Edited by Alistair McGuire and Joan Costa-Font
Sara Allin and Cristina Masseria 1. INTRODUCTION European governments seek to ensure that their citizens have access to safe and effective health care. Most countries have achieved universal coverage of health care for their populations. They have also made efforts to reduce barriers to accessing care for vulnerable groups and to more equitably distribute health services across the population. Moreover, at the EU level, improving access to health care is among the priority objectives for promoting social inclusion and equal opportunities for all (Atkinson et al., 2002; European Commission, 2005, 2007). Numerous studies have evaluated the extent to which equitable access to health care has been achieved, although there is no consensus on how to conceptualise and measure access. The aim of this chapter is to examine one indicator of access to health care: selfreported unmet need. First, it reviews some health system features that affect the accessibility of health care, and describes some of the challenges in defining and measuring access. Next, it presents unmet need and forgone care as indicators of access, reviewing their prevalence across countries, and examining the association between forgoing health care and both utilisation and health, drawing on the first two waves of the Survey of Health, Ageing and Retirement in Europe. Finally, the chapter concludes with a discussion of the policy relevance of this indicator and areas for future research. 2. WHAT AFFECTS ACCESS TO CARE? Access to care is a complex concept that relates to the health system, to the patients themselves,...
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