People, wherever they live, should have sufficient access to health professionals and healthcare facilities. Yet shortages in certain regions can lead to unequal physical access to healthcare, which can lead to unmet needs (see section on “Unmet needs for healthcare”). Countries have tackled this issue for many years, in particular implementing policies to incentivise more doctors to work in remote and sparsely populated areas.
In terms of availability of doctors, on average across 18 OECD countries in 2023, there were 5.0 doctors per 1 000 population in metropolitan areas, compared to 3.2 per 1 000 in remote areas (Figure 5.14). In Lithuania, while there were 6.6 doctors per 1 000 population in metropolitan areas, there were only two doctors per 1 000 in remote areas. There were also two or less doctors per 1 000 population working in remote areas in Türkiye and Poland. In general, doctors were more evenly distributed across regions in Belgium, Japan and Korea.
In Portugal, where there was also a marked difference between metropolitan and remote areas, more disaggregated data show that doctors were mostly centralised in the metropolitan area of Lisbon, with much lower distribution in remote localities (see section on “Doctors (overall number and distribution) in Chapter 8). In order to address this accessibility issue, the Portuguese Government implemented various policies, including the launch of “More Doctors in 2024”, which incentivises young medical professionals who choose to practise in hospitals in less densely populated areas with salary and housing incentives (OECD/European Observatory on Health Systems and Policies, 2023[1]). In Japan, where regional disparities in doctors are small, 16% of all medical students are from a regional quota scholarship programme. Recent research shows a higher retention rate among students from this programme, compared to other medical graduates. They are also more likely to work in rural hospitals afterwards, and less likely to specialise in urban-concentrated fields such as dermatology and ophthalmology (Matsumoto et al., 2021[2]).
Regarding physical access to hospitals, differences between rural areas and cities were also marked. On average across 14 OECD countries in 2023, while almost all the population living in cities were within a 45‑minute drive of a hospital, 17% of the rural population had to drive more than 45 minutes to reach their nearest hospital (Figure 5.15). The difference was largest in Norway and Sweden, where almost everyone living in cities had easy physical access to a hospital, while among those living in rural areas, only 57% in Norway and 66% in Sweden were within 45 minutes’ drive of a hospital. In Norway, accessibility issues are specifically highlighted for specialist appointments. For example, more than 80% of patients waited for more than three months for cataract surgery in 2024, which was the highest among 13 OECD countries with comparable data (see section on “Waiting times”).
In Greece, even for those located in cities, 15% of the population lived far from a hospital, and this increased to 43% in rural areas. Indeed, Greece reported the highest share of the population reporting unmet needs due to distance to travel among 28 OECD countries, with costs and waiting times also important barriers (see section on “Unmet needs for healthcare”). Disparities were smallest in Czechia, France and Japan, where more than 98% of people in rural areas had access to hospitals nearby. In France, a system of hospital care at home (l’hospitalisation à domicile) enables patients to receive continued care at home, even for complex cases.
