On behalf of the European
Commission, the European Social Policy Network (ESPN) carried out a
comprehensive study on ‘Inequalities in access to healthcare’. The study is less about objectively measurable health outcomes and more
about people’s subjective perception of gaps in healthcare. Within the
framework of the European Pillar of Social Rights, progress is measured by the
Social Scoreboard indicator of ‘self-reported unmet need for medical care’.
The starting point and benchmark is the
right of all people to timely access to affordable, high-quality healthcare. The
study found inequalities both between and within the 35 European countries
studied. The study concludes that the following areas are particularly
problematic: a) underfunding of public healthcare systems, b) out-of-pocket
payments, c) waiting lists and their lack of transparency, and d) fragmented
formal coverage. The focus was also on difficulties reaching socially
Underfunding of the public healthcare
system is an issue in at least ten countries. Although Germany is not one of
these countries, fixed budgets in Germany were named as a possible source of
Germany belongs to the comparatively large
group of countries in which co-payments have to be made. However, these user
charges are capped and have certain social criteria – which is the case in only
a few countries.
Paying more to get faster treatment
majority of the countries studied, waiting lists were not criticised per se but
rather the ability to bypass waiting times by paying for private health
insurance. Germany’s system is criticised for allowing private health insurance
patients to access services faster than those with social health insurance. In
countries without private health insurance, the proportion of under-the-table
payments is probably higher.
In terms of waiting times, the report is
also openly critical of company medical treatment schemes, such as those
that exist in Finland and the Netherlands. They allow easier and quicker access
to healthcare, especially for people who are financially better off. Even if
this form of insurance is more likely to be the exception in Germany because of
its effective statutory accident insurance system, the statements made in this
report appear rather out of place.
As is also the case with old-age pensions,
occupational insurance schemes are not the cause, but rather the response to
gaps in public schemes; furthermore, they also facilitate faster reintegration into
of formal access for citizens, Germany scores well with almost 100% coverage,
whereas Poland and Greece have substantial gaps in coverage with rates of 90%
and 80% respectively.
First access to medical care, in the sense
of a medical examination, has seen a significant decline in unmet need in
Germany to 0.3%, whereas in certain other countries it is well above 10%. Economic
status plays a decisive role in this. People who are not active in the labour
market, especially the unemployed and pensioners, have comparatively greater difficulties
report recommends that the Member States limit co-payments, especially for
vulnerable groups, so that user charges do not impede access to healthcare.
Priority-setting for waiting lists should
become more transparent, and doctors should no longer have incentives to
prioritise patients who pay more.
Voluntary health insurance systems should
not be directly or indirectly subsidised by the state, rather resources should
instead be invested in the statutory health system [editorial note: ‘Voluntary
health insurance’ as used in the report does not refer to voluntary health
insurance within the German statutory health insurance system].