A fundamental principle underpinning all health systems across OECD countries is to provide access to high-quality care for the whole population, irrespective of their circumstances. Yet access can be limited for several reasons, including limited availability or affordability of services. Policies therefore need to ensure an adequate supply and distribution of health workers and healthcare services throughout the country, and address any financial barriers to care (OECD, 2019[1]).
On average across 28 OECD countries with comparable data, only 3.4% of the population reported that they had unmet medical care needs due to cost, distance or waiting times in 2024 (Figure 5.4). However, over 8% of the population reported unmet care needs in Latvia (8.4%), Estonia (8.5%), Finland (8.6%), Canada (9.1%) and Greece (12.1%), while in Germany, the Netherlands and Czechia, fewer than 1% of the population reported unmet needs for medical care. The main reason cited for unmet needs for medical care in most countries was waiting times, with 2.3% of people reporting this issue in 2024, on average across OECD countries. In Latvia, Estonia and Finland, more than 5% of the population cited waiting times as a barrier. Cost was also cited as an important barrier to access, and was the main reason for unmet needs in Greece, Latvia and France, with at least 2% of people reporting this issue in 2024. Distance to travel was also cited as a barrier, but less frequently than waiting times or cost.
In all OECD countries analysed, socio‑economic disparities are significant (Figure 5.5). The burden of unmet needs for medical care falls disproportionally more on people in the lowest income group than those in the highest income group. People in the lowest income quintile were 2.5 times more likely to report unmet medical care needs than those in the highest quintile in 2024, on average across 28 OECD countries. The income gradient was largest in Greece, Latvia and Finland, with a difference of over 8 p.p. in the population reporting unmet needs between the lowest and highest income quintiles. In Greece, more than one in six people in the lowest income quintile reported unmet medical care needs, and in Estonia, Finland and Latvia this proportion reaches more than one in ten people in the lowest income quintile.
Reported unmet needs are generally larger for dental care than for medical care (Figure 5.6). This reflects the fact that dental care is less well covered by public schemes than medical care in most OECD countries, so people often have to pay out of pocket or purchase additional private health insurance (see section on “Extent of healthcare coverage”). More than 8% of people in Greece, Latvia and Iceland reported unmet dental care needs in 2024, compared to fewer than 1% in Germany, Hungary and the Netherlands, as well as accession country Croatia. In all countries analysed, the burden of unmet needs for dental care falls disproportionately on people with lower incomes. This was most evident in Greece, Latvia and Portugal, where more than 15% of people in the lowest income quintile reported forgoing needed dental care in 2024, compared to 5% or fewer in the highest quintile.
Unmet needs for medical care and dental care have increased in many OECD countries following the pandemic. In OECD countries analysed, unmet medical care needs across the entire population rose from 2.7% in 2019 to 3.4% in 2024. For dental care, unmet needs increased from 3.8% in 2019 to 4.1% in 2024. The main reason for the increase in unmet needs for medical and dental care were long waiting times. This is especially notable in Finland, Lithuania, Ireland, Greece, Spain and France, where unmet medical care needs due to waiting times increased by 1.4 p.p. or more since 2019. Some of these countries have introduced initiatives to reduce waiting times. Greece, for example, launched the Unified Digital List of Surgeries in 2024, to centralise state hospital surgery waiting lists into a single electronic platform, enabling real-time monitoring. In Spain, the National Health System established the Working Group on Waiting Lists (Grupo de Trabajo sobre Listas de Espera) to standardise management and reporting of waiting lists across the autonomous communities.
