Principle 16

Healthcare

"Everyone has the right to timely access to affordable, preventive and curative health care of good quality."

- Principle 16 of the European Pillar of Social Rights

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Access to healthcare as a determinant of health

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Our understanding of factors contributing to the spread and development of illnesses has grown considerably: some communicable diseases can be prevented through vaccinations, and early measures can be taken to slow down or avoid various noncommunicable diseases, mental health and obesity, and age-related conditions.

However, both curative and preventive healthcare can only be delivered if it is available, citizens know where to find it, and feel confident to seek healthcare free of judgement or repercussions, including financial and social. Equity in access in relation to primary and community-based health and long-term care are of concern as well.

Healthcare as a driver for health equity

Historically, the earliest measure to indicate whether people have access to good-quality healthcare has been avoidable mortality. That is any 'unnecessary, untimely death', meaning it could have been avoided, for example, by:

  • Immunising a person through vaccination before the disease even appeared (e.g., tuberculosis, measles).
  • Detecting the disease early (e.g., cervical cancer, diabetes, depression).
  • Treating the disease (e.g., high blood pressure, anxiety).
  • (Immediate) surgery (e.g., in case of appendicitis).
  • Promoting healthier lifestyle choices and increasing health literacy (e.g., overweight, tobacco, and alcohol use).

While more sophisticated and detailed measures have developed since then, these aspects show how much preventative healthcare and screening influence health and the danger of it not being available for all: The European Centre for Disease Control (ECDC) estimates that vaccinations prevent 2.7 million people from getting measles, one million from getting whooping cough, and two million babies from contracting tetanus - this is not even accounting for the role of vaccines and healthcare in the COVID-19 pandemic.

The WHO's 2019 Astana Declaration is the largest global commitment to make the highest possible standard of healthcare available to everyone. It outlines that the success of such a goal will depend on

  • knowledge and capacity building around primary healthcare.
  • increased human resources for health.
  • broadened access to medical technology and medicines.
  • consistent investments in healthcare systems.
Healthcare as a driver for health equity

Inequality and discrimination in access to care

Primary EU law (treaties) stipulates that “a high level of human health protection shall be ensured in all Union policies and activities and EU citizens have the right to access healthcare in any EU country. However, their implementation through secondary law (regulations, directives, and decisions) provides protection against discrimination in healthcare on the grounds of nationality, ethnic origin, and sex, but not religion, belief, gender identity, or sexual orientation. As such, a lot of protection against discrimination in healthcare still falls under national competencies and may differ extensively between EU Member States.

In addition, there is not sufficient information on discrimination that happens despite existing legislation. For example, a recent review finds that “[f]or many [European] country and healthcare contexts, evidence on racism in healthcare is lacking", with the available evidence rarely focused on an institutional or structural level. Racism in healthcare can take different forms, ranging across racist language and behaviour towards patients, health-related prejudice, and even differential medical treatment in the form of longer waiting times, a lack of proper examination, lower quality care, or a straight-up refusal to receive adequate treatment."

Currently, 27% of people aged 65 and over in the EU have permanent and severe difficulties with personal and household activities, which is already a significant problem in itself. The Joint Research Centre also estimates that the number of people in need of long-term care will increase by 24% in 2050.

Inequality and discrimination in access to care

Crossborder healthcare

Access to good quality healthcare is not limited to the country a person was born or lives in in Europe. Since 2011, EU citizens have the legal right to access healthcare in any EU country and to be reimbursed by the insurance in their home country. The Directive 2011/24/EU on patients' rights in cross-border healthcare lists the conditions under which citizens can travel to other countries to receive healthcare, what exactly can be reimbursed, and how this process works.

The Directive is the basis for the creation of National Contact Points in all Member States, which provide information on available healthcare in other European countries, as well as treatment options abroad, which may not be available in a citizen's home country. The law allows for the immediate treatment of a patient who falls ill or gets injured while being abroad, as well as planned treatment.

The implementation of the Directive is consistently monitored by the European Commission. Despite the immense potential, the total amount healthcare reimbursements within the EU only accounts for 0.01% of total government expenditures on healthcare. Citizens are often unaware of their rights: Only 17% of EU nationals say they are well-informed, and only 10% are aware that National Contact Points exist.

Crossborder healthcare
About principle 16

What does the EPSR Action Plan say?

The EPSR Action Plan sets out several overarching goals for EU Member States in the field of social rights more generally:

  • At least 60% of adults should participate in annual training with at least 80% of those aged 16-74 having basic digital skills: This will be key to ensure digital health literacy.

  • Member States should develop comprehensive policies to provide access to quality education for all and provide targeted support to disadvantaged learners.

  • At least 78% of the population aged 20 to 64 should be in employment by 2030, contributing to stable income provision, preventing poverty and social exclusion.

  • The number of people at risk of poverty or social exclusion should be reduced by at least 15 million by 2030, out of which at least 5 million should be children.

Where are we now?
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Where are we now?

The Social Scoreboard measures progress on the principles of the EPSR. Linked to Principle 16 the Scoreboard outlines that in the EU:

  • In 2022, 2.2% of EU citizens reported they were not able to get a medical diagnosis or treatment due to financial reasons, a too long waiting list, or healthcare provider too far.

  • While most healthcare in the EU is covered or (partially) reimbursed by insurances, people may also have direct 'out-of-pocket' expenses.

