To what extent does current health policy hinder or facilitate equitable access to high-quality healthcare?
Health policies are fully aligned with the goal of achieving equitable access to high-quality healthcare.
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Health policies are largely aligned with the goal of achieving equitable access to high-quality healthcare.
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Canada
Canada boasts universal access to a comprehensive public health system, albeit with lengthy wait times. Healthcare administration falls under the purview of the provinces and territories, resulting in some variability in health policy implementation. Consequently, the quality and availability of healthcare services can differ across regions.
Long wait times for certain medical procedures have been a concern in Canada. While the system aims to provide equal access to care, some individuals may face delays in receiving specific treatments, potentially affecting the overall quality of healthcare. This situation allows high-income patients to seek services in other provinces or countries, undermining the principle of equal access.
“Primary care access is crucial for preventing and managing health conditions, and securing an adequate supply of general practitioners has proven challenging for many Canadian governments.”
Factors outside the healthcare system, such as income, education and housing, also can significantly impact health outcomes. Greater efforts to address these disparities are needed to achieve health equity.
This issue is particularly pressing in Indigenous populations, which in Canada often experience severe health disparities compared to non-Indigenous populations. These disparities are partly due to their rural locations, as well as other factors mentioned above. Addressing these disparities requires targeted policies that consider the unique needs and challenges faced by Indigenous communities, and some progress has been made in this area in recent years.
Access to mental health services has been an ongoing concern. Mental health issues require comprehensive and accessible services, but improvements in this area have been slow to materialize.
The lack of universal prescription drug coverage is another area where disparities in access to healthcare can arise. Some individuals may face challenges affording necessary medications, although a new program has been promised as part of a power-sharing arrangement in Parliament between the minority Liberal government and the opposition NDP party (Martin et al. 2018).
Long wait times for certain medical procedures have been a concern in Canada. While the system aims to provide equal access to care, some individuals may face delays in receiving specific treatments, potentially affecting the overall quality of healthcare. This situation allows high-income patients to seek services in other provinces or countries, undermining the principle of equal access.
“Primary care access is crucial for preventing and managing health conditions, and securing an adequate supply of general practitioners has proven challenging for many Canadian governments.”
Factors outside the healthcare system, such as income, education and housing, also can significantly impact health outcomes. Greater efforts to address these disparities are needed to achieve health equity.
This issue is particularly pressing in Indigenous populations, which in Canada often experience severe health disparities compared to non-Indigenous populations. These disparities are partly due to their rural locations, as well as other factors mentioned above. Addressing these disparities requires targeted policies that consider the unique needs and challenges faced by Indigenous communities, and some progress has been made in this area in recent years.
Access to mental health services has been an ongoing concern. Mental health issues require comprehensive and accessible services, but improvements in this area have been slow to materialize.
The lack of universal prescription drug coverage is another area where disparities in access to healthcare can arise. Some individuals may face challenges affording necessary medications, although a new program has been promised as part of a power-sharing arrangement in Parliament between the minority Liberal government and the opposition NDP party (Martin et al. 2018).
Citations:
Martin, Danielle, Ashley P. Miller, Amélie Quesnel-Vallée, Nadine R. Caron, Bilkis Vissandjée, and Gregory P. Marchildon. 2018. “Canada’s Universal Health-Care System: Achieving Its Potential.” Lancet 391 (10131): 1718–35. https://doi.org/10.1016/S0140-6736(18)30181-8
Martin, Danielle, Ashley P. Miller, Amélie Quesnel-Vallée, Nadine R. Caron, Bilkis Vissandjée, and Gregory P. Marchildon. 2018. “Canada’s Universal Health-Care System: Achieving Its Potential.” Lancet 391 (10131): 1718–35. https://doi.org/10.1016/S0140-6736(18)30181-8
Germany
In Germany, everyone must participate in a health insurance plan, which means that nearly 100% of the population is insured. This mandate ensures affordable access to healthcare for all individuals, regardless of socioeconomic status, gender, age, ethnicity, and other factors (OECD/European Observatory on Health Systems and Policies, 2023).
There is a very small percentage of people with unmet needs for medical care, and the difference among income groups is negligible. In the lowest income quintile, 0.3% of households reported unmet healthcare needs, compared with 0.1% in the highest income quintile. Overall, only 0.2% of households mentioned unmet needs for medical care due to cost reasons (OECD/European Observatory on Health Systems and Policies, 2023).
The statutory health insurances cover a broad range of medical care and treatments, and the benefits are equal for anyone who is insured, regardless of socioeconomic status, gender, age, ethnicity, etc. Persons with high incomes may choose private insurance, which provides benefits that are at least equivalent to those of statutory insurance and often better. Asylum-seekers and recognized refugees are only entitled to emergency, maternity, and preventive care during the first 18 months of their stay. After that, they can access a broader range of healthcare (OECD/European Observatory on Health Systems and Policies, 2023).
A European Parliament study stated that the German health system provides equal access for both males and females (European Parliament, 2015).
A couple of years ago, the federal government commissioner for people with disabilities (Beauftragter der Bundesregierung für die Belange von Menschen mit Behinderungen), Jürgen Dusel, criticized that many doctors’ practices and their websites are not barrier-free and nursing staffs in hospitals are often not trained to deal with specific disabilities and the special needs of their disabled patients (Beauftragter der Bundesregierung für die Belange von Menschen mit Behinderungen, n.d.). Currently, the federal ministry for health (Bundesministerium für Gesundheit) is working on an action plan to reduce barriers and improve accessibility in the health system (Bundesministerium für Gesundheit, 2023).
To evaluate the equal accessibility of medical care across all regions of Germany, it is essential first to examine the differences among the sixteen federal states. In 2015, the number of healthcare professionals in the various federal states ranged from 55 to 75 professionals per 1,000 inhabitants, with the German average at 65. The disparities in healthcare expenses per capita were also minimal, ranging from approximately €4,000 to €4,400, with the German average at €4,213 (Statistisches Landesamt Rheinland-Pfalz, 2017). In 2022, the occupancy of hospital beds in Germany averaged 69%, with a range of 65% to 74% among the federal states (Gesundheitsberichterstattung des Bundes, 2023).
An emerging problem is the shortage of doctors in rural areas. Although there are more doctors than ever since German reunification, they often specialize or are drawn to the cities. In the countryside, however, a general practitioner is needed first. The federal states are trying to counteract this problem, for example, by providing scholarships for students who promise to settle in a rural area when finally becoming a doctor (Deutschlandfunk, 2022).
There is a very small percentage of people with unmet needs for medical care, and the difference among income groups is negligible. In the lowest income quintile, 0.3% of households reported unmet healthcare needs, compared with 0.1% in the highest income quintile. Overall, only 0.2% of households mentioned unmet needs for medical care due to cost reasons (OECD/European Observatory on Health Systems and Policies, 2023).
The statutory health insurances cover a broad range of medical care and treatments, and the benefits are equal for anyone who is insured, regardless of socioeconomic status, gender, age, ethnicity, etc. Persons with high incomes may choose private insurance, which provides benefits that are at least equivalent to those of statutory insurance and often better. Asylum-seekers and recognized refugees are only entitled to emergency, maternity, and preventive care during the first 18 months of their stay. After that, they can access a broader range of healthcare (OECD/European Observatory on Health Systems and Policies, 2023).
A European Parliament study stated that the German health system provides equal access for both males and females (European Parliament, 2015).
A couple of years ago, the federal government commissioner for people with disabilities (Beauftragter der Bundesregierung für die Belange von Menschen mit Behinderungen), Jürgen Dusel, criticized that many doctors’ practices and their websites are not barrier-free and nursing staffs in hospitals are often not trained to deal with specific disabilities and the special needs of their disabled patients (Beauftragter der Bundesregierung für die Belange von Menschen mit Behinderungen, n.d.). Currently, the federal ministry for health (Bundesministerium für Gesundheit) is working on an action plan to reduce barriers and improve accessibility in the health system (Bundesministerium für Gesundheit, 2023).
To evaluate the equal accessibility of medical care across all regions of Germany, it is essential first to examine the differences among the sixteen federal states. In 2015, the number of healthcare professionals in the various federal states ranged from 55 to 75 professionals per 1,000 inhabitants, with the German average at 65. The disparities in healthcare expenses per capita were also minimal, ranging from approximately €4,000 to €4,400, with the German average at €4,213 (Statistisches Landesamt Rheinland-Pfalz, 2017). In 2022, the occupancy of hospital beds in Germany averaged 69%, with a range of 65% to 74% among the federal states (Gesundheitsberichterstattung des Bundes, 2023).
An emerging problem is the shortage of doctors in rural areas. Although there are more doctors than ever since German reunification, they often specialize or are drawn to the cities. In the countryside, however, a general practitioner is needed first. The federal states are trying to counteract this problem, for example, by providing scholarships for students who promise to settle in a rural area when finally becoming a doctor (Deutschlandfunk, 2022).
Citations:
Beauftragter der Bundesregierung für die Belange von Menschen mit Behinderungen. n.d. “Gesundheit – gute Versorgung für alle.” https://www.behindertenbeauftragter.de/DE/AS/schwerpunkte/gesundheit/gesundheit-node.html
Bundesministerium für Gesundheit. 2023. “Startschuss: Aktionsplan für ein diverses, inklusives und barrierefreies Gesundheitswesen.” https://www.bundesgesundheitsministerium.de/presse/pressemitteilungen/startschuss-aktionsplan-fuer-diverses-inklusives-barrierefreies-gesundheitswesen
Deutschlandfunk. 2022. “Wie Länder und Kommunen Landärzte für sich gewinnen wollen.” https://www.deutschlandfunk.de/landaerzte-verzweifelt-gesucht-100.html
European Parliament. 2015. “The Policy on Gender Equality in Germany.” https://www.europarl.europa.eu/RegData/etudes/IDAN/2015/510025/IPOL_IDA(2015)510025_EN.pdf
Gesundheitsberichterstattung des Bundes. 2023. “Betten in Krankenhäusern.” https://www.gbe-bund.de/gbe/pkg_isgbe5.prc_menu_olap?p_uid=gastd&p_aid=3426115&p_sprache=D&p_help=0&p_indnr=115&p_indsp=5077&p_ityp=H&p_fid
OECD/European Observatory on Health Systems and Policies. 2023. Germany: Country Health Profile 2023, State of Health in the EU. Paris: OECD Publishing. https://doi.org/10.1787/21dd4679-en
Statistisches Landesamt Rheinland-Pfalz. 2017. “Vergleich des Gesundheitswesen für alle Bundesländer seit 2017 möglich.” Statistische Monatshefte Rheinland-Pfalz 12/2017. https://www.statistik.rlp.de/fileadmin/dokumente/monatshefte/2017/Dezember/12-2017-748.pdf
Beauftragter der Bundesregierung für die Belange von Menschen mit Behinderungen. n.d. “Gesundheit – gute Versorgung für alle.” https://www.behindertenbeauftragter.de/DE/AS/schwerpunkte/gesundheit/gesundheit-node.html
Bundesministerium für Gesundheit. 2023. “Startschuss: Aktionsplan für ein diverses, inklusives und barrierefreies Gesundheitswesen.” https://www.bundesgesundheitsministerium.de/presse/pressemitteilungen/startschuss-aktionsplan-fuer-diverses-inklusives-barrierefreies-gesundheitswesen
Deutschlandfunk. 2022. “Wie Länder und Kommunen Landärzte für sich gewinnen wollen.” https://www.deutschlandfunk.de/landaerzte-verzweifelt-gesucht-100.html
European Parliament. 2015. “The Policy on Gender Equality in Germany.” https://www.europarl.europa.eu/RegData/etudes/IDAN/2015/510025/IPOL_IDA(2015)510025_EN.pdf
Gesundheitsberichterstattung des Bundes. 2023. “Betten in Krankenhäusern.” https://www.gbe-bund.de/gbe/pkg_isgbe5.prc_menu_olap?p_uid=gastd&p_aid=3426115&p_sprache=D&p_help=0&p_indnr=115&p_indsp=5077&p_ityp=H&p_fid
OECD/European Observatory on Health Systems and Policies. 2023. Germany: Country Health Profile 2023, State of Health in the EU. Paris: OECD Publishing. https://doi.org/10.1787/21dd4679-en
Statistisches Landesamt Rheinland-Pfalz. 2017. “Vergleich des Gesundheitswesen für alle Bundesländer seit 2017 möglich.” Statistische Monatshefte Rheinland-Pfalz 12/2017. https://www.statistik.rlp.de/fileadmin/dokumente/monatshefte/2017/Dezember/12-2017-748.pdf
Japan
Article 25 of the Japanese constitution obliges the government to promote public health “in all spheres of life.” All Japanese citizens and resident non-citizens have to enroll either in the statutory health insurance system or in the public social assistance program, with coverage reaching around 98% of the population. At least 70% of the cost of healthcare services is covered by the state, while the insured pay 30% of costs, with reduced coinsurance rates for children up to six years old, people with chronic illnesses and elders. Benefits are comprehensive, covering hospital and mental healthcare, prescription drugs, outpatient and home healthcare, as well as dental care. In addition, there are a range of subsidies for some chronic diseases, as well as people living with disabilities and mental illnesses. There is also a yearly maximum for out-of-pocket payment for households using healthcare and long-term services, which varies depending on age and income.
