Access to health services in the European Union

The 28 Member States of the European Union (EU) have a clear mandate to ensure equitable access to high-quality health services for everyone living in their countries. This does not mean making everything available to everyone at all times. Rather, it means addressing unmet need for health care by ensuring that the resources required to deliver relevant, appropriate and cost-effective health services are as closely matched to need as possible. Access is a multi-dimensional issue. Barriers to access can be found at the level of individuals, health service providers and the health system. Access is also affected by public policy beyond the health system - especially fiscal policy, but also social protection, education, employment, transport and regional development policy. Survey data suggest that financial barriers are the largest single driver of unmet need for health care in the European Union. Between 2005 and 2009, EU Member States made huge progress in improving access to health care. The number of people reporting unmet need for health care due to cost, travel distance or waiting time fell steadily from 24 million in 2005 to 15 million in 2009. Since 2009, however, this positive trend has been reversed - a visible sign of the damage caused by the financial and economic crisis. By 2013, the number of people reporting unmet need for health care had risen to 18 million (3.6% of the EU population). This report highlights key access problems and policy responses in EU health systems. It is structured around eight policy areas: financial resources linked to health need; services affordable for everyone; relevant, appropriate and cost-effective services; facilities within easy reach; staff with the right skills in the right place; quality medicines and medical devices available at fair prices; everyone can use services when they need them; services acceptable to everyone. The report includes a focus on three groups of people who are systematically underserved: Roma, undocumented migrants and people with mental health problems. A final section of the report discusses the roles and responsibilities of the European Union and its Member States in ensuring equitable access to health services. The report emphasises the need for a new generation of data collection for effective, accessible, resilient and accountable health systems. It calls for better monitoring to identify the magnitude of access problems in a timely manner, to measure changes over time and across groups of people and to enhance international comparability. The ability to disaggregate data at sub-national level and by sub-groups in the population is essential. The report also calls for more policy analysis to enable a deeper understanding of the causes of access problems and to identify cost-effective policy responses, underpinned by research targeting groups of people facing multiple vulnerabilities. Policy responses should reflect the multi-dimensional nature of access problems, the importance of intersectoral action and the specificities of national and regional contexts.