Most OECD countries aim to provide equal access to health care for people in equal need. One method of gauging equity of access to services is through assessing reports of unmet needs for health care for some reason. The problems that patients report in getting care when they are ill or injured often reflect significant barriers to care.

Health care coverage promotes access to medical goods and services, as well as providing financial security against unexpected or serious illness (OECD, 2004a). However, total health insurance coverage – both public and private – is an imperfect indicator of accessibility, since the range of services covered and the degree of cost-sharing applied to those services can vary across countries.

Financial protection through public or private health insurance substantially reduces the amount that people pay directly for medical care, yet in some countries the burden of out-of-pocket spending can still create barriers to health care access and use. Households that have difficulties paying medical bills may delay or forgo needed health care (Hoffman et al., 2005; May and Cunningham, in Banthin et al., 2008). On average across OECD countries, 19% of health spending is paid directly by patients (see Indicator 7.5 “Financing of health care”).

Access to medical care requires an adequate number and proper distribution of physicians. Shortages of physicians in a geographic region can lead to increased travel times for patients and higher caseloads for doctors. The maldistribution of physicians is a challenge in a number of OECD countries, especially in territories with remote and sparsely populated areas, with long travelling times to the nearest urban region.

Measuring rates of health care utilisation, such as doctor consultations, is one way of identifying whether there are access problems for certain populations. Difficulties in consulting doctors because of excess cost, long waiting periods or travelling time, and lack of knowledge or incentive may lead to lower utilisation, and in turn to poorer health status and increased health inequalities.

Dental caries, periodontal (gum) disease and tooth loss are common problems in OECD countries. Despite improvements, problems in access persist, most commonly among disadvantaged and low income groups. In the United States, over 40% of low income persons aged 20-64 years had untreated dental caries in 2005-08, compared with only 16% of high income persons (NCHS, 2011). In Finland, onequarter of adults with lower education had six or more missing teeth, while less than 10% of those with higher education had the same amount of tooth loss (Kaikkonen, 2007).

Cancer is the second most common cause of death in OECD countries, responsible for 28% of all deaths in 2009. Among women, breast cancer is the most common form, accounting for 30% of new cases each year and 15% of cancer deaths in 2009. Cervical cancer adds an additional 3% of new cases, and 2% of female cancer deaths (see Indicator 1.4, “Mortality from cancer”).

Patients may need to wait for health services for a number of reasons, including a lack of medical equipment or no available hospital beds, short-staffing, or inefficiencies in the organisation of services. Excessive waiting times to see a doctor or for non-emergency surgery can sometimes lead to adverse health effects such as stress, anxiety or pain (Sanmartin, 2003). Dissatisfaction and strained patientdoctor relationships also damage public perceptions of the health system.