The goal of universal health coverage is to provide access to quality health services for everyone, regardless of their economic or social status. The OECD monitors and evaluates key aspects of universal health coverage, and assesses the future sustainability of universal health systems. OECD country experiences can also offer valuable lessons for other countries seeking to attain universal health coverage. While many countries already offer all their citizens affordable access to a comprehensive package of health services, they face challenges in sustaining these systems, especially in the current economic climate.
Health inequality and universal health coverage
Access to high-quality care for the whole population, irrespective of their socio-economic circumstances, is a fundamental principle underpinning all health systems across OECD countries. Still, large inequalities in health status and life expectancy persist. These should be urgently addressed to ensure people have access to the care they need to live happy and productive lives.
Key messages
Strengthening primary healthcare is key to achieving UHC and increasing health system resilience. The main reason cited for unmet needs for medical care across OECD countries was waiting times, followed by cost and distance to travel. Policies therefore need to ensure an adequate supply and distribution of health workers and healthcare services, as well as address any financial barriers that may prevent people getting the care they need.
Those living in deprived areas, the migrant population, and ethnic minorities are at higher risk of catching and dying from the virus than other groups. At the same time, mental health and routine care are struggling to recover to their pre-pandemic levels in many countries, disproportionately impacting those with chronic diseases or multiple health challenges. In order to address the root causes of health inequalities, countries should address the social determinants of health and look at other areas, such as social and housing policies.
Context
Population health coverage
Most OECD countries have achieved universal or near-universal coverage for a core set of health services, which usually include consultations with doctors, tests and examinations, and hospital care.
Population coverage for core services remained below 95% in six OECD countries in 2021, and below 90% in Mexico and the United States. Mexico has expanded coverage since 2004, when it was around 50%, but coverage has fallen in recent years. In the United States, the share of uninsured people decreased following the Affordable Care Act, from about 13% in 2013 to 9% in 2015, with a more gradual reduction in uninsured people since then.
Unmet needs for medical care
Despite generally high levels of coverage for core health services, unmet health needs vary significantly according to country and income level. For example, over 5% of the population reported unmet care needs in Estonia (8.1%) and Greece (6.4%), whereas in Germany, the Netherlands, Austria and Czechia, fewer than 0.5% of the population reported unmet needs for medical care.
Socio-economic disparities are significant: people in the lowest income group across 26 OECD countries were three times more likely to report unmet medical care needs than those in the highest group in 2021. This difference exists in all analysed countries, although the extent of the gap varies.
Access to primary care doctors
Consultations with primary care doctors are for many people the most frequent contact with healthcare services, and often provide an entry point for medical treatment. Having enough General Practitioners (GPs) or family doctors available is a crucial factor in ensuring people can access the care they need in a timely manner.
However, GPs represented less than one quarter (23%) of all physicians on average across OECD countries in 2021, ranging from around half in Portugal, Chile and Canada to just 6% in Korea and Greece.
Related data
Related publications
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Working paper9 March 2023