Abstract
Background
The European Pillar of Social Rights affirms the right to affordable and timely healthcare for all. Despite this, patients still face access barriers due to costs or waiting lists. Evidence suggests that these barriers are socially patterned and vary considerably between countries. This study compares the individual risk profiles associated with cost-related barriers and waiting-list barriers and examines whether national levels of socioeconomic development are associated with their prevalence.
Methods
Data were drawn from the International Social Survey Programme 2021 (ISSP), a cross-sectional survey of the adult population in 30 countries. Multilevel logistic regression models were used to identify individual risk factors for encountering cost-related barriers and waiting lists. National differences were analysed using the Human Development Index (HDI).
Results
The analysis included 29,784 respondents who had visited a doctor last year. Overall, 11% reported not receiving necessary treatment due to costs, while 19.9% reported unmet need due to waiting lists. The risk profiles for both barriers were largely overlapping: women, younger individuals, migrants, frequent healthcare users, people with chronic conditions, and those reporting poor health, low social status, or poor self-rated health were at increased risk. Low educational attainment and unemployment were additional risk factors for cost-related barriers but not for waiting lists. At the country level, higher HDI was associated with a lower likelihood of cost-related barriers, whereas no association was found between HDI and waiting lists.
Conclusions
In the public perception, access barriers to healthcare remain widespread, with waiting lists perceived as more prevalent than costs. Despite this, both barriers affect largely the same socially disadvantaged groups. Policies aimed at improving access should therefore prioritise populations that are already vulnerable in other social domains.
Key messages
• Socially disadvantaged groups face a higher risk of both cost-related barriers and waiting lists.
• Countries with a higher Human Development Index seem to be better able to avoid cost barriers. This does not apply to waiting lists.