From Policy to Reality: Discrepancies in Universal Health Care Systems across the European Union

von der leyen ursual

Ursula von der Leyen, President of the European Commission (Photographer: Etienne Ansotte European Union, 2019 Source: EC – Audiovisual Service)

This article was exclusively written for The European Sting by Mr. Giovanni Cuce’, a first-year medical student at the University of Catania, Italy. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.


Most Europeans take a certain pride in their healthcare system being universal, that is available to everyone without charge for most medical procedures. This pride is not unwarranted, considering that elsewhere healthcare expenditures are not provided for by the State and the burden falls entirely on the patient, sometimes with serious economic repercussions. But are we sure that healthcare is actually available to everyone across Europe? Are we sure that no one is being left behind? An analysis carried out by researchers at the London School of Economics seem to suggest otherwise.

Using data from the 2008 European Social Survey, the study aimed to find out how citizens from across 29 European countries felt about accessing health care, regardless of true accessibility or availability of health services. The main barriers in accessing healthcare were observed to be either economic or non-economic in nature and varied from region to region. It was found that the shortcomings of the system, such as long waiting times or poor-quality services, were supplemented by the private and informal sector. In this case, however, if no referral is presented the costs must be paid out-of-pocket by the individual.

Unsurprisingly, deprived groups, who are unable to afford private care, were the ones who felt accessing healthcare would be more difficult. This is especially true for those countries where less people feel unable to access health care, such as France and Belgium. However, other countries, such as Ukraine and Russia, show minimal difference between the percentages of high-income and low-income individuals who feel threatened by access barriers. This suggest that non-economic problems, which affect everyone without distinction, may play a major role.

Another study published on the European Journal of Public Health underlined how the Great Recession of 2008 and the subsequent austerity measures employed by the governments have increased the levels of unmet medical needs. The results show that approximately 1.5 million more people have faced unmet need for healthcare since the inception of the economic crisis. In line with previous studies, the poor groups are the most affected and the statistics are not homogenous among different European countries.

At this point it is only natural to ask: how can we ensure that everyone has access to healthcare services? The first step would be to cut down on austerity measures to reduce non-economic factors. This would include increasing expenditure on health services by opening more facilities and hiring more personnel. Investing on affordable transport would also ensure that access to healthcare is physically accessible to everyone. Furthermore, the proper attention should be paid to those who are nonetheless unable to access the system for economic reasons by lowering the cost of copayments, especially for pharmaceuticals and outpatient care, and by repealing policies restricting access for vulnerable groups, such as homeless persons and migrants.

Therefore, full resolution and swift action by European governments are paramount in ensuring that Europe remain a model of universal healthcare and a beacon for all the world to follow.

Works Cited

  • Cylus, J. & Papanicolas, I., 2015. An analysis of perceived access to health care in Europe: How universal is universal coverage?. Health Policy, 119(9), pp. 1133-1144.
  • Reeves, A., McKee, M. & Stuckler, D., 2015. The attack on universal health coverage in Europe: recession, austerity and unmet needs. European Journal of Public Health, 25(3), pp. 364-365.

About the author

Giovanni Cuce’ is a first-year medical student at the University of Catania, Italy.
He strives to create a world where health, both physical and mental, is not a
possibility, but a reality for everyone. He is a member of the Italian Secretariat of
Medical Students and has also volunteered with the Italian Red Cross for four years,
spreading knowledge about STDs prevention, first aid procedures and healthy habits
in his community.

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