Precarious employment, unmet care needs and presenteeism: longitudinal evidence from South Korea

Background

Precarious employment is hypothesised to increase unmet healthcare needs and presenteeism, yet causal longitudinal evidence remains scarce.

Methods

Five waves (2019–2023) of the Korea Health Panel Survey 2nd cohort were analysed (20,973 wage worker-year observations). Employment instability was operationalised as contract type (permanent, temporary, daily), a precarity index, and transitions. Outcomes included unmet healthcare needs by reason (cost, time), presenteeism, and absenteeism. Logistic regression, individual fixed-effects (FE) panel models, and stratified analyses used cluster-robust standard errors.

Results

Overall unmet healthcare needs did not differ by employment type after adjustment (temporary: OR = 0.92; daily: OR = 1.08, both ns). Mechanisms differed markedly: daily workers were nearly three times more likely to report cost barriers (OR = 3.35, 95%CI [2.10,5.35]), whereas permanent workers predominantly reported time constraints (78.7% vs. 53.9%). FE models yielded no significant effects, indicating selection into precarious employment drives cross-sectional associations rather than employment change itself. Presenteeism was paradoxically lower among daily workers (OR = 0.81, p = 0.038), consistent with absenteeism substitution. Female daily workers faced the strongest cost barriers (OR = 5.97, 95%CI [2.89,12.34]). Private insurance did not moderate associations.

Conclusions

Precarious employment does not increase overall unmet healthcare needs but substantially shapes how care goes unmet — economic barriers for non-permanent workers versus time barriers for permanent workers. Observed disparities appear to reflect pre-existing vulnerability rather than a direct effect of employment change, limiting causal claims. The extreme cost barriers faced by female daily workers underscore the need for targeted financial protection policies addressing intersecting labour and gender inequities, relevant wherever precarious work is expanding.

Key messages

• Precarious employment shapes how care goes unmet — cost barriers for daily workers, time barriers for permanent workers — a distinction invisible to aggregate analyses.

• Female daily workers face extreme cost-related barriers to care (OR = 5.97), revealing how sex and employment precarity intersect to produce compounded health access inequity.