In last week’s In focus we showed that, contrary to common belief, income inequality did not significantly and uniformly increase across the EU since the global financial crisis: between 2007 and 2019 income inequality rose (typically only slightly) in 14 member states, it fell (mostly also marginally) in 12 (no data for Croatia in 2007), and remained throughout Europe well below its level in the US.

The fact that income inequality fell in 2007-2019 in Greece, Portugal and Ireland is often met by disbelief. One common objection is that income inequality may have fallen in these and other countries, but inequalities along dimensions other than income must surely have risen. We test this assumption by looking at a different type of inequality: access to affordable medical care by income.

The notion that everyone, irrespective of income, should have access to affordable health care is one of the most distinct features of the European social model. Does the aspiration translate into practice? Have things got worse in recent years?

Our graph shows that in many parts of Europe access to affordable health care is virtually universal, even among the poor. In as many as twelve member states (Spain, Sweden, Malta, Slovenia, Czechia, the Netherlands, Finland, Germany, Lithuania, Estonia, Austria and Denmark), the share of survey respondents in the poorest 20% of population who in 2019 reported that they could not obtain the health care that they needed because it was ‘too expensive’ was below 1%. In another nine members states, the incidence of unmet need for health care for economic reasons among the poor was between 1% and 3%. In Italy and Bulgaria, it was between 3% and 4%. In Belgium, around 5%. In Latvia, 6%. In Romania, 7%. Greece really stood out: in 2019, among the poorest 20% of population, as many as 17% reported that they could not afford the health care they needed. What is more, that percentage had gone sharply up, from about 7% in 2008.

In contrast, in no EU member state was the incidence of unmet need for health care for economic reasons in the richest 20% of population greater than 1%. (In Greece, which again had the unenviable distinction of topping this EU league table, the figure was 0.9%.)

Comparing 2008 and 2019, the share of those reporting unmet need for health care because it was ‘too expensive’ actually declined among the poorest 20% population in most EU member states. In countries like Bulgaria, Romania and Latvia (but also Italy and Hungary), progress was very considerable. Greece, and to a lesser degree (and from a far lower base) Belgium, went the other direction.

The policy implication for Greece seems clear: partly as the result of austerity (public expenditure on health fell by 46% in 2009-2014) affordable health care has become increasingly inaccessible for too many citizens, especially if poor. In this respect, Greece is now unique among EU member states. Ensuring that every citizen has access to good-quality, affordable health care deserves the urgent attention of policy makers.