There are some disparities in healthcare access between regions. Due to the merger of many municipalities at the beginning of the 21st century, the provision of some healthcare services and long-term care services have become problematic in depopulated rural areas. The reduction of health disparities between prefectures has been specified as one of the goals of national health promotion strategies since 2012.
There are some disparities in healthcare access between regions. Due to the merger of many municipalities at the beginning of the 21st century, the provision of some healthcare services and long-term care services have become problematic in depopulated rural areas. The reduction of health disparities between prefectures has been specified as one of the goals of national health promotion strategies since 2012.
Citations:
Prime Minister of Japan and His Cabinet. 1946. “The Constitution of Japan.” https://japan.kantei.go.jp/constitution_and_government_of_japan/constitution_e.html
Tikkanen, Roosa, Robin Osborn, Elias Mossialos, Ana Djordjevic, George A. Wharton, and Ryozo Matsuda. 2020. “International Healthcare System Profiles: Japan.” https://www.commonwealthfund.org/international-health-policy-center/countries/japan
Prime Minister of Japan and His Cabinet. 1946. “The Constitution of Japan.” https://japan.kantei.go.jp/constitution_and_government_of_japan/constitution_e.html
Tikkanen, Roosa, Robin Osborn, Elias Mossialos, Ana Djordjevic, George A. Wharton, and Ryozo Matsuda. 2020. “International Healthcare System Profiles: Japan.” https://www.commonwealthfund.org/international-health-policy-center/countries/japan
Sweden
The healthcare system is part of Sweden’s welfare services. It offers universal healthcare, with the main objective of providing good and equitable health and care for the entire population (Janlöv et al., 2023). Healthcare is decentralized, with responsibility distributed among municipal, regional, national, and EU levels. The national government is responsible for policies and regulations – in this respect, the EU also provides incentives for national regulations – while the regions plan, organize, manage resource allocation, and are responsible for inpatient care and dental care. Municipalities are responsible for long-term care. Regions and municipalities divide the responsibility for ambulatory care and public health services (Janlöv et al., 2023).
An equitable and health-promoting healthcare system is one of eight target areas in Sweden’s public health initiatives, with several agencies involved in policy and evaluation. The policy aligns with Agenda 2030 and global targets, particularly target 3 concerning health and well-being. Despite efforts to ensure an equal healthcare system, differences in health persist between groups and regions.
The national evaluation of healthcare in 2022 shows a positive trend, but differences remain. Healthcare-related avoidable mortality and the health gap have decreased across the population, but they are larger for those with pre-secondary education compared to other education groups. Individuals in poor health report a more negative experience with healthcare and care coordination than those in good health.
“`Covid-19 affected the population unequally. The number of individuals who fell ill and required intensive care was higher among those with pre-secondary education and those born outside of Sweden. The relative difference between individuals with varying levels of education remained constant from 2020 to 2022. However, the disparity based on country of birth was significantly higher at the beginning of the pandemic but decreased in 2022 (PHA, 2023).“`
Further, regional differences affect the quality of and access to healthcare, particularly regarding waiting times, health outcomes, and the degree to which healthcare is “patient-oriented” (AHCSA, 2022). Issues of healthcare quality and accessibility are especially challenging in rural areas, due to factors such as long distances, medical outcome measures, and continuity (AHCSA, 2021).
An equitable and health-promoting healthcare system is one of eight target areas in Sweden’s public health initiatives, with several agencies involved in policy and evaluation. The policy aligns with Agenda 2030 and global targets, particularly target 3 concerning health and well-being. Despite efforts to ensure an equal healthcare system, differences in health persist between groups and regions.
The national evaluation of healthcare in 2022 shows a positive trend, but differences remain. Healthcare-related avoidable mortality and the health gap have decreased across the population, but they are larger for those with pre-secondary education compared to other education groups. Individuals in poor health report a more negative experience with healthcare and care coordination than those in good health.
“`Covid-19 affected the population unequally. The number of individuals who fell ill and required intensive care was higher among those with pre-secondary education and those born outside of Sweden. The relative difference between individuals with varying levels of education remained constant from 2020 to 2022. However, the disparity based on country of birth was significantly higher at the beginning of the pandemic but decreased in 2022 (PHA, 2023).“`
Further, regional differences affect the quality of and access to healthcare, particularly regarding waiting times, health outcomes, and the degree to which healthcare is “patient-oriented” (AHCSA, 2022). Issues of healthcare quality and accessibility are especially challenging in rural areas, due to factors such as long distances, medical outcome measures, and continuity (AHCSA, 2021).
Citations:
AHCSA. 2021. Långt bort men nära. Kartläggning av primärvården i landsbygden. Stockholm: The Agency for Health and Care Services Analysis.
AHCSA. 2022. Nationell uppföljning av hälso- och sjukvården 2022 - Indikatorer på kvalitet, jämlikhet och effektivitet. Stockholm: The Agency for Health and Care Services Analysis.
Janlöv, N., Blume, S., Glenngård, A.H., Hanspers, K., Anell, A., and Merkur, S. 2023. “Sweden: Health System Review.” Health Systems in Transition 25 (4). European Observatory on Health Systems and Policies.
PHA. 2023. “Folkhälsan i Sverige - Årsrapport 2023.” https://www.folkhalsomyndigheten.se/contentassets/a448b27d603c44f590fc1aff741b0d5d/folkhalsan-sverige-arsrapport-2023.pdf
AHCSA. 2021. Långt bort men nära. Kartläggning av primärvården i landsbygden. Stockholm: The Agency for Health and Care Services Analysis.
AHCSA. 2022. Nationell uppföljning av hälso- och sjukvården 2022 - Indikatorer på kvalitet, jämlikhet och effektivitet. Stockholm: The Agency for Health and Care Services Analysis.
Janlöv, N., Blume, S., Glenngård, A.H., Hanspers, K., Anell, A., and Merkur, S. 2023. “Sweden: Health System Review.” Health Systems in Transition 25 (4). European Observatory on Health Systems and Policies.
PHA. 2023. “Folkhälsan i Sverige - Årsrapport 2023.” https://www.folkhalsomyndigheten.se/contentassets/a448b27d603c44f590fc1aff741b0d5d/folkhalsan-sverige-arsrapport-2023.pdf
7
Austria
The existing policies and regulations largely ensure equitable access to healthcare. There are specific rules designed to support people with certain illnesses or, more generally, those with low incomes; for example, these groups do not have to pay any prescription fees for pharmaceuticals.
However, as mentioned above, the share of the population for whom swift treatment and free choice of doctors is always available is shrinking. This trend is due to an increasing shortage of registered doctors accepting patients with any kind of public health insurance. The lack of these “Kassenärzte” is particularly felt in rural areas. Additionally, there is a notable difference between individual states in terms of the number of hospitals, leading to certain regional disparities.
In 2022 it became known that the “Wiener Gesundheitsverbund” – which represents doctors and care staff in Vienna – had issued an internal directive instructing Viennese hospitals not to treat patients lacking primary residential status in Vienna, due to a lack of resources (Stepan 2022). This directive is not in line with laws that explicitly allow any resident of Austria to report to any hospital in the country.
People with private health insurance are generally admitted to hospitals more easily, receive more timely treatment, and sometimes even better care. For example, some medications, such as Sofosbuvir for Hepatitis C, are only available to those with private health insurance.
While a latent division exists between groups of the population dependent on publicly financed treatment and those able to pay for particular treatments from their own funds, this bias does not strongly correlate with other features such as gender or ethnicity. The group of resident migrants in Austria includes both poor and exceptionally well-off individuals. Additionally, unlike some other countries, such as Germany, asylum-seekers in Austria have full and immediate access to the Austrian health system (praktischarzt.at n.d.).
Furthermore, unmet need (see P11.8) is quite low in Austria, according to data from Eurostat.
However, as mentioned above, the share of the population for whom swift treatment and free choice of doctors is always available is shrinking. This trend is due to an increasing shortage of registered doctors accepting patients with any kind of public health insurance. The lack of these “Kassenärzte” is particularly felt in rural areas. Additionally, there is a notable difference between individual states in terms of the number of hospitals, leading to certain regional disparities.
In 2022 it became known that the “Wiener Gesundheitsverbund” – which represents doctors and care staff in Vienna – had issued an internal directive instructing Viennese hospitals not to treat patients lacking primary residential status in Vienna, due to a lack of resources (Stepan 2022). This directive is not in line with laws that explicitly allow any resident of Austria to report to any hospital in the country.
People with private health insurance are generally admitted to hospitals more easily, receive more timely treatment, and sometimes even better care. For example, some medications, such as Sofosbuvir for Hepatitis C, are only available to those with private health insurance.
While a latent division exists between groups of the population dependent on publicly financed treatment and those able to pay for particular treatments from their own funds, this bias does not strongly correlate with other features such as gender or ethnicity. The group of resident migrants in Austria includes both poor and exceptionally well-off individuals. Additionally, unlike some other countries, such as Germany, asylum-seekers in Austria have full and immediate access to the Austrian health system (praktischarzt.at n.d.).
Furthermore, unmet need (see P11.8) is quite low in Austria, according to data from Eurostat.
Citations:
https://kommunal.at/gesundheitsversorgung-im-laendlichen-raum
Stepan, Max. 2022. “Personen ohne Wiener Hauptwohnsitz werden in Wiener Spitälern abgewiesen.” https://www.derstandard.at/story/2000141642420/personen-ohne-hauptwohnsitz-werden-in-wiener-spitaelern-abgewiesen
praktischarzt.at. n.d. “Gesundheit von Flüchtlingen: Österreich vs. Deutschland.” https://www.praktischarzt.at/magazin/gesundheit-von-gefluechteten-oesterreich-vs-deutschland/
https://www.oesterreich.gv.at/themen/soziales/armut/3/Seite.1693901.html
https://kommunal.at/gesundheitsversorgung-im-laendlichen-raum
Stepan, Max. 2022. “Personen ohne Wiener Hauptwohnsitz werden in Wiener Spitälern abgewiesen.” https://www.derstandard.at/story/2000141642420/personen-ohne-hauptwohnsitz-werden-in-wiener-spitaelern-abgewiesen
praktischarzt.at. n.d. “Gesundheit von Flüchtlingen: Österreich vs. Deutschland.” https://www.praktischarzt.at/magazin/gesundheit-von-gefluechteten-oesterreich-vs-deutschland/
https://www.oesterreich.gv.at/themen/soziales/armut/3/Seite.1693901.html
Belgium
Belgium has a world-class healthcare system, with a large number of physicians, hospital beds, and equipment. However, these numbers are skewed by past investments, which led to overspending and a deficit. This issue is being addressed by policies that reduce the number of graduates allowed to practice medicine, as well as by cuts to wages and personnel. These budget cuts are likely to weaken the healthcare system in the long term. Importantly, this situation is shared with most other European countries and is not unique to Belgium, which currently performs better than, for instance, the UK. The current health minister is well aware of the problem and has implemented several measures to mitigate the risks. However, these measures alone will likely prove insufficient in the decades ahead.
Healthcare access in Belgium is not fully equal, with an increasing portion of the population postponing treatments for financial reasons, according to the Socialist mutual insurance company. However, this is not as severe a problem as in the United States. Belgium’s healthcare system provides near-universal access to a wide range of medical services, with the poorest benefiting from a “maximum à facturer,” which is a ceiling on total medical out-of-pocket expenses. Coverage includes preventive care (although increasingly difficult to access due to doctor shortages), hospital care (similarly challenging due to financial constraints), and prescription drugs. The system is funded through a combination of social security contributions and taxes, ensuring that everyone, regardless of income, has access to high-quality healthcare. Belgians report high satisfaction with their healthcare system, ranking among the best in the OECD (OECD 2023).
Policies have been implemented to reduce the burden of paying medical fees. Starting in 2024, citizens under 24 years old in poverty can visit the doctor without any cost. Generally, citizens do not have to pay the full cost of medication or medical appointments upfront but only a portion not covered by social security. These policies help to achieve equitable access to high-quality healthcare. Yet, a significant proportion of citizens (1 in 20, mainly young males in poor economic situations) cannot afford or decide not to seek medical care due to costs (https://www.lesoir.be/280978/article/2020-02-18/un-belge-sur-20-ne-va-pas-chez-le-medecin).
Healthcare access in Belgium is not fully equal, with an increasing portion of the population postponing treatments for financial reasons, according to the Socialist mutual insurance company. However, this is not as severe a problem as in the United States. Belgium’s healthcare system provides near-universal access to a wide range of medical services, with the poorest benefiting from a “maximum à facturer,” which is a ceiling on total medical out-of-pocket expenses. Coverage includes preventive care (although increasingly difficult to access due to doctor shortages), hospital care (similarly challenging due to financial constraints), and prescription drugs. The system is funded through a combination of social security contributions and taxes, ensuring that everyone, regardless of income, has access to high-quality healthcare. Belgians report high satisfaction with their healthcare system, ranking among the best in the OECD (OECD 2023).
