Access and Cost of Education and Health Services

Preparing Regions for Demographic Change

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Current population trends and the COVID-19 pandemic reinforce the need for efficient public service provision while guaranteeing good access to all. Population decline and ageing in rural regions affect the provision of services through lower economies of scale and scope, professional shortages and longer distances. Reliable estimates of the costs and access arising from demographic and geographical differences can help adapt the provision of services to different territorial realities. This report provides internationally comparable fine-grained present and future estimates of the cost and physical access to education (primary and secondary) and health services (cardiology, maternity and obstetrics) in European countries. The report finds that demographic change in the next decades will likely further strain the trade-off between costs and access, especially in remote rural areas. Adapting to changes in demand following lower fertility rates and ageing implies that services will need to become more widely available, while others will have to concentrate more. This report aims to support evidence-based policy decisions to ensure service provision allows for both cost efficiency and a sufficient level of access in all territories.


Service provision: Definition and trends

This chapter defines the scope of the report, discusses megatrends affecting the delivery of services, and summarises current discussions on planning for service provision. It starts with this report’s definition of public services, the scope of the services considered and the territorial typologies used in the analysis. It then describes how depopulation, ageing and climate change are affecting the provision of services in OECD countries. Finally, the chapter discusses the relationship between costs and access to public services and outlines forward-looking strategies for service provision in the context of demographic change.



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