Accessibility to health care can be limited for a number of reasons, including cost, distance to the closest health facility and waiting times. The disruption of health services during the pandemic also resulted in unmet health care needs as resources were mobilised to address the crisis and people were encouraged to stay home to reduce virus transmission. Information about unmet health care needs can be sought by using different survey instruments that provide different results. The data presented here rely on the regular Eurostat EU Statistics on Income and Living Conditions (EU-SILC) survey and Eurofound’s Living, working and COVID‑19 e‑survey.

The share of the population covered by a public or private scheme provides an important measure of access to care and the financial protection against the costs associated with health care. The COVID‑19 pandemic demonstrated the importance of universal health coverage as a key element for the resilience of health systems, as gaps in insurance coverage and high levels of out-of-pocket payments may deter people from seeking care, and thus contribute to virus transmission. Higher population coverage through public and primary private health insurance have been associated with lower COVID‑19 death and lower excess mortality in EU and other OECD countries (OECD, forthcoming[1]).

In addition to the share of the population entitled to core health services, the extent of health care coverage is defined by the range of services included in a publicly-defined benefit package and the proportion of costs covered. assesses the extent of coverage for key health care goods and services, by computing the share of expenditure covered under government schemes or compulsory health insurance. Differences across countries in the extent of coverage can be the result of specific goods and services being included or excluded in the publicly-defined benefit package, different cost-sharing arrangements or some services only being covered for specific population groups in a country.

Where health systems fail to provide adequate financial protection, people may suffer financial hardship from paying for health care, or they simply forgo health care altogether because they cannot afford it. As a result, lack of financial protection can reduce access to health care, undermine health status, deepen poverty and exacerbate health and socio‑economic inequalities. On average across the EU, around 15% of all spending on health care comes directly from patients through out-of-pocket (OOP) payments. People experience financial hardship when the burden of OOP payments is large in relation to their ability to pay. Poorer households and those who have to pay for long-term treatment are particularly vulnerable.

Proper access to medical care requires having a sufficient number of doctors, with a proper mix of generalists and specialists, and a proper geographic distribution to serve the population in the whole country.

The remuneration of various categories of doctors affects the financial attractiveness of general practice and different specialties. Differences in remuneration levels of doctors across countries can also act as a “push” or “pull” factor when it comes to physician migration. In many countries, governments can determine or influence the level and structure of physician remuneration by regulating their fees or by setting salaries when doctors are employed in the public sector.

Dental health is an integral part of general health and quality of life. Access to dental care was often disrupted during the pandemic, with over one‑fourth of people in the EU reporting unmet needs for dental care in spring 2021 and spring 2022 (Eurofound, 2022[1]).

Nurses make up the most numerous category of health workers in nearly all EU countries. The key role they play in providing care in hospitals, long-term care facilities and the community was highlighted again during the COVID‑19 pandemic. Pre‑existing shortages of nurses were exacerbated during the peaks of the epidemic, particularly in intensive care units but also in other hospital units and long-term care facilities (OECD, forthcoming[1]).

The COVID‑19 pandemic has brought further attention to the pay rate of nurses and the need to ensure sufficient remuneration to attract and retain nurses in the profession.

Modern diagnostic technologies play an important role in health systems, allowing physicians to better diagnose health issues. However, they can also drive up costs, particularly if they are overused or misused.

The COVID‑19 pandemic highlighted the need to have a sufficient number of hospital beds and flexibility in their use to address any unexpected surge in demand.

Hip and knee replacements are amongst the most frequent elective (non-urgent) surgical procedures in the EU. Until the pandemic, hip and knee replacement rates were growing fairly steadily, driven by increases in osteoarthritis and other types of arthritis caused by ageing populations and growing obesity rates.

Long waiting times for elective (non-urgent) surgery have been a longstanding issue in many European countries dating back well before the pandemic, but the disruption of elective care during the pandemic exacerbated waiting times as many non-urgent interventions were suspended, generating more backlogs of patients on waiting lists. Long waiting times generate dissatisfaction for patients because the health benefits from treatment are postponed, patients can experience pain and discomfort while waiting, and the wait may worsen health outcomes for patients before and after the intervention.