Gaps in access undermine universal health coverage across the EU

Johannah Jorgensen

Gaps in the accessibility of health care and a lack of data are undermining universal health coverage across the European Union (EU), say the State of Health in the EU Country Health Profiles and Companion Report.

The Profiles, released today by the European Commission’s Directorate-General for Health and Food Safety (DG SANTE), were developed by WHO’s European Observatory on Health Systems and Policies and the Organisation for Economic Co-operation and Development. The Companion Report, also published by DG SANTE, picks up on the clear finding of the Profiles – that access to health care remains a challenge in every EU country.

Published every two years, this project provides insights into health and health systems across the EU. It complements WHO’s Thirteenth General Programme of Work (GPW 13) and its focus on helping Member States achieve universal health coverage.

What we know

Costs, waiting times and travel distances to reach medical care are classic barriers to access. The Companion Report, drawing on the soon-to-be-published European Observatory report “Gaps in coverage and access in the European Union”, explores the challenges further.

It shows that not only rural populations but also peripheral populations are beyond the reach of mainstream care. Those who are older, less mobile, more vulnerable or living in the heart of urban areas but at the fringes of society all face difficulties with access in at least half of all EU Member States. Irregular residents are also excluded from normal statutory health coverage in a third of Member States; refugees and homeless people in particular suffer from a lack of access.

The project also flags challenges related to financial resources; the distribution of health workers, including getting the right people with the right skills in the right place; shortages of well equipped facilities within easy reach of vulnerable populations; and whether the services offered are acceptable to all users.

Earlier this year, WHO’s work on out-of-pocket payments for health care explained how barriers to access can lead to catastrophic health-care spending for households. Universal health coverage does not just protect individuals and families from long-term financial impacts, it also provides insurance – this prevents insecurity and anxiety while fostering societal well-being.

An incomplete picture

The Companion Report reveals gaps in the data that Member States collect, and highlights how vital it is to capture this evidence. More granular data are needed to measure how socioeconomic factors impact access and to take into account the different challenges faced by those with particular clinical needs or from different population groups. The Report also recommends more research on the level of informal payments, care coordination, health literacy and access to preventive services.

A lack of data and in-depth knowledge hampers understanding of gaps in access to health care, prevents effective action and heightens the risk of complacency. Better information will inform more holistic service delivery that recognizes patients’ perspectives without losing sight of a system’s cost–effectiveness. It will help governments understand the reality of population access and support them in delivering affordable, quality preventive and curative health care.