Policies have been implemented to reduce the burden of paying medical fees. Starting in 2024, citizens under 24 years old in poverty can visit the doctor without any cost. Generally, citizens do not have to pay the full cost of medication or medical appointments upfront but only a portion not covered by social security. These policies help to achieve equitable access to high-quality healthcare. Yet, a significant proportion of citizens (1 in 20, mainly young males in poor economic situations) cannot afford or decide not to seek medical care due to costs (https://www.lesoir.be/280978/article/2020-02-18/un-belge-sur-20-ne-va-pas-chez-le-medecin).
Citations:
OECD 2023: https://www.oecd.org/publication/government-at-a-glance/2023/country-notes/belgium-054f6923/
https://www.ghsindex.org/country/belgium/
https://www.lesoir.be/280978/article/2020-02-18/un-belge-sur-20-ne-va-pas-chez-le-medecin
WHO. 2023. “Can People Afford to Pay for Healthcare? New Evidence on Financial Protection in Belgium.” https://www.who.int/europe/news/item/28-02-2023-can-people-afford-to-pay-for-health-care–new-evidence-on-financial-protection-in-belgium
https://vandenbroucke.belgium.be/fr/114-millions-d-euros-pour-un-trajet-de-soins-sp-cialis-pour-les-jeunes-souffrant-de-troubles
https://vandenbroucke.belgium.be/fr/frank-vandenbroucke-investit-dans-un-meilleur-suivi-des-m-res-vuln-rables-pendant-et-apr-s-la
https://vandenbroucke.belgium.be/fr/s-curit-tarifaire-meilleure-accessibilit-meilleurs-soins-et-r-mun-rations-correctes-gr-ce-des
OECD 2023: https://www.oecd.org/publication/government-at-a-glance/2023/country-notes/belgium-054f6923/
https://www.ghsindex.org/country/belgium/
https://www.lesoir.be/280978/article/2020-02-18/un-belge-sur-20-ne-va-pas-chez-le-medecin
WHO. 2023. “Can People Afford to Pay for Healthcare? New Evidence on Financial Protection in Belgium.” https://www.who.int/europe/news/item/28-02-2023-can-people-afford-to-pay-for-health-care–new-evidence-on-financial-protection-in-belgium
https://vandenbroucke.belgium.be/fr/114-millions-d-euros-pour-un-trajet-de-soins-sp-cialis-pour-les-jeunes-souffrant-de-troubles
https://vandenbroucke.belgium.be/fr/frank-vandenbroucke-investit-dans-un-meilleur-suivi-des-m-res-vuln-rables-pendant-et-apr-s-la
https://vandenbroucke.belgium.be/fr/s-curit-tarifaire-meilleure-accessibilit-meilleurs-soins-et-r-mun-rations-correctes-gr-ce-des
Czechia
A core set of healthcare services covers the entire population in Czechia. Under the public health insurance system, all individuals with permanent residence in Czechia are required to have health insurance. Additionally, individuals without permanent residence in Czechia must be insured if they are employed by an employer with a registered office or permanent residence in the country. Currently, there are seven health insurance companies in Czechia, though they do not compete on the quality of healthcare provision.
Mandatory prepayment covers 86.4% of total healthcare expenditure (2021), which is higher than the OECD average. Healthcare is generally accessible to all population groups without exception. General satisfaction with the availability of quality healthcare in Czechia is high at 77%, compared to the OECD average of 67% (OECD 2023).
Health insurance companies are obligated to ensure the timely and local availability of healthcare. However, according to data from the Institute of Health Information and Statistics of the Czech Republic (ÚZIS ČR), an average of 8% of children were not registered with a pediatrician by the end of 2022. Many Ukrainian refugees in Czechia have also reported difficulties finding a general practitioner, pediatrician, dentist, or gynecologist. There are regional differences in healthcare availability that seem inversely related to need. For example, life expectancy is 5% higher in Prague than in Ústecký, the region with the worst health profile, and infant mortality in Prague is only one-third the level in Ústecký. Long-term health problems are also more commonly reported in Ústecký. Despite this, the number of non-hospital doctors is 2.2 times higher in Prague than in the Ústecký region.
Mandatory prepayment covers 86.4% of total healthcare expenditure (2021), which is higher than the OECD average. Healthcare is generally accessible to all population groups without exception. General satisfaction with the availability of quality healthcare in Czechia is high at 77%, compared to the OECD average of 67% (OECD 2023).
Health insurance companies are obligated to ensure the timely and local availability of healthcare. However, according to data from the Institute of Health Information and Statistics of the Czech Republic (ÚZIS ČR), an average of 8% of children were not registered with a pediatrician by the end of 2022. Many Ukrainian refugees in Czechia have also reported difficulties finding a general practitioner, pediatrician, dentist, or gynecologist. There are regional differences in healthcare availability that seem inversely related to need. For example, life expectancy is 5% higher in Prague than in Ústecký, the region with the worst health profile, and infant mortality in Prague is only one-third the level in Ústecký. Long-term health problems are also more commonly reported in Ústecký. Despite this, the number of non-hospital doctors is 2.2 times higher in Prague than in the Ústecký region.
Citations:
Health at a Glance. OECD 2023. https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2023_7a7afb35-en
Health at a Glance. OECD 2023. https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2023_7a7afb35-en
Denmark
The Danish healthcare system is universal and provides healthcare to all citizens. The system is based on the premise of equity in healthcare provision. Essential healthcare is available in all regions of the country, but the Ministry of the Interior and Healthcare is concerned that doctors and other healthcare staff cannot be recruited in the low-population parts of the country (Ministry of the Interior and Healthcare 2023).
The lack of trained personnel has the potential to create unequal access to healthcare across different regions.
Several governments have pursued a strategy of consolidating treatments in so-called super-hospitals to offer specialized care that requires high levels of expertise. The cost of this consolidation is that distances to hospitals have increased significantly in parts of the country. To remedy this issue, the current government has proposed establishing 21 hospitals that offer fewer treatments than the super-hospitals, but are closer to local communities. According to the plan, these hospitals will be built starting in 2024. The staff-shortage problems are not alleviated by building more hospitals, however.
The lack of trained personnel has the potential to create unequal access to healthcare across different regions.
Several governments have pursued a strategy of consolidating treatments in so-called super-hospitals to offer specialized care that requires high levels of expertise. The cost of this consolidation is that distances to hospitals have increased significantly in parts of the country. To remedy this issue, the current government has proposed establishing 21 hospitals that offer fewer treatments than the super-hospitals, but are closer to local communities. According to the plan, these hospitals will be built starting in 2024. The staff-shortage problems are not alleviated by building more hospitals, however.
Citations:
Ministry of the Interior and Healthcare. 2023. “Udfordringer i Sundhedsvæsnet.” https://sum.dk/nyheder/2023/december/analyse-sundhedsvaesenets-udfordringer
Ministry of the Interior and Healthcare. 2023. “Udfordringer i Sundhedsvæsnet.” https://sum.dk/nyheder/2023/december/analyse-sundhedsvaesenets-udfordringer
France
The French healthcare system provides good access to care with low out-of-pocket payments (OECD 2023).
Two sources of inequality can be identified: one financial and one geographical. Cost-sharing, in which the statutory health insurance program often reimburses only a tiny share of the patient’s expenditure, may constitute an insurmountable burden for low-income households. This being said, there are specific schemes for protecting very low-income and chronically ill populations from cost-sharing and up-front payments. Furthermore, the situation has improved recently for basic dentures, hearing aids and optical services, but remains problematic when it comes to consulting certain specialists. However, most of the population relies on complementary health insurance programs that are not tied to incomes, and thus create significant differences in access.
These problems may become particularly problematic when combined with geographical inequalities. Even basic primary care can be very difficult to access in certain areas. Despite the advertised goal of creating multidisciplinary primary care units, there has not been a substantial improvement in coverage. Access times for outpatient settings may diverge widely; waiting times can be significant, and appear to be increasing. According to Eurostat figures, unmet care needs in France were slightly higher than the EU average in 2021.
Two sources of inequality can be identified: one financial and one geographical. Cost-sharing, in which the statutory health insurance program often reimburses only a tiny share of the patient’s expenditure, may constitute an insurmountable burden for low-income households. This being said, there are specific schemes for protecting very low-income and chronically ill populations from cost-sharing and up-front payments. Furthermore, the situation has improved recently for basic dentures, hearing aids and optical services, but remains problematic when it comes to consulting certain specialists. However, most of the population relies on complementary health insurance programs that are not tied to incomes, and thus create significant differences in access.
These problems may become particularly problematic when combined with geographical inequalities. Even basic primary care can be very difficult to access in certain areas. Despite the advertised goal of creating multidisciplinary primary care units, there has not been a substantial improvement in coverage. Access times for outpatient settings may diverge widely; waiting times can be significant, and appear to be increasing. According to Eurostat figures, unmet care needs in France were slightly higher than the EU average in 2021.
Citations:
OECD. 2023. “France: Country Health Profile 2023.” https://eurohealthobservatory.who.int/publications/m/france-country-health-profile-2023
OECD. 2023. “France: Country Health Profile 2023.” https://eurohealthobservatory.who.int/publications/m/france-country-health-profile-2023
Italy
Universal access to healthcare is a constitutional guarantee in Italy. However, significant differences exist in the quality of services provided. Even at the essential national level, disparities result in a pronounced gap between northern and southern Italy. Each year, about 1 million southern Italians travel to northern and central Italy to address their health needs. Long queues in public facilities for free access to more expensive medical tests and analyses often push people to seek private facilities, which come at a cost, disproportionately affecting lower-income individuals.
In 2021, a national plan for equity in health was launched (Plan 2021–2027) with investments from the European Regional Development Fund. The results of this plan are not yet available.
In 2021, a national plan for equity in health was launched (Plan 2021–2027) with investments from the European Regional Development Fund. The results of this plan are not yet available.
Citations:
Ministry of Health. 2021. “National Plan for Equity in Health.” https://www.pnes.salute.gov.it/imgs/C_17_pagineAree_6049_0_file.pdf
Fondazione Gimbe. 2023. “Rapporto sulla mobilitl regionale 2020.” https://www.gimbe.org/osservatorio/Report_Osservatorio_GIMBE_2023.02_Mobilita_sanitaria_2020.pdf
Ministry of Health. 2021. “National Plan for Equity in Health.” https://www.pnes.salute.gov.it/imgs/C_17_pagineAree_6049_0_file.pdf
Fondazione Gimbe. 2023. “Rapporto sulla mobilitl regionale 2020.” https://www.gimbe.org/osservatorio/Report_Osservatorio_GIMBE_2023.02_Mobilita_sanitaria_2020.pdf
Norway
Norway has universal health insurance, covering the entire population for all health issues except dental care. The country is divided into four health regions, with hospitals organized as public enterprises financed by a combination of state grants, activity-related transfers, and patient co-payments. Primary care is the responsibility of the 357 local authorities.
In 2022, 10% of GDP was allocated to health services. Generally, the services are of high quality and accessible to all in need throughout the country. Every citizen has their own GP. For 2024, the maximum patient co-payment is limited to NOK 3,165, which is so small that, in practice, no groups are excluded from the help they need.
There is a system of guarantees for treatment within a specified time limit for different conditions, but there are no formal sanctions if hospitals violate these norms. Social inequalities in health are significant and persistent. However, differences in social class lifestyles and behavior are more powerful explanations for these inequalities than differences in access to health services.
In 2022, 10% of GDP was allocated to health services. Generally, the services are of high quality and accessible to all in need throughout the country. Every citizen has their own GP. For 2024, the maximum patient co-payment is limited to NOK 3,165, which is so small that, in practice, no groups are excluded from the help they need.
There is a system of guarantees for treatment within a specified time limit for different conditions, but there are no formal sanctions if hospitals violate these norms. Social inequalities in health are significant and persistent. However, differences in social class lifestyles and behavior are more powerful explanations for these inequalities than differences in access to health services.
Portugal
The Constitution of the Portuguese Republic explicitly guarantees the right to health protection through a universal and comprehensive national health service accessible to everyone across the country (CRP, Article 64). While there are more private hospitals, the majority of health services are still provided by hospitals in the national health service or through public-private partnerships (INE, 2023). Access to public hospitals generally involves low fees, with exemptions for certain groups such as lower-income households from paying “user fees” (“taxas moderadoras”). The Ministry of Health has also introduced programs to ensure universal access to certain medications, including a recent initiative to provide new-generation insulin pumps through the NHS until 2026 (SNS, 2023).
Despite these provisions, there are challenges with access to primary healthcare. Approximately 1.7 million Portuguese lack a regular family doctor, a proportion that has risen by 29% in just one year, mainly due to the retirement of doctors that were not replaced (Diário de Notícias, 2023). This shortage has led to long queues for appointments at health centers and compromises timely medical care for some, especially those without access to private healthcare. Consequently, an increasing number of Portuguese are opting for health insurance and turning to the private sector. The challenge is further compounded by regional disparities, particularly in low-density areas like Alentejo, where there is a smaller network of public and private health facilities.
However, these challenges do not completely hinder access to healthcare. The OECD’s most recent health profile for Portugal, from 2021, indicates that only a small percentage of people reported unmet medical needs due to factors such as cost, distance, or waiting time (OECD, 2021). Existing evidence suggests a deterioration of this pattern since that report was published.
