Gaps in coverage and access in the European Union

• Published in: Health policy (Amsterdam) 2021-03, Vol.125 (3), p.341-350
• Main Authors: Palm, Willy, Webb, Erin, Hernández-Quevedo, Cristina, Scarpetti, Giada, Lessof, Suszy, Siciliani, Luigi, van Ginneken, Ewout
• Format: Article
• Language: English
• Subjects: Access; Access to health care; Accumulation; Cancer; Civil service; Cost-sharing; Dental care; Expenditures; Government employees; Health administration; Health benefits; Health services; Intelligence; Mental health services; Patients; Personal expenditure; Physicians; Physiotherapy; Political asylum; Prescription drugs; Psychotherapy; Questionnaires; Rare diseases; Refugees; Reproductive health; Residents; Social groups; Treatment methods; Universal coverage; Vulnerability; Waiting times
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2020.12.011

•Despite near-universal population coverage, significant gaps in access exist in the EU.•Groups often excluded from statutory coverage include asylum seekers and irregular residents.•Excluded or restricted services include optical treatments, dental care, physiotherapy, reproductive health, psychotherapy and new drugs.•Low perceived quality, long waiting times and physical distance pose barriers for many groups, especially rural residents.•Available indicators fail to capture the underlying causes of gaps in coverage and access. This study identifies gaps in universal health coverage in the European Union, using a questionnaire sent to the Health Systems and Policy Monitor network of the European Observatory on Health Systems and Policies. The questionnaire was based on a conceptual framework with four access dimensions: population coverage, service coverage, cost coverage, and service access. With respect to population coverage, groups often excluded from statutory coverage include asylum seekers and irregular residents. Some countries exclude certain social-professional groups (e.g. civil servants) from statutory coverage but cover these groups under alternative schemes. In terms of service coverage, excluded or restricted services include optical treatments, dental care, physiotherapy, reproductive health services, and psychotherapy. Early access to new and expensive pharmaceuticals is a concern, especially for rare diseases and cancers. As to cost coverage, some countries introduced protective measures for vulnerable patients in the form of exemptions or ceilings from user chargers, especially for deprived groups or patients with accumulation of out-of-pocket spending. For service access, common issues are low perceived quality and long waiting times, which are exacerbated for rural residents who also face barriers from physical distance. Some groups may lack physical or mental ability to properly formulate their request for care. Currently, available indicators fail to capture the underlying causes of gaps in coverage and access.