Most OECD countries have achieved universal (or near-universal) coverage for a core set of health services, which usually include consultations with doctors and hospital care. National health systems or social health insurance are used to achieve universal health coverage, though a few countries (the Netherlands and Switzerland) have done so through compulsory private health insurance. Some affordability or accessibility issues can hinder the use of health services. These are mostly related to out of pocket (OOP) payments , distance to health services or waiting times for appointments.
Unmet needs for health care are a relevant indicator of access barriers. The EU Statistics on Income and Living Conditions (EU-SILC) survey asks respondents whether they forewent a medical examination in the past 12 months for different reasons. In 2018, 2.7% of the population in OECD European countries experienced unmet health care needs due to costs, distance or waiting times. This proportion rose to 4.6% for lower income citizens. On average, 16.4% of respondents in Estonia and 8.8% in Greece reported unmet care needs. Income inequality in access to care is highest in Greece, Latvia, Turkey and Belgium.
Across OECD countries, an average household spent almost 3% directly from its income on medical services in 2017 (a proportion that has remained stable since 2013). OOP spending is highest in Switzerland and Korea where households spend over 6% of their income on health services. In France, Luxembourg and Slovenia, households spend less than one-third than Swiss households spend.
Policies can contribute to lowering the financial burden on households. In the Slovak Republic, the share of OOP has decreased since 2013, following the introduction of policies to limit such payments for people with chronic conditions and vulnerable groups, as well as tightening the rules on additional charges by private providers (OECD and European Observatory, 2017a). In Latvia, the Safety Net and Social Sector Reform Programme reduced OOP payments for low-income households between 2009 and 2011, which exempted them from co-payments and subsidised pharmaceuticals. After 2011 the programme narrowed its scope to target specific patient groups, increasing direct payments and reverting OOP to 2009 levels (OECD and European Observatory, 2017b).
The under-supply of physicians can lead to longer waiting times or patients having to travel far to access services (OECD, 2019). The overall number and geographic distribution of doctors varies across OECD countries. In 2017, there were 2 active physicians per 1 000 population in Korea, Poland and Turkey, whereas this number was much greater in countries like Austria and Greece. In many countries such as Greece, the Czech Republic, the Slovak Republic and the United States, there is a large concentration of physicians in the national capital region.
