The share of a population covered for a core set of health services offers an initial indicator of access to care and financial protection. 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 (Figure 5.1). National health services or social health insurance have typically been the financing schemes for achieving universal health coverage. A few countries (such as the Netherlands and Switzerland) have achieved universality through compulsory private health insurance – supported by public subsidies and strong regulation on the scope and depth of coverage.
Population coverage for core services remained below 95% in four OECD countries in 2024, and was below 90% in Mexico and accession country Romania. In the United States, the share of uninsured people decreased following the Affordable Care Act, and about 25 million people were uninsured in 2023. Uninsured people tend to be working-age adults with lower education or income levels. In Ireland, although coverage is universal, fewer than half of the population are covered for the cost of all general practitioner (GP) services, but new eligibility measures introduced since 2023 have increased the proportion covered.
Beyond population coverage rates, satisfaction with the availability of quality health services offers further insight into effective coverage. The Gallup World Poll collects data on citizens’ satisfaction with health and other public services. While contextual and cultural factors influence survey responses, the poll allows citizens’ opinions to be compared based on the same survey question. Satisfaction with the availability of quality health services averaged 64% across OECD countries in 2024 (Figure 5.2). Swiss citizens were most likely to be satisfied (89%), while those in Greece, Türkiye, Hungary, Italy, Chile and Colombia were least likely to be satisfied (lower than 50%). While satisfaction levels have decreased on average across OECD countries over the past decade, this masks wide cross-country variation: Türkiye experienced the largest decline in satisfaction of 30 percentage points (p.p.), while Canada, France and New Zealand also had declines of over 20 p.p. Conversely, in Chile and Estonia satisfaction levels increased by 10 p.p. or more.
In many countries, citizens can purchase additional health coverage through voluntary private health insurance. This can cover any cost-sharing left after basic coverage (complementary insurance), add further services (supplementary insurance), or provide faster access or a wider choice of providers (duplicate insurance). Among 29 OECD countries with recent comparable data, nine had additional private insurance coverage for over half of the population in 2024 (Figure 5.3). Complementary insurance to cover cost-sharing is widely used in Belgium (97% of the population). Israel and the Netherlands had the largest supplementary health insurance market (over 80% of the population). Duplicate private health insurance was most widely used in Australia and Ireland. Over the last decade, the population covered by additional private health insurance has increased in 16 of 29 OECD countries with comparable data, with large increases in Belgium and Denmark (over 15 p.p.). In Slovenia, a major policy reform in 2024 replaced its complementary insurance with a new compulsory healthcare contribution as part of its social health insurance system.
