An analysis of perceived access to health care in Europe: How universal is universal coverage?

- We examine variations in perceptions of access to health care across and within 29 European countries.
- Across Europe, the poor are over 5 times more likely than the wealthy to perceive access barriers.
- Probabilities of feeling unable to access care are often relatively similar among the rich and poor within countries with high overall perceived access barriers.
- Out-of-pocket spending as a share of total health expenditures is a weak proxy for access barriers.

The objective of this paper is to examine variations in perceptions of access to health care across and within 29 European countries. Using data from the 2008 round of the European Social Survey, we investigate the likelihood of an individual perceiving that they will experience difficulties accessing health care in the next 12 months, should they need it (N = 51,835). We find that despite most European countries having mandates for universal health coverage, individuals who are low income, in poor health, lack citizenship in the country where they reside, 20-30 years old, unemployed and/or female have systematically greater odds of feeling unable to access care. Focusing on the role of income, we find that while there is a strong association between low income and perceived access barriers across countries, within many countries, perceptions of difficulties accessing care are not concentrated uniquely among low-income groups. This implies that factors that affect all income groups, such as poor quality care and long waiting times may serve as important barriers to access in these countries. Despite commitments to move towards universal health coverage in Europe, our results suggest that there is still significant heterogeneity among individuals' perceptions of access and important barriers to accessing health care.