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The study provides an overview of inequality in access to healthcare in 35 European countries. It demonstrates the serious and persisting problem of inequalities of access to healthcare, leading to wider health inequalities. On the first anniversary of the endorsement of the European Pillar of Social Rights, it responds to principle 16 of the Pillar which stresses the right to ‘timely access to affordable, preventative, and curative health care of good quality’. The report reinforces the need to link health and health inequalities to the European Semester process of economic and fiscal policy coordination.

The report on inequalities in access to healthcare describes the main features of health systems enabling access, analyses the main challenges in inequalities in access to healthcare identified in the 35 European countries and how they are tackled, and briefly discusses the indicators available at national and European level to measure access to healthcare.

Health systems in Europe face the challenge of ageing populations and increasing demand, which can also result from non-demographic factors such as the emergence of new (often expensive) treatments. In some European countries, costs and waiting time remain important barriers to accessing healthcare. Against a background of rising demand for healthcare resources, and public budgets which are often under pressure, ensuring universal and timely access to high quality healthcare — whilst also guaranteeing the financial sustainability of health systems — is a challenge which requires increased efforts to improve the efficiency and effectiveness of health systems.

The report concludes that significant inequalities in access to healthcare persist, both between and within countries. Large shares of the EU population face multiple hurdles and therefore do not obtain the care they need. People on a low income or with low health literacy find it difficult to access healthcare. Geographical mobility can also hinder accessibility. High out-of-pocket payments and lack of protection of vulnerable groups from user charges are among the main challenges identified. Even in countries providing nearly universal population coverage, some specific population groups fall through the safety net. Socio-economic inequalities are also reported in access to health promotion and preventative services such as cancer screening, vaccinations and preventative dental care.

The report is complimentary to the ongoing work of DG SANTE on the State of Health in the EU (update to be published this week), on the inclusion people experiencing vulnerability, people experiencing poverty and social exclusion, and on addressing inequalities in health and social outcomes in general.