The European Social Policy Network (ESPN), managed jointly by LISER, Applica and European Social Observatory, has just published a Synthesis Report describing the main features of health systems in terms of access to healthcare in 35 European countries. The report

• identifies key challenges in inequalities in access to healthcare;
• discusses recent and planned reforms;
• analyses the inequalities in access between different population groups;
• puts forward a number of policy recommendations.

Despite a general trend towards improved access, inequalities persist in many European countries. The key challenges identified in the report can be summarised as follows:

• The amount of public resources spent on healthcare varies considerably between the countries analysed. Underfunded systems seem to perform worse than the EU average with regard to access to healthcare, but the impact of public spending on access to healthcare can be quite different even when expenditure is similar.
• In some countries, a significant percentage of the population is not covered by the statutory health system and several population groups (including the lowest income quintiles, women, ethnic minorities and migrants) have difficulties in accessing healthcare. High out-of-pocket payments, in particular for pharmaceuticals, are often a cause of concern.
• Access to healthcare depends on how healthcare provision is organised and the extent to which vulnerable groups are exempted from user charges (rather than on the type of health system). Waiting lists are an issue in a large majority of European countries as is the inadequate supply of health services (especially shortages of health professionals and in rural areas). The growing importance of voluntary and occupational health insurance arrangements could exacerbate inequalities.

The Synthesis report  as well as the 35 Country reports on which it is based can be downloaded from the Commission website.