Most OECD countries have achieved universal health care coverage, either through private or public insurance schemes. Coverage has remained stable among most top performers since 2014. In Greece, the last economic crisis meant around 30% of the population lost access to care, but by 2018 the country had once more achieved universal coverage after introducing remedial legislation in 2016 to secure funding for the system and restore universal coverage. In Lithuania health care coverage increased by 6 p.p. between 2014 and 2018. The National Health Insurance Fund provides coverage for all residents of the country, subject to confirmed insurance status, so the 2% of people who are not covered may be those who lost their employment and had not made the mandatory contributions to the health care system, or people living abroad registered as residents (OECD/European Observatory, 2019). On the other hand, Mexico has seen a reduction in health care coverage from 93% in 2014 to 88% in 2018, in line with declining spending on health as a proportion of GDP (OECD, 2021).
The range of services covered by health insurance schemes and the extent to which patients have to cover expenses from their own budgets vary across OECD countries. For example, in Mexico, given the limited coverage of health care, a large proportion of health expenditure comes from citizens’ pockets. However, the share of out-of-pocket (OOP) expenditure on household consumption alone does not indicate whether citizens are benefiting from access to care. During the COVID-19 pandemic, a large proportion of citizens had to forego care due to lockdown restrictions and the lack of remote alternatives, such as telemedicine. For instance, in Germany OOP spending as a share of health expenditure is in line with the OECD mean, but a larger proportion of citizens than in other countries were able to keep their doctors’ appointments.
Education systems across the OECD provide universal access to education for children of compulsory school age, which varies across countries. However, access to early childhood and tertiary education depends partially on public resources made available to finance them. For instance, in Colombia, a large share of expenditure on education from primary to tertiary level comes from private sources, which results in lower enrolment rates in early childhood and primary education among 4-year-olds, and in tertiary education for those under the age of 25. In other countries, such as Finland, where there is a tracking system in place (i.e. students are assigned to classes or types of secondary education curricula according to their achievements), the relationships between public funding and enrolment rates at the two ends of the education cycle are not linear.
The high share of private funding in some countries is due to grants and transfers to individuals or private institutions. For example, the United Kingdom has achieved 100% enrolment in early childhood education because every 4-year-old is entitled to 15 hours of free care whether in public or private institutions. Chile introduced a law in 2018 that established tertiary education as a right that should be accessible for everyone without discrimination. In order to implement this law, universities can request financing from the government to provide free tertiary education, but they are not obliged to do so. Chile has achieved the highest enrolment rate under the age of 25 in the OECD. Chile’s first-time tertiary enrolment rate under the age of 25 has also increased between 2013 and 2018.
In order to access justice, individuals must be aware of their rights and of the mechanisms in place to resolve their disputes, and be able to afford the costs that the process entails. Civil justice in Denmark, Germany, and the Netherlands are the most affordable and accessible for citizens, according to data from World Justice Project (WJP). Alternative dispute resolution (ADR) is a way of settling disputes outside of the courtroom. The WJP expert survey asks about the integrity of arbitrators, the costs and timeliness of ADRs, and the enforcement of settlements in commercial cases. According to these data, ADRs in Estonia, Japan, Korea and Norway are the most accessible, impartial and effective.