Despite these provisions, there are challenges with access to primary healthcare. Approximately 1.7 million Portuguese lack a regular family doctor, a proportion that has risen by 29% in just one year, mainly due to the retirement of doctors that were not replaced (Diário de Notícias, 2023). This shortage has led to long queues for appointments at health centers and compromises timely medical care for some, especially those without access to private healthcare. Consequently, an increasing number of Portuguese are opting for health insurance and turning to the private sector. The challenge is further compounded by regional disparities, particularly in low-density areas like Alentejo, where there is a smaller network of public and private health facilities.
However, these challenges do not completely hinder access to healthcare. The OECD’s most recent health profile for Portugal, from 2021, indicates that only a small percentage of people reported unmet medical needs due to factors such as cost, distance, or waiting time (OECD, 2021). Existing evidence suggests a deterioration of this pattern since that report was published.
Citations:
CRP, Constituição da República Portuguesa, artigo 64º (Capítulo II, Parte I).
Diário de Notícias. 2023. “Utentes sem médico de família aumentam 29% num ano.”
https://www.dn.pt/sociedade/utentes-sem-medico-de-familia-aumentam-29-num-ano–16375028.html
OECD. 2021. Portugal: Country Health Profile 2021, State of Health in the EU. Paris: OECD Publishing/European Observatory on Health Systems and Policies, Brussels.
https://health.ec.europa.eu/system/files/2021-12/2021_chp_pt_english.pdf
INE. 2023. “Indicadores da Saúde.” https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_indicadores&userLoadSave=Load&userTableOrder=11485&tipoSeleccao=1&contexto=pq&selTab=tab1&submitLoad=true
SNS. 2023. “Governo cria programa de acesso universal a bombas de insulina de nova geração.” https://www.sns.gov.pt/noticias/2023/05/31/governo-cria-programa-de-acesso-universal-a-bombas-de-insulina-de-nova-geracao/
CRP, Constituição da República Portuguesa, artigo 64º (Capítulo II, Parte I).
Diário de Notícias. 2023. “Utentes sem médico de família aumentam 29% num ano.”
https://www.dn.pt/sociedade/utentes-sem-medico-de-familia-aumentam-29-num-ano–16375028.html
OECD. 2021. Portugal: Country Health Profile 2021, State of Health in the EU. Paris: OECD Publishing/European Observatory on Health Systems and Policies, Brussels.
https://health.ec.europa.eu/system/files/2021-12/2021_chp_pt_english.pdf
INE. 2023. “Indicadores da Saúde.” https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_indicadores&userLoadSave=Load&userTableOrder=11485&tipoSeleccao=1&contexto=pq&selTab=tab1&submitLoad=true
SNS. 2023. “Governo cria programa de acesso universal a bombas de insulina de nova geração.” https://www.sns.gov.pt/noticias/2023/05/31/governo-cria-programa-de-acesso-universal-a-bombas-de-insulina-de-nova-geracao/
Spain
Equitable access to healthcare is guaranteed throughout Spain, despite persistent social differences. The system offers universal healthcare regardless of socioeconomic status, age, gender, or ethnicity. However, the challenges facing the public health system have led Spaniards to spend a record amount on private health insurance in 2022.
Essential healthcare is guaranteed in all autonomous communities, and individual satisfaction with the health system does not vary substantially across regions (with Cantabria peaking at 6.83 and Andalusia recording the lowest at 5.87 in 2023). Nonetheless, significant differences exist among and within autonomous communities regarding access to healthcare. Variations in regional health spending reflect efforts to ensure equivalent access to welfare across the country, but differences persist due to regional governments’ preferences and ideologies and varying service provision conditions (population dispersion or congestion). These issues highlight the need for reforming the financing of the Spanish territorial model.
Essential healthcare is guaranteed in all autonomous communities, and individual satisfaction with the health system does not vary substantially across regions (with Cantabria peaking at 6.83 and Andalusia recording the lowest at 5.87 in 2023). Nonetheless, significant differences exist among and within autonomous communities regarding access to healthcare. Variations in regional health spending reflect efforts to ensure equivalent access to welfare across the country, but differences persist due to regional governments’ preferences and ideologies and varying service provision conditions (population dispersion or congestion). These issues highlight the need for reforming the financing of the Spanish territorial model.
Citations:
Ministerio de Sanidad. 2023. “Indicadores clave del sistema nacional de salud.” URL
Rosa Urbanos-Garrido. 2016. “La desigualdad en el acceso a las prestaciones sanitarias. Propuestas para lograr la equidad.” Gaceta Sanitaria 30(S1): 25–30.
Ministerio de Sanidad. 2023. “Indicadores clave del sistema nacional de salud.” URL
Rosa Urbanos-Garrido. 2016. “La desigualdad en el acceso a las prestaciones sanitarias. Propuestas para lograr la equidad.” Gaceta Sanitaria 30(S1): 25–30.
Switzerland
High-quality healthcare is accessible to all inhabitants, as basic insurance coverage is mandatory in Switzerland. However, an explorative small-N study conducted in the canton of Vaud showed that 40% of health insurance companies refused affiliation to undocumented migrants, which is against the law (Dabboudi et al. 2011).
However, there are further qualifications: As in many other countries, the supply of medical services varies by region, with large cities having higher densities of medical staff. More serious are the side effects of self-payments by patients. The share of healthcare costs borne by individuals is comparatively very high in Switzerland. Individuals pay a monthly health insurance premium (on average more than CHF 300), an annual deductible, and an additional participation in purchased medication and hospitalization costs. The basic insurance package does not cover elements that are considered basic elsewhere, including dental care, glasses or physiotherapy. For additional optional health insurance packages, the costs depend on individual characteristics, and health insurance providers can reject applicants. This accounts for inequalities in health access.
Drawing on several studies, the federal government reported that the proportion of people who forego medical services for cost reasons is in the range of 10% to 20% of the population. According to a report by the Swiss Health Observatory, the proportion of the population that has given up going to the doctor because of cost-related reasons rose sharply between 2010 and 2016, and is most marked in the 18 to 45 age group, with an increase of around 15% (Merçay 2016). The proportion of those who would forego necessary services is in the lower single-digit percentage range, although it is very difficult to define “necessary treatments” (Federal Council 2017: 22-26).
However, there are further qualifications: As in many other countries, the supply of medical services varies by region, with large cities having higher densities of medical staff. More serious are the side effects of self-payments by patients. The share of healthcare costs borne by individuals is comparatively very high in Switzerland. Individuals pay a monthly health insurance premium (on average more than CHF 300), an annual deductible, and an additional participation in purchased medication and hospitalization costs. The basic insurance package does not cover elements that are considered basic elsewhere, including dental care, glasses or physiotherapy. For additional optional health insurance packages, the costs depend on individual characteristics, and health insurance providers can reject applicants. This accounts for inequalities in health access.
Drawing on several studies, the federal government reported that the proportion of people who forego medical services for cost reasons is in the range of 10% to 20% of the population. According to a report by the Swiss Health Observatory, the proportion of the population that has given up going to the doctor because of cost-related reasons rose sharply between 2010 and 2016, and is most marked in the 18 to 45 age group, with an increase of around 15% (Merçay 2016). The proportion of those who would forego necessary services is in the lower single-digit percentage range, although it is very difficult to define “necessary treatments” (Federal Council 2017: 22-26).
Citations:
Dabboubi, N., J. Diakhate, S. Piergiovanni, D. Solari, and D. Utebay. 2011. “Sans-papiers mais pas sans droit à la santé.” Revue médicale suisse 288 (3): 717–718.
Federal Council (Bundesrat). 2017. Kostenbeteiligung in der obligatorischen Krankenpflegeversicherung. Bericht des Bundesrats in Erfüllung des Postulats Schmid-Federer vom 22.03.2013 (13.3250 «Auswirkung der Franchise auf die Inanspruchnahme von medizinischen Leistungen») 28.06.2017. Bern: Bundesrat.
Mercay, Clémence. 2016. “Expeìrience de la population âgeìe de 18 ans et plus avec le systeÌme de santeì – Situation en Suisse et comparaison internationale: Analyse de l’International Health Policy Survey 2016 du Commonwealth Fund sur mandat de l’Office feìdeìral de la santeì publique (OFSP) (Obsan Dossier No. 56).” Neuchâtel: Observatoire suisse de la santeì. https://www.obsan.admin.ch/fr/publications/2016-experience-de-la-population-agee-de-18-ans-et-plus-avec-le-systeme-de-sante
Dabboubi, N., J. Diakhate, S. Piergiovanni, D. Solari, and D. Utebay. 2011. “Sans-papiers mais pas sans droit à la santé.” Revue médicale suisse 288 (3): 717–718.
Federal Council (Bundesrat). 2017. Kostenbeteiligung in der obligatorischen Krankenpflegeversicherung. Bericht des Bundesrats in Erfüllung des Postulats Schmid-Federer vom 22.03.2013 (13.3250 «Auswirkung der Franchise auf die Inanspruchnahme von medizinischen Leistungen») 28.06.2017. Bern: Bundesrat.
Mercay, Clémence. 2016. “Expeìrience de la population âgeìe de 18 ans et plus avec le systeÌme de santeì – Situation en Suisse et comparaison internationale: Analyse de l’International Health Policy Survey 2016 du Commonwealth Fund sur mandat de l’Office feìdeìral de la santeì publique (OFSP) (Obsan Dossier No. 56).” Neuchâtel: Observatoire suisse de la santeì. https://www.obsan.admin.ch/fr/publications/2016-experience-de-la-population-agee-de-18-ans-et-plus-avec-le-systeme-de-sante
6
Australia
The Medicare system and the Pharmaceutical Benefits scheme together do a reasonably good job in promoting equitable access to high-quality healthcare. Nonetheless, there are important deficiencies (Butler et al. 2019). For those residing outside major cities, access to medical care is significantly less developed. This is primarily due to difficulties in attracting healthcare workers to these regions, despite efforts to encourage them. Additionally, there are substantial disparities in healthcare service provision and outcomes across socioeconomic groups and between Australia’s Indigenous and non-Indigenous populations. Consequently, the burden of risk factors is unequally distributed. For instance, obesity (high body mass index) is the leading risk factor in the population. While 31% of Australians live with obesity, the figure rises to 43% among Indigenous people. (The Lancet Public Health 2023).
Citations:
Butler, S., Daddia, J., Azizi, T. 2019. “The time to act is now.” https://www.pwc.com.au/health/health-matters/the-future-of-health-in-australia.html
The Lancet Public Health. 2023. “Health and Inequity in Australia.” The Lancet 8 (8): E575. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00157-3/fulltext
Butler, S., Daddia, J., Azizi, T. 2019. “The time to act is now.” https://www.pwc.com.au/health/health-matters/the-future-of-health-in-australia.html
The Lancet Public Health. 2023. “Health and Inequity in Australia.” The Lancet 8 (8): E575. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00157-3/fulltext
Finland
The national hospital system delivers high-quality care for acute conditions, but key challenges include improving primary care for the growing number of people with chronic conditions and enhancing coordination between primary care and hospitals.
The Finnish healthcare system divides people into two main categories. Occupational primary healthcare is available for employed individuals. Those outside the labor force – such as the unemployed, temporary workers and self-employed people – rely instead on the public healthcare service, which has fewer resources and offers fewer services. As a result, equitable access to primary healthcare in terms of timeliness, quality and scope, regardless of socioeconomic status, is not ensured. Consequently, socioeconomic inequalities in health outcomes persist (YLE News, 2023).
There is more equitable access to specialized care, but the fact that patients are often channeled from primary to specialized care means there is also unequal access to specialized care.
Integration of occupational primary healthcare and public primary healthcare has proved impossible due to the vested interests of private healthcare companies and labor unions.
However, social and healthcare reform has successfully reduced regional differences in access to essential healthcare, as the number of healthcare organizers was dramatically reduced in the reform.
The Finnish healthcare system divides people into two main categories. Occupational primary healthcare is available for employed individuals. Those outside the labor force – such as the unemployed, temporary workers and self-employed people – rely instead on the public healthcare service, which has fewer resources and offers fewer services. As a result, equitable access to primary healthcare in terms of timeliness, quality and scope, regardless of socioeconomic status, is not ensured. Consequently, socioeconomic inequalities in health outcomes persist (YLE News, 2023).
There is more equitable access to specialized care, but the fact that patients are often channeled from primary to specialized care means there is also unequal access to specialized care.
Integration of occupational primary healthcare and public primary healthcare has proved impossible due to the vested interests of private healthcare companies and labor unions.
However, social and healthcare reform has successfully reduced regional differences in access to essential healthcare, as the number of healthcare organizers was dramatically reduced in the reform.
Citations:
YLE News. 2023. “Amnesty Report: Parts of Finland’s Healthcare System Have Failed.” https://yle.fi/a/74-20036481
YLE News. 2023. “Amnesty Report: Parts of Finland’s Healthcare System Have Failed.” https://yle.fi/a/74-20036481
Israel
There are differences in the availability of healthcare services between the center and periphery of the country. The average distance to the closest healthcare facility in the center is 29.7 km, while the average distance in the north is 133 km. The number of hospital beds is also lower in peripheral regions than in the center, as are waiting times for specialist services.
