers, with a particular emphasis on ‘need factors’, which directly impact medical service utilisation.
In this study, the UMN of police officers was 16.7%. This indicates a considerably large difference compared with the UMN incidence rate of 6.7% (2021) surveyed in the general population of South Korea.4 In South Korea, universal health coverage began in 1989, allowing all citizens to have access to necessary medical services.26 When examining the occupational environment of police officers, those who experienced UMN had a poorer occupational environment than those who did not experience UMN (table 3). In particular, among those who experienced UMN, rough physical activity was found to be the most prevalent among several factors (table 1). Thus, the occupational environment can be considered an important factor in the incidence of UMN. Therefore, regularly investigating and managing UMN among police officers is necessary.
When examining predisposing factors, it was evident that both being a woman and having attained higher education levels significantly impacted UMN among police officers. Thus, women officers and individuals with a higher level of education were more prone to experiencing UMN. These findings presented certain differences compared with previous research, particularly educational attainment.26 27 Few studies have explored UMN in police officers; thus, direct comparisons are limited. Comparing these findings with those found in the general population showed the following results. According to a study examining the UMN effect on older adults in Korea,26 it was found that UMN is frequent among those with a lower educational level. A study of the general population of Turkey reported similar findings.27 Research results on police officers and the general population differ. Therefore, it is necessary to identify the job characteristics of police work. In essence, the responsibility inherent in law enforcement places a premium on adhering to norms and discipline, distinguishing it from many other occupations. In general, higher educational attainment is associated with an increased likelihood of occupying managerial positions.28 This could potentially entail work schedules and limited flexibility when seeking medical services. Consequently, it is conceivable that access to medical care may be constrained due to the demands of adhering to predetermined work hours.
Job position and the level of annual leave guarantee emerged as significant factors that influenced enabling aspects. In other words, individuals in higher-ranking job positions and those facing constraints on taking annual leave were more likely to experience UMN. These findings align with previous studies.27 28 Achieving higher job positions often requires a longer tenure as a police officer, and this extended experience may increase the likelihood of encountering UMN. Moreover, individuals grappling with the challenges of using annual leave owing to shift work or extended overtime hours were at a higher risk of experiencing UMN compared with their counterparts with regular work hours.8
It was established that all need factors had a significant influence on UMN. In other words, when a police officer has a chronic disease, the higher the level of depression, the lower the subjective health and the higher the stress level. When experiencing rough physical activity, the likelihood of having UMN is higher. These findings align with previous studies. According to a study,29 police officers are likely to experience rough physical activity owing to the nature of their jobs, which can result in musculoskeletal disorders. Additionally, a study of police officers showed that higher stress and lower subjective health were linked to an increased likelihood of various health problems.30 According to previous studies,13 31 depression, chronic diseases, work stress and irregular working conditions have been identified as factors that tend to cause health problems among police officers. Among the factors considered, those falling under the need factors category are the most modifiable compared with others. In other words, it is necessary to recognise them as the most directly influential factors in the use of medical services and major intervention points for reducing and preventing the possibility of UMN.
To address these factors systematically, it is essential to implement screening and monitoring processes. These processes can be categorised into primary and secondary prevention, where coworkers serve as gatekeepers to identify individuals in need of observation and report them to the workplace health management team. Furthermore, it is important to develop health education and management programmes that account for these factors. For secondary prevention, a support system should be established to allow the health management team to accurately diagnose these patients and provide continuous care in collaboration with medical institutions and the local community. The current health management programme available to police officers includes special health checkups and various counselling services to improve mental health; however, these services are limited or focused on specific treatment.28 Considering this situation, rather than creating entirely new prevention methods, it would be feasible to expand the scope, scale and financial support for existing screening programmes, ensuring adequate time for regular healthcare visits.
This study has several limitations. First, owing to the constraints of cross-sectional research, the possibility of reverse causation cannot be ruled out. Specifically, this study used medication duration as a measure of chronic disease. This may be a proxy index; thus, future studies should determine the number of chronic conditions experienced by participants for a more accurate effect. Second, some of the independent variables used in this study may also be used as dependent variables in similar future studies. Typically, depression and chronic disease are not only health problems themselves but also factors that cause health problems. In this study, based on existing literature, depression and chronic disease were used as independent factors affecting UMN in police officers, and the two factors were confirmed to significantly affect UMN. Third, the detailed professional characteristics of police officers were not considered. Police officers’ roles can encompass various job duties, such as local police, transportation and investigation, potentially leading to different factors influencing the incidence of UMN based on their specific work. Future research should consider the diverse work characteristics of police officers by distinguishing between these roles and conducting comparative analyses on the levels and influencing factors of UMN. Fourth, the cause of UMN was not specifically identified. There are three main causes of UMN: availability, accessibility and acceptability.32 Future studies should identify the cause of UMN occurrence and compare it with the related influencing factors. Fifth, the study participation rate was low compared with the targeted population. The study targeted 126 746 people; however, 6616 people participated in the study, showing a participation rate of 5.2%. This can be observed as a limitation of online surveys. Sixth, there are limitations to the generalisability of our findings. Until now, it was difficult to compare whether the results of this study were reasonably understandable because there were insufficient UMN-related investigations on police officers. In the future, a long-term study on various influencing factors and intervention measures for UMN of police officers must be conducted. Nevertheless, this study is significant as it is the first to examine UMN in a relatively large sample of police officers and to identify a range of influencing factors.
Conclusion
The primary objective of this study was to assess the extent of UMN among police officers in South Korea and identify the factors influencing these needs. The study revealed that various factors influence the incidence of UMN. Notably, among these factors, those categorised as need factors were identified as particularly influential, including the presence of chronic diseases, lower subjective health, higher depression levels, stress and experiences of rough physical activity. Among these, higher stress levels and the experience of rough physical activity emerged as significant influencing factors. To safeguard the health of police officers, it is imperative to reduce and prevent UMN. Given the diverse occupational characteristics of police officers, future research should distinguish between various roles and conduct a comparative analysis of the levels and influencing factors of UMN within these distinct roles.
Data availability statement
Data are available on reasonable request. The data supporting the findings of this study are available from the Korean National Police Agency; however, restrictions apply to the availability of these data and they are not publicly available.
Ethics statements
Patient consent for publication
Ethics approval
Before commencing the study, approval was obtained from the D Institutional Review Board (approval number: 1041493-A-2021-011). An explanation of the study was presented on a computer or mobile phone screen. The explanation included the purpose and related content of the study, procedures, potential benefits, risks of participation, and the option to withdraw participation at any time. Additionally, the collected data were announced, and it was clarified that the data would be exclusively used for research purposes.
Acknowledgments
This work was conducted during a sabbatical year supported by Dongseo University in 2023.
References
Footnotes
X @Hyo Young Lee
Contributors HYL: writing–review and editing, writing–original draft, validation, supervision, project administration, methodology, investigation, funding acquisition, formal analysis, data curation, conceptualistion. HI: writing–review and editing, writing–original draft, data curation. KKM: writing–review and editing, writing–original draft, project administration, data curation, conceptualisation. All authors have read and approved the final fraft of the manuscript. HYL and KKM are the guarantors.
Funding This work was supported by the Korean National Police Agency and funded by 2021 Policy Research (grant number: 2021061708941808).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.