Health care coverage, through government schemes and private health insurance, provides financial security against unexpected or serious illness. However, the percentage of the population covered by such schemes does not provide a complete indicator of accessibility, since the range of services covered and the degree of cost-sharing applied to those services also affects access to care.

Access to health care may be prevented for a number of reasons. These can be due to the functioning of the health care system (such as the cost of health care, distance to the closest health care facility, or waiting lists) or to personal reasons (including fear of not being understood by the doctor or not having the time to seek care). People who forgo health care when they need it may jeopardise their health status.

Financial protection through compulsory or voluntary health coverage can substantially reduce the amount that people need to pay directly for medical care. Yet in some countries the burden of out-of-pocket spending can still create barriers to health care access and use: households that face difficulties paying medical bills may delay or even forgo needed health care. On average across OECD countries, a fifth of all spending on health care comes directly from patients (see indicator “Financing of health care”).

Access to medical care requires an adequate number and proper distribution of doctors in all parts of the country. Concentration of doctors in one region and shortages in others can lead to inequities in access such as longer travel or waiting times. The uneven distribution of doctors and the difficulties in recruiting and retaining doctors in certain regions is an important policy issue in most OECD countries, especially those with remote and sparsely populated areas, and those with deprived rural and urban regions.

Long waiting times for health services is an important policy issue in many OECD countries (Siciliani et al., 2013), although less relevant in some (e.g. Belgium, France, Germany, Japan, Korea, Luxembourg, Switzerland, United States). Long waiting times for elective (non-emergency) surgery, such as cataract surgery, hip and knee replacement, generates dissatisfaction for patients because the expected benefits of treatments are postponed and the pain and disability remain.