In 2018, the Ministry of Health issued a directive that health equity should be considered in all healthcare policymaking. The ministry has provided guidelines on promoting health equity when designing policies. Additionally, it created a database on health inequalities and gaps among various populations, which is periodically updated.
One of the barriers to equitable health treatment is the availability of expert physicians in peripheral areas. To address this issue, expert physicians working in these regions and specializing in fields where there is a shortage of physicians will be eligible for a special grant.
Equality in healthcare provision is somewhat hindered by the availability of private medical services, which operate within some semi-public hospitals, and are financed by private and semi-private insurance. These services and insurance plans mainly serve middle-class families and allow them, for example, to choose a surgeon or to receive medical treatments that are not included in the universal healthcare basket (Filc 2018).
In 2018, the Ministry of Health issued a directive that health equity should be considered in all healthcare policymaking. The ministry has provided guidelines on promoting health equity when designing policies. Additionally, it created a database on health inequalities and gaps among various populations, which is periodically updated.
One of the barriers to equitable health treatment is the availability of expert physicians in peripheral areas. To address this issue, expert physicians working in these regions and specializing in fields where there is a shortage of physicians will be eligible for a special grant.
Equality in healthcare provision is somewhat hindered by the availability of private medical services, which operate within some semi-public hospitals, and are financed by private and semi-private insurance. These services and insurance plans mainly serve middle-class families and allow them, for example, to choose a surgeon or to receive medical treatments that are not included in the universal healthcare basket (Filc 2018).
Citations:
Filc, D. 2018. “Transformation and Commodification of Healthcare Services: The Israeli Case.” In A. Paz-Fuchs, R. Mandelkern, and I. Galnoor, eds. The Privatization of Israel: The Withdrawal of State Responsibility. 123-145. Palgrave Macmillan US. https://doi.org/10.1057/978-1-137-58261-4_6
Filc, D. 2018. “Transformation and Commodification of Healthcare Services: The Israeli Case.” In A. Paz-Fuchs, R. Mandelkern, and I. Galnoor, eds. The Privatization of Israel: The Withdrawal of State Responsibility. 123-145. Palgrave Macmillan US. https://doi.org/10.1057/978-1-137-58261-4_6
Lithuania
Health policies are largely aligned with the goal of achieving equitable access to high-quality healthcare, although actual access varies depending on particular location and institution. Although almost all of the population is covered for a core set of services, according to the OECD (2023), only 51% of people in Lithuania were satisfied with the availability of quality healthcare – a share considerably lower than the OECD average of 67%. The 69% of patients covered by mandatory prepayment plans was lower than the OECD average of 76%. Out-of-pocket spending, which accounted for 30% of healthcare expenditure, was higher than the OECD average of 18%. Lithuania spent $3,587 per capita on health, less than the OECD average of $4,986 (in purchasing power parity terms), which was equal to 7.5% of GDP compared to the OECD average of 9.2%.
The number of practicing doctors – 4.5 per 1,000 population – is higher than the OECD (2023) average of 3.7, but the number of practicing nurses – 7.9 per 1,000 population – is lower than the OECD average of 9.2. Lithuania had 6.1 hospital beds per 1,000 population, more than the OECD average of 4.3.
The 2020 government coalition committed to reducing the large differences in terms of healthcare that result from poverty or economic, social or regional divergences (Seimas 2020). It also indicated the intention to improve the accessibility of healthcare services irrespective of geography, organization or patient economic situation by reducing bureaucratic constraints and excessive administrative burdens, improving the access and quality of primary care, expanding the services provided by family doctors, expanding emergency services, and expanding access to and choice of compensated medicines, as well as by offering patients the best available innovative and effective methods of treatment. It also pointed to the importance of ensuring that members of the medical profession are well paid, qualified and motivated.
In 2022, the government adopted changes to the Law on Healthcare Institutions and the Law on the Healthcare System, establishing a model for the provision of individual healthcare services based on regional cooperative networks. It also amended the Law on Pharmacies, seeking to expand patients’ access to compensated medicines, while additionally expanding the list of such medicines. It also allocated new funding in order to increase salaries within the medical profession.
The number of practicing doctors – 4.5 per 1,000 population – is higher than the OECD (2023) average of 3.7, but the number of practicing nurses – 7.9 per 1,000 population – is lower than the OECD average of 9.2. Lithuania had 6.1 hospital beds per 1,000 population, more than the OECD average of 4.3.
The 2020 government coalition committed to reducing the large differences in terms of healthcare that result from poverty or economic, social or regional divergences (Seimas 2020). It also indicated the intention to improve the accessibility of healthcare services irrespective of geography, organization or patient economic situation by reducing bureaucratic constraints and excessive administrative burdens, improving the access and quality of primary care, expanding the services provided by family doctors, expanding emergency services, and expanding access to and choice of compensated medicines, as well as by offering patients the best available innovative and effective methods of treatment. It also pointed to the importance of ensuring that members of the medical profession are well paid, qualified and motivated.
In 2022, the government adopted changes to the Law on Healthcare Institutions and the Law on the Healthcare System, establishing a model for the provision of individual healthcare services based on regional cooperative networks. It also amended the Law on Pharmacies, seeking to expand patients’ access to compensated medicines, while additionally expanding the list of such medicines. It also allocated new funding in order to increase salaries within the medical profession.
Citations:
OECD. 2023. “Health at a Glance 2023 Country Note: Lithuania.” https://www.oecd.org/health/health-at-a-glance/
The Seimas. 2020. “Resolution on The Program of the Eighteenth Government of Lithuania” (in Lithuanian). 11 December, No. XIV-72
The Government of Lithuania. 2023. “The Government Annual Report for 2022.” 17 May (in Lithuanian). https://epilietis.lrv.lt/lt/naujienos/seimui-teikiama-vyriausybes-2022-metu-veik los-ataskaita
OECD. 2023. “Health at a Glance 2023 Country Note: Lithuania.” https://www.oecd.org/health/health-at-a-glance/
The Seimas. 2020. “Resolution on The Program of the Eighteenth Government of Lithuania” (in Lithuanian). 11 December, No. XIV-72
The Government of Lithuania. 2023. “The Government Annual Report for 2022.” 17 May (in Lithuanian). https://epilietis.lrv.lt/lt/naujienos/seimui-teikiama-vyriausybes-2022-metu-veik los-ataskaita
New Zealand
Despite New Zealand’s commitment to universal healthcare and policies emphasizing the importance of primary healthcare services, disparities in access to healthcare among different population groups persist.
Māori and Pasifika populations continue to face significant challenges in accessing healthcare services, resulting in poorer health outcomes than among other segments of society. Life expectancy at birth is 73.0 years for Māori males, 77.1 years for Māori females, 74.5 years for Pasifika males and 78.7 years for Pasifika females – far below the national average of 79.5 years for males and 83.2 years for females (Walters 2018). Other indicators tell the same story. For example, Pasifika and Māori children have the highest hospitalization rates for some of the most preventable diseases and infections, including respiratory and rheumatic fever (Tokalau 2023). Additionally, Māori and Pasifika women are more likely to die of breast cancer than European New Zealanders (Kowhai 2022). Furthermore, 19.9% of Māori smoke cigarettes daily, compared to a smoking rate of 7.2% for non-Māori (RNZ 2022a).
The government has implemented several policies and initiatives to address these health inequities – for example, a new algorithm used in New Zealand hospitals that will push Māori and Pasifika patients higher on waiting lists for elective surgery (Lardies 2023), the Rheumatic Fever Roadmap 2023 – 2028 (Rovoi 2023), and programs to boost the number of Māori and Pasifika doctors (RNZ 2022b). The Labour-led government (2017 – 2023) also established the Māori Health Authority (Te Aka Whai Ora), intended to address disparities in health outcomes for the Māori population. However, the new coalition government led by National has signaled that it will abolish the authority (Hill 2023).
Māori and Pasifika populations continue to face significant challenges in accessing healthcare services, resulting in poorer health outcomes than among other segments of society. Life expectancy at birth is 73.0 years for Māori males, 77.1 years for Māori females, 74.5 years for Pasifika males and 78.7 years for Pasifika females – far below the national average of 79.5 years for males and 83.2 years for females (Walters 2018). Other indicators tell the same story. For example, Pasifika and Māori children have the highest hospitalization rates for some of the most preventable diseases and infections, including respiratory and rheumatic fever (Tokalau 2023). Additionally, Māori and Pasifika women are more likely to die of breast cancer than European New Zealanders (Kowhai 2022). Furthermore, 19.9% of Māori smoke cigarettes daily, compared to a smoking rate of 7.2% for non-Māori (RNZ 2022a).
The government has implemented several policies and initiatives to address these health inequities – for example, a new algorithm used in New Zealand hospitals that will push Māori and Pasifika patients higher on waiting lists for elective surgery (Lardies 2023), the Rheumatic Fever Roadmap 2023 – 2028 (Rovoi 2023), and programs to boost the number of Māori and Pasifika doctors (RNZ 2022b). The Labour-led government (2017 – 2023) also established the Māori Health Authority (Te Aka Whai Ora), intended to address disparities in health outcomes for the Māori population. However, the new coalition government led by National has signaled that it will abolish the authority (Hill 2023).
Citations:
Hill, R. 2023. “Election Could Bring Massive Change for Māori Health Services.” RNZ, October 12. https://www.rnz.co.nz/news/te-manu-korihi/499995/election-could-bring-massive-change-for-maori-health-services
Kowhai, T. 2022. “Report finds Māori and Pasifika women more likely to die of breast cancer.” Newshub, February 4. https://www.newshub.co.nz/home/new-zealand/2022/02/report-finds-m-ori-and-pasifika-women-more-likely-to-die-of-breast-cancer.html
Lardies, G. 2023. “New Zealand starts giving priority to Māori and Pacific elective surgery patients.” The Guardian, June 20. https://www.theguardian.com/world/2023/jun/20/new-zealand-starts-giving-priority-to-maori-and-pacific-elective-surgery-patients
RNZ. 2022. “Daily Smoking Rates at All-Time Low but Remain High for Māori, Figures Show.” 17 November. https://www.rnz.co.nz/news/national/478958/daily-smoking-rates-at-all-time-low-but-remain-high-for-maori-figures-show
RNZ. 2022. “Medical School Data Shows Māori and Pasifika Doctors Likely in Coming Years.” 31 May. https://www.rnz.co.nz/news/national/468233/medical-school-data-shows-maori-and-pasifika-doctors-likely-in-coming-years
Rovoi, C. 2023. “Pasifika, Māori Prioritised as Govt Launches Roadmap to Tackle Rheumatic Fever.” Stuff, June 13. https://www.stuff.co.nz/pou-tiaki/132309132/pasifika-mori-prioritised-as-govt-launches-roadmap-to-tackle-rheumatic-fever
Tokalau, T. 2023. “Pasifika, Māori children hospitalised more often with preventable diseases, report finds.” Stuff, May 16. https://www.stuff.co.nz/national/health/132044728/pasifika-mori-children-hospitalised-more-often-with-preventable-diseases-report-finds
Walters, L. 2018. “Fact Check: Disparities Between Māori and Pākehā.” Stuff, February 9. https://www.stuff.co.nz/national/politics/101231280/fact-check-disparities-between-mori-and-pkeh
Hill, R. 2023. “Election Could Bring Massive Change for Māori Health Services.” RNZ, October 12. https://www.rnz.co.nz/news/te-manu-korihi/499995/election-could-bring-massive-change-for-maori-health-services
Kowhai, T. 2022. “Report finds Māori and Pasifika women more likely to die of breast cancer.” Newshub, February 4. https://www.newshub.co.nz/home/new-zealand/2022/02/report-finds-m-ori-and-pasifika-women-more-likely-to-die-of-breast-cancer.html
Lardies, G. 2023. “New Zealand starts giving priority to Māori and Pacific elective surgery patients.” The Guardian, June 20. https://www.theguardian.com/world/2023/jun/20/new-zealand-starts-giving-priority-to-maori-and-pacific-elective-surgery-patients
RNZ. 2022. “Daily Smoking Rates at All-Time Low but Remain High for Māori, Figures Show.” 17 November. https://www.rnz.co.nz/news/national/478958/daily-smoking-rates-at-all-time-low-but-remain-high-for-maori-figures-show
RNZ. 2022. “Medical School Data Shows Māori and Pasifika Doctors Likely in Coming Years.” 31 May. https://www.rnz.co.nz/news/national/468233/medical-school-data-shows-maori-and-pasifika-doctors-likely-in-coming-years
Rovoi, C. 2023. “Pasifika, Māori Prioritised as Govt Launches Roadmap to Tackle Rheumatic Fever.” Stuff, June 13. https://www.stuff.co.nz/pou-tiaki/132309132/pasifika-mori-prioritised-as-govt-launches-roadmap-to-tackle-rheumatic-fever
Tokalau, T. 2023. “Pasifika, Māori children hospitalised more often with preventable diseases, report finds.” Stuff, May 16. https://www.stuff.co.nz/national/health/132044728/pasifika-mori-children-hospitalised-more-often-with-preventable-diseases-report-finds
Walters, L. 2018. “Fact Check: Disparities Between Māori and Pākehā.” Stuff, February 9. https://www.stuff.co.nz/national/politics/101231280/fact-check-disparities-between-mori-and-pkeh
Slovakia
Policies and regulations largely ensure equitable access to healthcare in terms of timeliness, quality, and scope, regardless of socioeconomic status, age, gender, ethnicity, etc., as guaranteed by the constitution. However, fully equitable access to healthcare is not always possible. For example, people in rural communities do not have the same access time to emergency services as those close to main hospitals. Although there is a regulation stipulating a 15-minute response time for emergencies, in practice, this depends on the availability of emergency services.
