Promoting a better sharing of the benefits of growth and equality of opportunities are key components of a strategy to foster social cohesion and the sustainability of economic growth. Yet, in many aspects of life, inequalities between different population groups have persisted at high level or even widened further over the last decade. Across the OECD, the top 10% of income earners now take home nearly ten times more pay than the bottom 10%. Wage inequality has reached record-high levels in some OECD countries, related to the workers’ skills but also type of contract. There is also a clear geographical dimension to income inequalities and job quality. And more than in the past, inequality of opportunities feeds into inequality of outcomes and vice versa reducing social mobility from one generation to the next.

Health is one of the main components of a good life. In addition to having value in itself, good health also translates into a better chance of succeeding in education and in the labour market – ultimately contributing to enhance opportunities for people to improve their standing in life. At the same time, inequalities in income and educational attainment contribute to health inequality. Ensuring that everyone, regardless of socio-economic circumstances, has access to the health system can help make sure that economic prosperity is shared by the entire population.

This chapter provides an overview of the report on socio-economic inequalities in health and health systems. It presents the rationale of the report as well as the overall approach selected to analyse inequalities in 33 OECD and EU countries. Key findings on inequalities in risk factors and health outcomes are discussed followed by a presentation of inequalities in utilisation of health services, unmet needs for health care and financial hardship when seeking care. The results confirm that people from disadvantaged socio-economic backgrounds frequently are in worse health, have higher exposure to risk factors and struggle more to access the health system than the better-off or better educated. However, the extent of these inequalities differs across countries. The chapter also assesses whether some countries systematically concentrate inequalities in health and health systems and concludes by discussing policy options to redress them.

This chapter examines education-related inequalities in health status and its determinants across OECD and European countries. The chapter starts with the brief discussion on the links between health and employment to show that being in good health is instrumental in achieving good labour market outcomes. The chapter then analyses the extent to which exposure to behavioural risk factors (overweight, smoking and heavy drinking) differs across European and OECD countries and, within countries, across the social spectrum. Lastly, education-related health inequalities are investigated considering three health variables (self-assessed health status, limitations in daily activities and multiple chronic conditions), and patterns of health inequalities across European and OECD countries are analysed.

This chapter turns to the question of whether health systems treat people with comparable needs equally irrespective of their income. It measures income-related inequalities in health care services utilisation, adjusted for needs where relevant, based on national health survey data for 33 EU and OECD countries carried out between 2014 and 2017. It investigates inequalities in doctor visits, hospital admissions, as well as preventive care such as cancer screening, flu vaccination, and dental care. Summary measures of inequality are derived to compare results across the various health care services and countries.

This chapter focuses on individuals who have faced barriers in accessing health care and as a result declare that their needs have not been met, and it assesses the extent to which the distribution of unmet needs is unequal across income groups. The chapter starts with a brief discussion of the unmet needs variable and how it relates to other access measures. Unmet needs across income groups are then analysed for 31 countries. Reasons for unmet needs which are more linked to the supply of services - distance and waiting time - are first reviewed, followed by affordability. Where possible, the analysis of unmet needs for financial reasons explores medical care, dental care and prescription drugs separately. The chapter concludes by analysing patterns of unmet needs across countries.

High out-of-pocket payments for health care services can prevent patients from seeking needed care or can cause financial hardship among those who do. This chapter analyses the affordability of health care services in European countries and explores the extent to which poorer households are more likely to face financial hardship when seeking care. The chapter analyses possible gaps in coverage in EU and OECD countries that can lead to financial hardship and explores whether voluntary health insurance can compensate for gaps in publicly financed coverage. Gaps in coverage are explored from different dimensions, first looking into population groups that may go without coverage before comparing the scope and depth of coverage for different types of care across countries. This discussion will help to identify some key features of coverage that contribute to explaining differences in financial protection across different population groups and countries.