Accessibility is one of the key objectives of any health system. If access to care is limited for some population groups or the population at large, the result may be poorer health outcomes and greater health inequalities. Access to care can be limited for different reasons: it may not be affordable, the distance to the closest health care facility may be too great or waiting times for treatment too long.
Unmet needs for health care is an important indicator of accessibility problems as reported by the population itself. Recent survey data show that the share of the population reporting unmet care needs is generally low in most EU countries, but low-income households are much more likely to report unmet care needs than high-income households, mainly for financial reasons.
The affordability of health services can be restricted when they involve high out-of-pocket payments. On average across EU countries, 18% of health spending is paid out-of-pocket by households, but with wide variations. In general, countries that have a high share of out-of-pocket spending also have a high proportion of the population facing catastrophic payments for health services, particularly among low-income groups. To promote access to care for the whole population, most EU countries have achieved universal coverage for a core set of health services, although the range of services covered and the degree of cost-sharing vary.
In addition to being affordable, health services also need to be accessible when and where people need them. Although the number of doctors and nurses per population has increased over the past decade in nearly all EU countries, shortages of general practitioners persist in many countries, particularly in rural and remote areas. The use of health services varies widely across EU countries. While these variations may reflect differences in health care needs, they also suggest either some under-use of some services for population groups facing accessibility issues or a possible over-use of some services.
Long waiting time for elective surgery is an important policy issue in many EU countries, as it restricts timely access to care and generates patient dissatisfaction. In countries where this is an issue, waiting times have frequently gone up in recent years as the demand for surgery increased more rapidly than the supply, following some success in bringing waiting times down before 2010.