Another practical limitation is the situation of the LGBTQ+ community. The 2023 government, at the request of the SNS party, abolished changes that simplified the process of changing gender (HNonline, 21 November 2023).
Access to essential healthcare is relatively equally guaranteed across all regions of the country by the minimum network of healthcare facilities, as mandated by government decree 640/2008. Access to basic, non-urgent services does not significantly differ between the center and the periphery, thanks to this minimum network. However, the situation is slightly worsening in peripheral areas today due to a shortage of general practitioners. It is becoming increasingly difficult to find new GPs and nurses to replace those who have retired.
As in most countries, people living in the capital, Bratislava, with its seven academic hospitals and one new, well-equipped private hospital, and to a large extent those living in cities (such as Banska Bystrica and Kosice, each with two academic hospitals, as well as Martin, Nitra, Trencin, Presov, Trnava, and Zilina), have better access to more specialized treatments.
Another practical limitation is the situation of the LGBTQ+ community. The 2023 government, at the request of the SNS party, abolished changes that simplified the process of changing gender (HNonline, 21 November 2023).
Access to essential healthcare is relatively equally guaranteed across all regions of the country by the minimum network of healthcare facilities, as mandated by government decree 640/2008. Access to basic, non-urgent services does not significantly differ between the center and the periphery, thanks to this minimum network. However, the situation is slightly worsening in peripheral areas today due to a shortage of general practitioners. It is becoming increasingly difficult to find new GPs and nurses to replace those who have retired.
As in most countries, people living in the capital, Bratislava, with its seven academic hospitals and one new, well-equipped private hospital, and to a large extent those living in cities (such as Banska Bystrica and Kosice, each with two academic hospitals, as well as Martin, Nitra, Trencin, Presov, Trnava, and Zilina), have better access to more specialized treatments.
Citations:
Nariadenie vlády Slovenskej republiky o verejnej minimálnej sieti poskytovateľov zdravotnej starostlivosti 640/2008. https://www.zakonypreludi.sk/zz/2008-640
HNonline. 2023. “Rezort zdravotníctva vyhovie SNS. Zruší zjednodušenie zmeny pohlavia pre transrodových ľudí.” https://hnonline.sk/slovensko/96116453-rezort-zdravotnictva-vyhovie-sns-zrusi-zjednodusenie-zmeny-pohlavia-pre-transrodovych-ludi
Nariadenie vlády Slovenskej republiky o verejnej minimálnej sieti poskytovateľov zdravotnej starostlivosti 640/2008. https://www.zakonypreludi.sk/zz/2008-640
HNonline. 2023. “Rezort zdravotníctva vyhovie SNS. Zruší zjednodušenie zmeny pohlavia pre transrodových ľudí.” https://hnonline.sk/slovensko/96116453-rezort-zdravotnictva-vyhovie-sns-zrusi-zjednodusenie-zmeny-pohlavia-pre-transrodovych-ludi
Netherlands
The Netherlands, often lauded for its exemplary healthcare system, is currently facing growing health disparities and accessibility problems. The Council for Public Health and Society (RVS) has warned that the existing pressure on healthcare is causing bottlenecks in access. These are evident in difficulties finding a general practitioner, prolonged waits for home assistance for elderly individuals, and extended waiting times in mental health and hospital care. A notable concern is that a significant number of insurance doctors wish to quit their jobs at the Employee Insurance Agency (UWV) due to an extensive backlog, causing delays of up to a year in the granting of benefits. Additionally, shortages of general practitioners and medical personnel at all levels are exacerbating the challenges.
In a recent advisory report, the RVS emphasized the steady deterioration of healthcare accessibility. General practitioners are rejecting new patients, emergency hospital departments are temporarily closing and waiting times for mental health services are escalating, all contributing to the overarching problem. The healthcare sector’s fragmentation and complexity hinder effective care, prompting calls for reduced competition and improved cooperation, especially with regard to district nursing, acute care and mental health services.
In response to increasing demand, the basic insurance premium is set to rise by approximately €12 per month in 2024, resulting in an average monthly health insurance premium of €149 per person. Alarmingly, health disparities between affluent and less affluent individuals in the Netherlands are widening. The RVS urges a shift toward prioritizing health impacts in all government policies, focusing on preventive measures rather than reactive responses to illness. To address these pressing issues, the national government and the healthcare sector have been called upon to better inform citizens about the growing scarcity of care and the changes necessary to maintain accessibility and affordability.
Among general practitioner care, there has been a slight increase in the number of people seeking care mediation, varying by region. This may potentially ad pressure on GPs. Hospital care shows mixed trends, with urgent care maintaining levels similar to 2019, but ICU-dependent plannable care slightly below that benchmark. Waiting times, which saw a slight decrease after the summer, now appear to be stagnating nationally. This highlights the need for transparency in regional care capacity and insight into waiting lists. Long-term care is grappling with a persistent increase in waiting lists, prompting ongoing exploration with relevant parties to understand and address the issue to maintain care accessibility. The overall trend indicates a growing number of people waiting for long-term care services.
In a recent advisory report, the RVS emphasized the steady deterioration of healthcare accessibility. General practitioners are rejecting new patients, emergency hospital departments are temporarily closing and waiting times for mental health services are escalating, all contributing to the overarching problem. The healthcare sector’s fragmentation and complexity hinder effective care, prompting calls for reduced competition and improved cooperation, especially with regard to district nursing, acute care and mental health services.
In response to increasing demand, the basic insurance premium is set to rise by approximately €12 per month in 2024, resulting in an average monthly health insurance premium of €149 per person. Alarmingly, health disparities between affluent and less affluent individuals in the Netherlands are widening. The RVS urges a shift toward prioritizing health impacts in all government policies, focusing on preventive measures rather than reactive responses to illness. To address these pressing issues, the national government and the healthcare sector have been called upon to better inform citizens about the growing scarcity of care and the changes necessary to maintain accessibility and affordability.
Among general practitioner care, there has been a slight increase in the number of people seeking care mediation, varying by region. This may potentially ad pressure on GPs. Hospital care shows mixed trends, with urgent care maintaining levels similar to 2019, but ICU-dependent plannable care slightly below that benchmark. Waiting times, which saw a slight decrease after the summer, now appear to be stagnating nationally. This highlights the need for transparency in regional care capacity and insight into waiting lists. Long-term care is grappling with a persistent increase in waiting lists, prompting ongoing exploration with relevant parties to understand and address the issue to maintain care accessibility. The overall trend indicates a growing number of people waiting for long-term care services.
Citations:
De staat van de zorg. 2023. Nederlandse zorgautoriteit. 12.10.2023. https://www.nza.nl/onderwerpen/stand-van-de-zorg
De E-healthmonitor. 2021-2023. “Plan van aanpak op hoofdlijnen.” RIVM. https://open.overheid.nl/documenten/ronl-d0462ee1-7a94-4b34-b510-c5dbdaa555b6/pdf
EY Barometer Nederlandse Gezondheidszorg. 2023. “Resultaten 2023: Nederlandse zorgsector in zeer zwaar weer beland.” https://www.ey.com/nl_nl/health/ey-barometer-nederlandse-gezondheidszorg
Het Integraal Zorgakkoord - samenwerken aan gezonde zorg, Het Integraal Zorgakkoord - samenwerken aan gezonde zorg
Kiezen voor houdbare zorg. Mensen, middelen en maatschappelijk draagvlak, WRR. 2021. https://www.wrr.nl/publicaties/rapporten/2021/09/15/kiezen-voor-houdbare-zorg
https://www.rijksoverheid.nl/onderwerpen/prinsjesdag/zorg-en-gezondheid
https://vng.nl/nieuws/uitvoering-integraal-zorgakkoord-iza-onder-druk
De staat van de zorg. 2023. Nederlandse zorgautoriteit. 12.10.2023. https://www.nza.nl/onderwerpen/stand-van-de-zorg
De E-healthmonitor. 2021-2023. “Plan van aanpak op hoofdlijnen.” RIVM. https://open.overheid.nl/documenten/ronl-d0462ee1-7a94-4b34-b510-c5dbdaa555b6/pdf
EY Barometer Nederlandse Gezondheidszorg. 2023. “Resultaten 2023: Nederlandse zorgsector in zeer zwaar weer beland.” https://www.ey.com/nl_nl/health/ey-barometer-nederlandse-gezondheidszorg
Het Integraal Zorgakkoord - samenwerken aan gezonde zorg, Het Integraal Zorgakkoord - samenwerken aan gezonde zorg
Kiezen voor houdbare zorg. Mensen, middelen en maatschappelijk draagvlak, WRR. 2021. https://www.wrr.nl/publicaties/rapporten/2021/09/15/kiezen-voor-houdbare-zorg
https://www.rijksoverheid.nl/onderwerpen/prinsjesdag/zorg-en-gezondheid
https://vng.nl/nieuws/uitvoering-integraal-zorgakkoord-iza-onder-druk
UK
The National Health Service (NHS) is held in high esteem by the British public, who strongly support its long-established principle of “free at the point of care.” While this provides equitable access in theory, there are significant inequalities in demand and provision. Health is a devolved competence, with block grants from the central government determining the overall resources available to the respective administrations, from which they allocate health spending.
Health provision across the UK is under considerable strain. In England, for example, the waiting list for treatment soared from around 2.5 million in 2012 to a record 7.8 million in autumn 2023, with no sign of improvement. Emergency department waiting times have also increased significantly, with the proportion of patients exceeding the four-hour target peaking at 50% at the end of 2022, before slightly improving in 2023. The proportion of cancer patients starting treatment within 62 days has declined sharply, from meeting the 85% target in 2018 to around 60% in the last year. Devolved governments have also seen record levels of waiting lists.
Reducing these waiting times was one of the five pledges made by Rishi Sunak when he became prime minister, but the combination of the pandemic’s legacy (with many treatments postponed) and strike action by nurses and doctors in 2023 has aggravated the problem. Initiatives to address these issues, such as increasing training places for doctors and nurses, will take time to show results. In the meantime, inequality persists as patients with the financial means opt for private treatment.
Health provision across the UK is under considerable strain. In England, for example, the waiting list for treatment soared from around 2.5 million in 2012 to a record 7.8 million in autumn 2023, with no sign of improvement. Emergency department waiting times have also increased significantly, with the proportion of patients exceeding the four-hour target peaking at 50% at the end of 2022, before slightly improving in 2023. The proportion of cancer patients starting treatment within 62 days has declined sharply, from meeting the 85% target in 2018 to around 60% in the last year. Devolved governments have also seen record levels of waiting lists.
Reducing these waiting times was one of the five pledges made by Rishi Sunak when he became prime minister, but the combination of the pandemic’s legacy (with many treatments postponed) and strike action by nurses and doctors in 2023 has aggravated the problem. Initiatives to address these issues, such as increasing training places for doctors and nurses, will take time to show results. In the meantime, inequality persists as patients with the financial means opt for private treatment.
Citations:
https://commonslibrary.parliament.uk/research-briefings/cbp-7281/
https://commonslibrary.parliament.uk/research-briefings/cbp-7281/
Health policies are only somewhat aligned with the goal of achieving equitable access to high-quality healthcare.
5
Estonia
Health inequality between different socioeconomic groups and regional disparities remain an issue in the Estonian healthcare system (NAO 2022). The share of out-of-pocket expenditure is high (22%) and leaves the most disadvantaged groups without access to treatment. Additionally, several healthcare policy risks, including behavioral risk factors such as tobacco smoking, dietary risks, alcohol consumption and low levels of physical activity, as well as outputs like life expectancy, self-reported health status and unmet healthcare needs, exhibit a strong socioeconomic gradient.
Health workforce shortages are being addressed but remain an urgent policy issue, and are likely to test the resilience of the health system. Currently, the limited availability of specialist care and family medical care means that patients who should be treated either in a hospital or by a family physician end up in inpatient nursing care or emergency medicine departments (EMD).
Health workforce shortages are being addressed but remain an urgent policy issue, and are likely to test the resilience of the health system. Currently, the limited availability of specialist care and family medical care means that patients who should be treated either in a hospital or by a family physician end up in inpatient nursing care or emergency medicine departments (EMD).
