Background: Romania allocates the lowest proportion of healthcare spending to outpatients in Europe, while inpatient expenditures account for a disproportionate share of the national health budget. This imbalance generates access barriers and unmet healthcare needs (UHNs). Furthermore, heavy reliance on general practitioners (GPs) predominantly for bureaucratic functions (referrals), coupled with a high rate of hospital self-initiated admissions suggest bypass behaviors indicating existing UHNs. Our objective is to identify access barriers and resulting UHNs in the patient group interviewed, focusing on care-seeking behaviors. Methods: This analytical, cross-sectional, multi-center, hospital-based study identifies barriers and UHNs among hospitalized patients. Data collection occurred between April and June 2024 in two Romanian hospitals, across three wards: Urology, Pneumology, Obstetrics-Gynecology. A stratified proportionate sampling strategy was implemented with consecutive convenience sampling. A 22-item questionnaire was administered by nurses. Sociodemographic (covariates) and barriers (explanatory variables) follow Andersen’s and Tanahashi’s models, focusing on contact and effective coverage. Dependent variables include GP visit frequency (contact coverage) and hospital admission modes (effective coverage). Negative binomial regression and univariate logistic models assess associations between dependent variables and predictors. Results: A total of 217 patients were eligible for final analysis, representing 12.5% of total ward admissions. Contact coverage: significant associations were observed between GP visits and both gender (predisposing) and presence of chronic diseases (need). Men had a 32% lower rate of visits [Exp(B) =0.68, 95% confidence interval (CI): 0.54–0.87, P=0.002], chronic patients exhibited a 51% higher rate [Exp(B) =1.51, 95% CI: 1.18–1.94, P=0.001]. Time constraints (accessibility) reduced by half the frequency of visits [Exp(B) =0.50, 95% CI: 0.31–0.82, P=0.005]. Reflecting acceptability, individuals who rely on pharmacists had a 39% lower rate [Exp(B) =0.61, 95% CI: 0.38–0.99, P=0.045], while patients seeking advice from family or friends had a 44% lower frequency of GP visits [Exp(B) =0.56, 95% CI: 0.34–0.92, P=0.02]. Effective coverage: chronic patients were more than twice as likely to be hospitalized via GP referral [odds ratio (OR) =2.23, 95% CI: 1.23–4.05, P=0.008]. Financial constraints (accessibility) act as deterrents for patient-initiated admissions; higher costs induce 68% lower odds of self-initiated admissions (OR =0.32, 95% CI: 0.12–0.85, P=0.02). GP visits for referrals decrease the odds of GP-referred hospital admissions (OR =0.38, 95% CI: 0.17–0.84, P=0.02). Conclusions: Barriers encompass accessibility and acceptability factors. While primary care (contact coverage) is hindered by time constraints, financial burdens are obstacles to hospital self-initiated admissions (effective coverage). Men, chronic patients, and those who bypass formal consultations seeking advice from pharmacists, family or friends are particularly susceptible to UHNs. Even GP consultations involving bureaucratic referrals effectively divert outpatients from becoming inpatients. Policies should transform primary care to ensure effective coverage and mitigate avoidable hospital admissions.