Accessibility to health care can be limited for a number of reasons, including cost, distance to the closest health facility and waiting times. Unmet care needs may result in poorer health for people forgoing care and may increase health inequalities if such unmet needs are concentrated among poor people. As noted by the Expert Panel on Effective Ways of Investing in Health, there are many challenges in measuring unmet needs for particular interventions, but the data from the EU Statistics on Income and Living Conditions survey (EU-SILC) are the only timely and comparable source of information available across all Member States (Expert Panel on Effective Ways of Investing in Health, 2018).

People experience financial hardship when direct out-of-pocket payments – formal and informal – are large in relation to their ability to pay for health care. Even small out-of-pocket payments can cause financial hardship for poor households and those who have to pay for long-term treatment such as medicines for chronic illness. Where health systems fail to provide adequate financial protection, people may not have enough money to pay for health care or to meet other basic needs. As a result, lack of financial protection may reduce access to health care, undermine health status, deepen poverty and exacerbate health and socioeconomic inequalities. Because all health systems involve a degree of out-of-pocket payments, financial hardship can be a problem in any country.

The share of the population covered by a public or private scheme provides some indication of the financial protection against the costs associated with health care, but this is not a complete indicator of affordability as the range of services covered and the degree of cost-sharing applied to those services also matter. These three dimensions – the “breadth”, “depth” and “height” of coverage – define how comprehensive health care coverage is in a country. The indicator presented here on population coverage looks at the first dimension only, whereas the next indicator on the extent of health care coverage takes a broader look at these three dimensions together.

In addition to the share of the population entitled to basic health services, the range of services included in a publicly defined benefit package and the proportion of costs covered are the other dimensions defining the extent of health care coverage in a country. assesses these three dimensions of coverage for a selected number of key health care functions. For each function, it displays the share of the costs that is funded collectively – either by government schemes or compulsory insurance arrangements. Differences across countries in the share of the costs covered can be due to the fact that some specific goods and services are included in the public benefit package in one country but not in another (e.g. a particular drug or medical procedure), that cost-sharing arrangements for the same goods and services vary or that some services are only covered for specific population groups in a country.

Access to medical care requires an adequate number of doctors, with a proper mix between generalists and specialists and a proper distribution in all parts of the country.

Nurses greatly outnumber physicians in most EU countries, with a ratio of two to four nurses per doctor in many countries. Nurses play a critical role in providing health care not only in hospitals and long-term care institutions, but increasingly also in primary care and in home care settings.

Consultations with doctors are, for most people, the most frequent contacts with health services. These consultations can take place either in doctors’ offices or clinics, in hospital outpatient departments or, in some cases, in patients’ own homes.

This section presents data on the availability and use of two diagnostic imaging technologies: computed tomography (CT) scanners and magnetic resonance imaging (MRI) units. CT and MRI exams help physicians diagnose a wide range of conditions. Unlike conventional radiography and CT scanning, MRI exams do not expose patients to ionising radiation.

The number of hospital beds provides an indication of the resources available for delivering services to inpatients in hospitals. The influence of the supply of hospital beds on hospital admission rates has been widely documented, confirming that a greater supply generally leads to greater admissions (Rohmer’s law that a “built bed is a filled bed”).

Long waiting times for elective (non-emergency) surgery are an important policy issue in many European countries as they generate dissatisfaction for patients because the expected benefits of treatments are postponed, and the pain and disability remain while waiting.