Citations:
National Audit Office. 2022. “Healthcare Trends in Estonia.” https://www.riigikontroll.ee/tabid/215/Audit/3555/WorkerTab/Audit/WorkerId/40/language/et-EE/Default.aspx
National Audit Office. 2022. “Healthcare Trends in Estonia.” https://www.riigikontroll.ee/tabid/215/Audit/3555/WorkerTab/Audit/WorkerId/40/language/et-EE/Default.aspx
Greece
Equitable healthcare provision in Greece remains suboptimal. The country ranks below the OECD average in infant mortality (World Bank 2021), and the perceived healthcare status of Greeks varies significantly by income group (Eurostat 2022a). Greece also ranks among the worst EU countries for self-reported unmet medical care needs (Eurostat 2022b), with only slight improvements over time.
Additionally, Greeks who can afford it often rely on the private healthcare system, which has expanded in urban areas. About 5% of all healthcare spending in Greece comes directly from patients through out-of-pocket payments (OECD 2022), making Greece one of the worst performers among OECD countries in this regard. The healthcare system is notably uneven, with most facilities and medical personnel concentrated in the largest cities, exacerbating regional disparities in healthcare access.
Additionally, Greeks who can afford it often rely on the private healthcare system, which has expanded in urban areas. About 5% of all healthcare spending in Greece comes directly from patients through out-of-pocket payments (OECD 2022), making Greece one of the worst performers among OECD countries in this regard. The healthcare system is notably uneven, with most facilities and medical personnel concentrated in the largest cities, exacerbating regional disparities in healthcare access.
Citations:
Eurostat. 2022. “Self-perceived health by sex, age and income quintile.” https://ec.europa.eu/eurostat/da
tabrowser/view/hlth_silc_10/default/table?lang=en
Eurostat. 2022b. “Self-reported unmet need for medical care by sex.” https://ec.europa.eu/eurostat/databrowser/view/HLTH_SILC_08__custom_6429904/default/table?lang=en
OECD. 2022. “Health at a Glance: Europe 2022 – Financial Hardship and Out-of-Pocket Health Expenditure.” https://www.oecd-ilibrary.org/docserver/cf40210d-en.pdf?expires=1705757565&id=id&accname=guest&checksum=8E16481FF8767301F6B27B1B743557C9
World Bank. 2021. “World Development Indicators, Mortality Rate, Infant (Per 1,000 Live Births).”
https://databank.worldbank.org/source/world-development-indicators
Eurostat. 2022. “Self-perceived health by sex, age and income quintile.” https://ec.europa.eu/eurostat/da
tabrowser/view/hlth_silc_10/default/table?lang=en
Eurostat. 2022b. “Self-reported unmet need for medical care by sex.” https://ec.europa.eu/eurostat/databrowser/view/HLTH_SILC_08__custom_6429904/default/table?lang=en
OECD. 2022. “Health at a Glance: Europe 2022 – Financial Hardship and Out-of-Pocket Health Expenditure.” https://www.oecd-ilibrary.org/docserver/cf40210d-en.pdf?expires=1705757565&id=id&accname=guest&checksum=8E16481FF8767301F6B27B1B743557C9
World Bank. 2021. “World Development Indicators, Mortality Rate, Infant (Per 1,000 Live Births).”
https://databank.worldbank.org/source/world-development-indicators
Ireland
Connolly (2023) finds that high user charges, long waits and limited availability of some services characterize Irish healthcare, and that the implementation of reform proposals aimed at improving access to healthcare is limited. The Irish healthcare system is two-tiered, with 51% relying exclusively on the public healthcare system and 49% paying for costly private insurance to obtain quicker access to hospital treatment. This has led to reductions in private insurance coverage and issues relating to the transparency of pricing and benefits (Irish Times 2023).
Sláintecare, a cross-party 10-year plan (Burke et al. 2023), aims to make healthcare universal but has faced significant delays in implementation, obstruction by elite medical interests and a lack of political commitment. The 2023 action plan – the last phase – outlines Sláintecare and Programme for Government priorities, including improving access, outcomes and affordability for patients by increasing the capacity and effectiveness of the workforce, infrastructure and delivery of patient care. Key measures include public-only consultant contracts to remove private care from public hospitals, implementing the Waiting List Action Plan 2023, shifting to enhanced community care to provide health services closer to people’s homes and reduce pressure on acute hospitals and establishing new elective hospitals and surgical hubs. Plans also include key digital and eHealth solutions, a new Digital Health Strategic Framework and governance shifts and realignments. However, the record of implementation is poor, and expectations are low that all of this will be delivered.
The OECD (2023) notes differences in healthcare accessibility across income groups, with 3.2% of those in the lowest income quintile reporting unmet medical needs due to waiting times, compared to 1.1% in the highest income quintile. The OECD also notes that the design of Ireland’s healthcare system is unusual within the EU in not providing universal health coverage for all residents, with excessively long waiting lists being the primary cause of unmet medical needs. Additionally, the limited capacity of public hospitals hinders timely access to services.
Sláintecare, a cross-party 10-year plan (Burke et al. 2023), aims to make healthcare universal but has faced significant delays in implementation, obstruction by elite medical interests and a lack of political commitment. The 2023 action plan – the last phase – outlines Sláintecare and Programme for Government priorities, including improving access, outcomes and affordability for patients by increasing the capacity and effectiveness of the workforce, infrastructure and delivery of patient care. Key measures include public-only consultant contracts to remove private care from public hospitals, implementing the Waiting List Action Plan 2023, shifting to enhanced community care to provide health services closer to people’s homes and reduce pressure on acute hospitals and establishing new elective hospitals and surgical hubs. Plans also include key digital and eHealth solutions, a new Digital Health Strategic Framework and governance shifts and realignments. However, the record of implementation is poor, and expectations are low that all of this will be delivered.
The OECD (2023) notes differences in healthcare accessibility across income groups, with 3.2% of those in the lowest income quintile reporting unmet medical needs due to waiting times, compared to 1.1% in the highest income quintile. The OECD also notes that the design of Ireland’s healthcare system is unusual within the EU in not providing universal health coverage for all residents, with excessively long waiting lists being the primary cause of unmet medical needs. Additionally, the limited capacity of public hospitals hinders timely access to services.
Citations:
Burke, S., Thomas, S., and Johnston, B. 2023. “Joint Committee on Health Submission Sláinte Care’s Implementation Path.” https://data.oireachtas.ie/ie/oireachtas/committee/dail/33/joint_committee_on_health/submissions/2023/2023-03-01_opening-statement-dr-sara-burke-associate-professor-in-health-policy-and-management-centre-for-health-policy-and-management-trinity-college-dublin_en.pdf
Irish Times. 2023. “New health insurance increases to add hundreds to annual cost.” The Irish Times March 1.
Burke, S., et al. 2018. “Sláintecare - A Ten-Year Plan to Achieve Universal Healthcare in Ireland.” Health Policy 122 (12): 1278-1282.
Sláintecare Action Plan. 2023. Right Care; Right Place; Right Time. Dublin: Department of Health.
Connolly, S. 2023. “Improving Access to Healthcare in Ireland: An Implementation Failure.” Health Economics, Policy and Law First View: 1-11.
https://doi.org/10.1017/S1744133123000130
OECD. 2023. “State of Health in the EU Ireland Country Health Profile 2023.” https://read.oecd.org/10.1787/3abe906b-en?format=pdf
Burke, S., Thomas, S., and Johnston, B. 2023. “Joint Committee on Health Submission Sláinte Care’s Implementation Path.” https://data.oireachtas.ie/ie/oireachtas/committee/dail/33/joint_committee_on_health/submissions/2023/2023-03-01_opening-statement-dr-sara-burke-associate-professor-in-health-policy-and-management-centre-for-health-policy-and-management-trinity-college-dublin_en.pdf
Irish Times. 2023. “New health insurance increases to add hundreds to annual cost.” The Irish Times March 1.
Burke, S., et al. 2018. “Sláintecare - A Ten-Year Plan to Achieve Universal Healthcare in Ireland.” Health Policy 122 (12): 1278-1282.
Sláintecare Action Plan. 2023. Right Care; Right Place; Right Time. Dublin: Department of Health.
Connolly, S. 2023. “Improving Access to Healthcare in Ireland: An Implementation Failure.” Health Economics, Policy and Law First View: 1-11.
https://doi.org/10.1017/S1744133123000130
OECD. 2023. “State of Health in the EU Ireland Country Health Profile 2023.” https://read.oecd.org/10.1787/3abe906b-en?format=pdf
Latvia
Latvia has shown a commitment to enhancing its healthcare system, as evidenced by the increasing allocation of its GDP to health expenditure. This upward trend is clear, with incremental rises observed annually. The allocation climbed to 6.2% in 2016, dipped slightly to 6.0% in 2017, rebounded to 6.2% in 2018, and escalated to 6.6% in 2019 and 7.2% in 2020. Notably, in 2021, health expenditure surged to 9.0% of GDP. However, in 2022, there was a marginal reduction, bringing it down to 8.8%.
Concurrently, the healthcare workforce saw growth in 2022, with the number of medical professionals per 1,000 inhabitants increasing to 28.1 from 26.98 in 2021. This reflects a recent improvement in the country’s healthcare resources.
A 2020 survey by the National Health Service of Latvia gauged patient satisfaction with its services. The findings revealed varying levels of satisfaction across different healthcare offerings. Higher satisfaction rates were reported for services such as exemption from co-payments and the provision of patient information. In contrast, there was greater dissatisfaction with areas like medication compensation and consultations regarding healthcare service payments.
Latvia has a significant gender disparity in its aging population. Although boys outnumber girls at birth, women constitute a larger portion of the population over 40, with the highest female population proportion in the EU at 54%. According to 2022 data, 56% of men and 45.7% of women rated their health as good or very good. The lower self-assessment among women is attributed to the greater proportion of older women. Among those aged 65 and older, women are 3.8 percentage points less likely to rate their health positively compared to men.
In 2022, 70.3% of men and 83.0% of women visited a family doctor at least once. However, 8.0% of men and 10.9% of women reported not undergoing necessary medical check-ups or treatments for various reasons, including 23.7% of men and 25.5% of women who couldn’t afford them. Latvia scores 78.9 points on the EU Gender Equality Index in the health domain, which is lower than the EU average of 88.5. This score is impacted by women’s lower health self-assessment and a smaller proportion of women engaging in physical activities.
Addressing inequality and fostering social inclusion are pivotal objectives outlined in the Public Health Guidelines for 2021–2027. These guidelines highlight that access to healthcare is compromised by insufficient public financial contributions and significant direct payments by patients. These factors are substantial hindrances to accessing timely and patient-centric healthcare.
The ombudsman’s 2022 report highlights recurring issues with the accessibility of medical services. During visits to the branches of four state social care centers for children, the ombudsman noted concerns about respect for children’s rights, the provision of social and medical rehabilitation, and access to healthcare. One of the main findings was that existing institutional care cannot provide children with developmentally appropriate services and support needed for full societal integration.
Regarding the assurance of healthcare service availability, while local government law mandates the involvement of municipalities, the definitions of their roles need more precise descriptions. Although municipalities are assigned the autonomous function of ensuring healthcare service availability, interpretations vary. Consequently, the degree of involvement by each local authority in providing accessible healthcare varies greatly, heavily dependent on the financial resources available to the municipality.
In 2023, the Centers for Disease Control and Prevention developed guidelines for municipalities to promote health. These guidelines include information on key concepts, principles, and process descriptions for municipalities to encourage better health.
This situation calls for a unified approach and precise definitions of local governments’ responsibilities to ensure disparities in healthcare service availability across municipalities are addressed, contributing to a more equitable healthcare system throughout Latvia.
Concurrently, the healthcare workforce saw growth in 2022, with the number of medical professionals per 1,000 inhabitants increasing to 28.1 from 26.98 in 2021. This reflects a recent improvement in the country’s healthcare resources.
A 2020 survey by the National Health Service of Latvia gauged patient satisfaction with its services. The findings revealed varying levels of satisfaction across different healthcare offerings. Higher satisfaction rates were reported for services such as exemption from co-payments and the provision of patient information. In contrast, there was greater dissatisfaction with areas like medication compensation and consultations regarding healthcare service payments.
Latvia has a significant gender disparity in its aging population. Although boys outnumber girls at birth, women constitute a larger portion of the population over 40, with the highest female population proportion in the EU at 54%. According to 2022 data, 56% of men and 45.7% of women rated their health as good or very good. The lower self-assessment among women is attributed to the greater proportion of older women. Among those aged 65 and older, women are 3.8 percentage points less likely to rate their health positively compared to men.
In 2022, 70.3% of men and 83.0% of women visited a family doctor at least once. However, 8.0% of men and 10.9% of women reported not undergoing necessary medical check-ups or treatments for various reasons, including 23.7% of men and 25.5% of women who couldn’t afford them. Latvia scores 78.9 points on the EU Gender Equality Index in the health domain, which is lower than the EU average of 88.5. This score is impacted by women’s lower health self-assessment and a smaller proportion of women engaging in physical activities.
Addressing inequality and fostering social inclusion are pivotal objectives outlined in the Public Health Guidelines for 2021–2027. These guidelines highlight that access to healthcare is compromised by insufficient public financial contributions and significant direct payments by patients. These factors are substantial hindrances to accessing timely and patient-centric healthcare.
