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. There are many ways to seek information from the population about unmet health care needs that will provide different results. The data presented here are based on the EU Statistics on Income and Living Conditions survey (EU-SILC) as they are the most timely and comparable source of information available across all EU countries.

Where health systems fail to provide adequate financial protection, people may not have enough money to pay for health care or meet other basic needs. As a result, lack of financial protection can reduce access to health care, undermine health status, deepen poverty and exacerbate health and socio-economic inequalities. On average across EU member states, around a fifth of all spending on health care comes directly from patients through out-of-pocket (OOP) payments (see indicator “Financing of health expenditure” in Chapter 5). People experience financial hardship when the burden of such OOP payments is large in relation to their ability to pay. Poor households and those who have to pay for long-term treatment such as medicines for chronic illness are particularly vulnerable.

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 core health services, the extent of health care coverage is defined by the range of services included in a publicly defined benefit package and the proportion of costs covered. assesses the extent of coverage for selected health care goods and services, by calculating the share of expenditure covered under government schemes or compulsory health insurance. Differences across countries in the extent of coverage can be due to specific goods and services being included or excluded in the publicly defined benefit package (e.g. a particular drug or medical treatment); different cost-sharing arrangements; or some services only being covered for specific population groups in a country (e.g. dental treatment).

Doctors and other health workers are crucial for addressing the health needs of the population in normal circumstances and even more so during exceptional circumstances such as the COVID‑19 pandemic. Proper access to medical care requires a sufficient number of doctors, with a proper mix of generalists and specialists and a proper geographic distribution to serve the population in the whole country.

Consultations with doctors are, for most people, the most frequent contacts with health services and often provide an entry point for subsequent medical treatment. Consultations can take place in different settings, including doctors’ offices, hospital outpatient departments or patients’ own homes. Increasingly, consultations can also take place online and through video calls, through the development of teleconsultations (Oliveira Hashiguchi, 2020). The use of teleconsultations increased greatly during the COVID‑19 pandemic as a way to protect both patients and doctors and avoid spreading the virus. For example, in France, the number of teleconsultations reached close to 1 million per week in April 2020 compared to around 10 000 per week before March. In Norway, the share of teleconsultations with a general practitioner rose from 5% before the pandemic to almost 60% during the pandemic.

Oral health is an important, although often neglected public health issue. The economic burden of oral diseases is substantial. Oral diseases account for more than 5% of total health spending on average across EU countries, and productivity losses due to oral diseases have been estimated at around EUR 57 billion a year (Platform for Better Oral Health in Europe, 2019). Dentists play a key role in both preventing and treating oral health problems.

Nurses play a critical role in providing care in hospitals and long-term care institutions under normal circumstances, and their role was even more critical during the COVID‑19 pandemic. Pre-existing shortages of nurses were exacerbated during the peak of the epidemic, also because many nurses themselves became infected by the virus (see Chapter 1 on resilience to COVID‑19).

Technology plays an important role in health systems, allowing physicians to better diagnose and treat patients. However, new technologies can also drive up costs, particularly if they are overused or misused.

The number of hospital beds provides an indication of the resources available for delivering services to inpatients in hospitals for different types of care. The COVID‑19 pandemic highlighted the need to have a sufficient number of hospital beds and flexibility in their use to address any unexpected increase in demand for intensive care, together with a sufficient number of doctors and nurses with the right skills to provide the required services (see Chapter 1 on resilience to COVID‑19).

The average length of stay in hospital is often regarded as an indicator of efficiency in health service delivery. All else being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive settings. Longer stays can be a sign of poor care coordination, resulting in some patients waiting unnecessarily in hospital until rehabilitation or long-term care can be arranged. At the same time, some patients may be discharged too early, when staying in hospital longer could have improved their health outcomes or reduce chances of re-admissions.

Long waiting times for elective (non-urgent) surgery have been a longstanding issue in many European countries as they generate dissatisfaction for patients because the expected benefits of treatments are postponed. The COVID‑19 pandemic will likely increase waiting times for many elective surgery, at least temporarily, as non-urgent interventions have often been postponed during the peak of the epidemic.