Duration of Residence, Enabling Conditions, and Unmet Healthcare Needs Among Immigrants in South Korea: A Pooled Repeated Cross-Sectional Analysis.

Immigrants often face barriers to healthcare access, but it remains unclear whether unmet healthcare needs are associated with duration of residence itself or with enabling and institutional conditions in South Korea. We conducted a pooled repeated cross-sectional analysis of nationally representative survey data from 2018, 2020, 2022 and 2024 (N = 88,116). Multivariable logistic regression models were constructed according to the Behavioral Model of Health Services Use. Reasons for unmet healthcare needs were categorized using the 3A framework. A sub-analysis among wage workers (n = 37,576) examined employment insurance and industrial accident insurance as indicators of employment-related social protection. In the base model, immigrants residing in Korea for 1-3 years had higher odds of unmet healthcare needs than those residing for ≥ 10 years (OR = 1.40, 95% CI: 1.26-1.56). After adjustment, the association was substantially attenuated. Acceptability-related barriers were most common among recent immigrants (< 3 years; 63.2%), whereas accessibility-related barriers predominated among long-term residents (≥ 10 years; 54.4%). Among wage workers, lack of industrial accident insurance was associated with higher odds of unmet healthcare needs, whereas employment insurance was not. Duration-related differences in unmet healthcare needs were substantially attenuated after adjustment for measured enabling conditions, although a modest association with duration remained. These findings support attention to visa-, employment-, financial-, and language-related barriers to care and to labour-related protections for immigrants.