The ombudsman’s 2022 report highlights recurring issues with the accessibility of medical services. During visits to the branches of four state social care centers for children, the ombudsman noted concerns about respect for children’s rights, the provision of social and medical rehabilitation, and access to healthcare. One of the main findings was that existing institutional care cannot provide children with developmentally appropriate services and support needed for full societal integration.
Regarding the assurance of healthcare service availability, while local government law mandates the involvement of municipalities, the definitions of their roles need more precise descriptions. Although municipalities are assigned the autonomous function of ensuring healthcare service availability, interpretations vary. Consequently, the degree of involvement by each local authority in providing accessible healthcare varies greatly, heavily dependent on the financial resources available to the municipality.
In 2023, the Centers for Disease Control and Prevention developed guidelines for municipalities to promote health. These guidelines include information on key concepts, principles, and process descriptions for municipalities to encourage better health.
This situation calls for a unified approach and precise definitions of local governments’ responsibilities to ensure disparities in healthcare service availability across municipalities are addressed, contributing to a more equitable healthcare system throughout Latvia.
Citations:
OECD. 2023. “Health Systems Resilience.” https://www.oecd.org/health/health-systems-resilience.htm
Health Care Financing Law. https://likumi.lv/ta/en/en/id/296188-health-care-financing-law
OECD. 2022. “Healthcare resources.” https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_REAC
OECD. 2022. “Healthcare Expenditure and Financing.” https://stats.oecd.org/Index.aspx?DataSetCode=SHA
Ministru kabinets. 2022. Sabiedrības veselības pamatnostādnes 2021.-2027. gadam. https://likumi.lv/ta/id/332751-sabiedribas-veselibas-pamatnostadnes-2021-2027-gadam
Tiesībsargs. 2023. 2022. gada ziņojums. https://www.tiesibsargs.lv/wp-content/uploads/2023/03/tiesibsarga_2022_gada_zinojums.pdf
OECD. 2023. “Health Systems Resilience.” https://www.oecd.org/health/health-systems-resilience.htm
Health Care Financing Law. https://likumi.lv/ta/en/en/id/296188-health-care-financing-law
OECD. 2022. “Healthcare resources.” https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_REAC
OECD. 2022. “Healthcare Expenditure and Financing.” https://stats.oecd.org/Index.aspx?DataSetCode=SHA
Ministru kabinets. 2022. Sabiedrības veselības pamatnostādnes 2021.-2027. gadam. https://likumi.lv/ta/id/332751-sabiedribas-veselibas-pamatnostadnes-2021-2027-gadam
Tiesībsargs. 2023. 2022. gada ziņojums. https://www.tiesibsargs.lv/wp-content/uploads/2023/03/tiesibsarga_2022_gada_zinojums.pdf
Slovenia
Structurally and administratively, public healthcare institutions in Slovenia remain much the same as they were in 1991. The Slovenian healthcare system faces serious challenges that call for reform. In recent years, Slovenia’s population has aged, while significant progress has been made in medicine. The aging population requires the healthcare system to adapt in order to improve its accessibility and efficiency. Although the number of health workers is increasing, there is still a personnel shortage. Consequently – and perhaps also due to the inadequate financing model of some services – waiting periods in many areas are unacceptably long, preventing equal access to health services for all. Those who can afford it visit private clinics, where doctors from public institutions work in the afternoon. Due to their high workload, these personnel are exhausted.
Patients’ needs for healthcare services in Slovenia are substantial, and the healthcare system does not provide optimal options for choosing a personal physician, dentist, or gynecologist due to a shortage of doctors and medical staff in primary healthcare. Healthcare activities are carried out across Slovenia, with accessibility to healthcare services varying throughout the country. Emergency centers are overburdened by accessibility problems at the primary level. At the same time, the operation of these emergency centers is not uniform. Reforming the healthcare system and strengthening public healthcare are imperative.
In 2020, according to the indicator of expected healthy years of life at birth, Slovenia exceeded the EU average. On the regional level, the indicator reveals significant differences. Men in the coastal Karst region can expect the longest life without disabilities at birth, while men in the Podravja region can expect the shortest. Women in the Gorenjska region can expect to lead the longest healthy lives, while women in the Pomurje region can expect the shortest.
Compared to previous years, the gap in unmet needs between the population’s first and fifth income levels increased in 2021. The main reason for unmet needs in Slovenia is the long waiting times, whereas in most EU member states, the reason is financial. This disparity is related to the broad basket of rights in Slovenia, which is partly covered by compulsory health insurance and partly by supplementary health insurance (though since January 2024, it has shifted to single insurance). However, access to many services remains limited.
Patients’ needs for healthcare services in Slovenia are substantial, and the healthcare system does not provide optimal options for choosing a personal physician, dentist, or gynecologist due to a shortage of doctors and medical staff in primary healthcare. Healthcare activities are carried out across Slovenia, with accessibility to healthcare services varying throughout the country. Emergency centers are overburdened by accessibility problems at the primary level. At the same time, the operation of these emergency centers is not uniform. Reforming the healthcare system and strengthening public healthcare are imperative.
In 2020, according to the indicator of expected healthy years of life at birth, Slovenia exceeded the EU average. On the regional level, the indicator reveals significant differences. Men in the coastal Karst region can expect the longest life without disabilities at birth, while men in the Podravja region can expect the shortest. Women in the Gorenjska region can expect to lead the longest healthy lives, while women in the Pomurje region can expect the shortest.
Compared to previous years, the gap in unmet needs between the population’s first and fifth income levels increased in 2021. The main reason for unmet needs in Slovenia is the long waiting times, whereas in most EU member states, the reason is financial. This disparity is related to the broad basket of rights in Slovenia, which is partly covered by compulsory health insurance and partly by supplementary health insurance (though since January 2024, it has shifted to single insurance). However, access to many services remains limited.
Citations:
Ministrstvo za zdravje. 2023. “Pregled stanja na področju zdravstva v Sloveniji – januar 2023.” https://www.gov.si/assets/ministrstva/MZ/DOKUMENTI/NOVICE/Zdravstveni-sistem-v-Sloveniji-januar-2023.pdf
UMAR. 2023. “Poročilo o razvoju 2023.” https://www.umar.gov.si/fileadmin/user_upload/razvoj_slovenije/2023/slovenski/POR2023-splet.pdf
Ministrstvo za zdravje. 2023. “Pregled stanja na področju zdravstva v Sloveniji – januar 2023.” https://www.gov.si/assets/ministrstva/MZ/DOKUMENTI/NOVICE/Zdravstveni-sistem-v-Sloveniji-januar-2023.pdf
UMAR. 2023. “Poročilo o razvoju 2023.” https://www.umar.gov.si/fileadmin/user_upload/razvoj_slovenije/2023/slovenski/POR2023-splet.pdf
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Hungary
The share of Hungarians reporting unmet needs for medical examinations was surprisingly low, below the EU average in 2022. The difference in self-reported unmet health needs between high-income and low-income groups in Hungary was much smaller than the EU average in 2022. However, these numbers can be misleading as essential services are provided to everyone in an acceptable timeframe. Nevertheless, long waiting lists exist for certain nonessential surgeries. Approximately 40,000 people are registered on waiting lists for specific surgeries, with cataract, knee and hip surgeries being the most requested. The average waiting time for a knee replacement surgery in 2023 reached 230 days (Szopkó 2023). Specialized treatment is often outsourced to private providers, where income disparity significantly impacts access. Moreover, certain services, such as urgent care, are unavailable under private schemes.
Issues related to gender gaps or ethnicity-based disparities in essential services are not present. Services are accessible across the entire country, but many small hospitals in rural areas are maintained despite being unprofitable. Public opinion hinders substantial reform efforts. The Hungarian population is aging fast, and the health status of older people is poor. A significant number of older Hungarians live with chronic conditions and disabilities, and the rates of multimorbidity and limitations in daily life are among the highest in the EU (OECD European Observer 2023:6).
Issues related to gender gaps or ethnicity-based disparities in essential services are not present. Services are accessible across the entire country, but many small hospitals in rural areas are maintained despite being unprofitable. Public opinion hinders substantial reform efforts. The Hungarian population is aging fast, and the health status of older people is poor. A significant number of older Hungarians live with chronic conditions and disabilities, and the rates of multimorbidity and limitations in daily life are among the highest in the EU (OECD European Observer 2023:6).
Citations:
OECD/European Observatory on Health Systems and Policies. 2023. Hungary: Country Health Profile 2023. Paris: OECD Publishing/Brussels: European Observatory on Health Systems and Policies. https://health.ec.europa.eu/system/files/2023-12/2023_chp_hu_english.pdf
Szopkó, Z. 2023. “Some patients wait almost a year for treatment – Hungarian hospital waiting lists in infographics.” Atlatszo.hu, April 20. https://english.atlatszo.hu/2023/04/20/some-patients-wait-almost-a-year-for-treatment-hungarian-hospital-waiting-lists-in-infographics/
OECD/European Observatory on Health Systems and Policies. 2023. Hungary: Country Health Profile 2023. Paris: OECD Publishing/Brussels: European Observatory on Health Systems and Policies. https://health.ec.europa.eu/system/files/2023-12/2023_chp_hu_english.pdf
Szopkó, Z. 2023. “Some patients wait almost a year for treatment – Hungarian hospital waiting lists in infographics.” Atlatszo.hu, April 20. https://english.atlatszo.hu/2023/04/20/some-patients-wait-almost-a-year-for-treatment-hungarian-hospital-waiting-lists-in-infographics/
Poland
In Poland, policies and regulations ensure equal access to healthcare in terms of timeliness, quality and scope, irrespective of socioeconomic status, age, gender or ethnicity. However, challenges persist, and achieving complete equity remains an ongoing goal.
Access to healthcare can vary between urban and rural areas, with some regions facing challenges related to healthcare infrastructure, specialist availability and medical facilities.
According to reports from Watch Health Care (2023), the average waiting time for specialist appointments in Poland has increased by almost two months in recent years. In 2022, the longest queues for specialist doctors were observed for orthodontists (11.7 months) and pediatric neurologists (11 months). The waiting time for a single healthcare service averaged 3.5 months in 2023 (Watch Health Care 2023). Insufficient accessibility to specialists and medical examinations has led to a significant increase in the popularity of private health insurance. By the end of 2022, the number of private health insurance policies reached 4.23 million, 9.2% more than the previous year (Polska Izba Ubezpieczeń 2023).
Access to healthcare can vary between urban and rural areas, with some regions facing challenges related to healthcare infrastructure, specialist availability and medical facilities.
According to reports from Watch Health Care (2023), the average waiting time for specialist appointments in Poland has increased by almost two months in recent years. In 2022, the longest queues for specialist doctors were observed for orthodontists (11.7 months) and pediatric neurologists (11 months). The waiting time for a single healthcare service averaged 3.5 months in 2023 (Watch Health Care 2023). Insufficient accessibility to specialists and medical examinations has led to a significant increase in the popularity of private health insurance. By the end of 2022, the number of private health insurance policies reached 4.23 million, 9.2% more than the previous year (Polska Izba Ubezpieczeń 2023).
Citations:
Polska Izba Ubezpieczeń. 2023. “Ponad 4 miliony Polaków korzysta z prywatnych ubezpieczeń zdrowotnych.” https://piu.org.pl/prywatne-ubezpieczenia-zdrowotne-ma-ponad-4-mln-polakow/
Watch Healtch Care. 2023. “Barometr. Raport dotyczący zmian dostępności do gwarantowanych świadczeń zdrowotnych w Polsce.” Nr 01/09.
Polska Izba Ubezpieczeń. 2023. “Ponad 4 miliony Polaków korzysta z prywatnych ubezpieczeń zdrowotnych.” https://piu.org.pl/prywatne-ubezpieczenia-zdrowotne-ma-ponad-4-mln-polakow/
Watch Healtch Care. 2023. “Barometr. Raport dotyczący zmian dostępności do gwarantowanych świadczeń zdrowotnych w Polsce.” Nr 01/09.
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USA
The United States does a poor job ensuring equitable access to high-quality healthcare. Although the Affordable Care Act of 2009 (Obamacare) improved the situation somewhat by requiring minimum coverage for insurers and eliminating discrimination based on a “pre-existing condition,” the legislation did not guarantee an equitable standard of healthcare to all Americans, regardless of economic resources. Americans still experience different quality of healthcare based on their ability to pay.
State policies contribute to these inequities. For example, under Obamacare, states have been encouraged to expand the Medicaid health insurance program to cover all citizens living at or below 137% of the federal poverty line. The federal government would pay for nearly all of the coverage for these additional Medicaid recipients. However, for largely ideological or partisan reasons, a handful of states have refused to expand Medicaid or have only done so with conditions like work requirements, depriving millions of Americans of access to public health insurance to which they would otherwise be entitled.
State policies contribute to these inequities. For example, under Obamacare, states have been encouraged to expand the Medicaid health insurance program to cover all citizens living at or below 137% of the federal poverty line. The federal government would pay for nearly all of the coverage for these additional Medicaid recipients. However, for largely ideological or partisan reasons, a handful of states have refused to expand Medicaid or have only done so with conditions like work requirements, depriving millions of Americans of access to public health insurance to which they would otherwise be entitled.
Health policies are not at all aligned with the goal of achieving equitable access to high-quality healthcare.
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