  • Healthy life years across the EU have improved slightly from 9.3 years in 2015 to 9.9 years in 2021 for women, and from 9.2 to 9.5 years for men.

  • Most recent data from 2022 estimates that 21.6% of EU citizens were at risk of poverty or social exclusion, compared to 24% in 2015.

What are public health actors doing?
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What are public health actors doing?

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The following actions taken by public health actors at (sub)national level can support the implementation of EPSR principle 16.

Click on a country to learn about initiatives taking place.

Austria - Health education video series for new arrivals

Gesundheit Österreich GmbH has developed four short videos in multiple languages explaining, e.g., where to go with health questions or what to do in case of different health conditions. The videos were funded the Austrian Ministry of Health's Agenda Health Promotion programme, and developed through a participatory process with selected target groups.

These videos are based on previous participatory research, and aim to help particularly recent migrants and refugees find orientation on questions regarding topics such as:

By providing information, the videos empower patients who just migrated or fled to Austria to better access healthcare services that are affordable, available, adequate, and timely. This is not limited to physical health but also includes psychosocial and mental health promotion.

Austria - health education video

Italy (Apulia Region) - Breaking down language barriers to empower foreign communities in Italy's health system

In 2018, the Local Health Authority of Taranto and neighbouring authorities launched the FARI (Training, Taking Care, Responding, and Including) project.

This project provides information to help foreign communities in navigating the health and social systems. It promotes several initiatives to support individuals applying for residency or living in vulnerable circumstances. The project includes cultural mediation services, training for healthcare providers, and an informative smartphone app.

The app, available in 10 languages, offers healthcare information and services in Taranto, Lecce, and Brindisi, along with insights into the Italian health system and foreigners' health rights nationwide.

The accompanying website, also in 10 languages, provides information tools that guide users through Italian health and social services, facilitate contact with experts, and enable users to form discussion groups. By doing so, it makes it easier for people to find information in different languages and exchange experiences and knowledge with others in similar situations.

Read more about the FARI project in EuroHealthNet Magazine.

Italy - addressing language barriers

Active ageing policies in Sweden

Active ageing policies in Sweden have been integrated into various policy areas, including housing, the labour market, social care, and healthcare.

With respect to long-term care, a greater focus is placed on homecare instead of residential care and on enabling most older people to live at home.

Sweden's local and regional authorities, who are responsible for specialised housing, healthcare, and social care for older people, promote a range of homecare services to enable people to live at home for longer. These include:

  • Care services to support personal care and day-to-day needs. healthcare services to avoid hospitalisation (including recently-established mobile care teams).
  • Daily ready-made food deliveries are offered by most municipalities.
  • Training and provision of digital monitoring devises to empower older people to monitor their health situation at home and provide self-care.
Sweden - active ageing

Austria - ensuring better access to health for underserved children

The electronic Parent-Child Health Passport (Eltern-Kind-Pass) helps improve access to healthcare for under-privileged children and their families. The platform records details of the medical examinations conducted during pregnancy and up to the child’s 5th birthday. All examinations set out by the Parent-Child Health Passport are considered important for both mother and child, and are free of charge when carried out by contracted physicians working for registered health insurers.

The platform will be further developed into an electronic documentation and communication platform to

  • simplify access to examination results.
  • increase (equal) opportunities in healthcare for pregnant women and their children (especially for disadvantaged families).
  • improve accessibility (especially for socially disadvantaged families).
  • create an opportunity to evaluate information for health policy, economic and social issues.

The Parent-Child Health Passport is part of Austria's National Action Plan to implement the European Child Guarantee.

Austria's Parent-Child Health Passport

AcToVax4NAM- developing innovative solutions to enhance vaccination access for migrants

The AcToVax4NAM project aims to improve vaccination uptake in the EU while reducing access inequities. This EU-funded project focuses specifically on newly arrived migrants and works with Partners in Greece, Italy, Cyprus, Germany, Poland, Malta, Spain and Romania. AcToVax4NAM is coordinated by the Prolepsis Institute in Greece.

The project targets vaccine preventable diseases that are part of the national immunisation plans. It identifies solutions for overcoming healthcare system barriers, addresses vaccine literacy, develops country-specific action-oriented flow charts to overcome system barriers, pilots interventions and different tools, and strengthens networking capacity.

AcToVax4NAM - vaccinations for migrants
What other tools are out there?

EU tools that help to implement Principle 16

There are EU policies and instruments that can help relevant actors in the field, including public health, to work together to achieve EPSR Principle 16.

More information about the EU institutions and programmes is available on EuroHealthNet's Health Inequalities Portal.

The European Child Guarantee
The European Child Guarantee

Adopted in 2021, the European Child Guarantee aims to prevent social exclusion and guarantee children access to a number of services, including free healthcare. This includes the facilitation of early detection and treatment of disorders, both physical and mental. It also aims to ensure access to regular medical examinations, screening programmes, and follow-up interventions.

In addition, Member States are required to provide at least one healthy meal each school day and access to healthy nutrition, as well as education and early childhood education and care. Children with disabilities should receive rehabilitation services.

The EU4Health Programme
The European Care Strategy
WHO Surgical Safety Checklist
The Pharmaceutical Stategy for EU
The new EU Mental Health Approach
Read about EU funding and contact points

Available resources

For more supportive policy instruments on the topic, consult our other flashcards:

Available EU funding

Available EU funding

Contact points for further assistance

Useful contacts and information:

Contact points for further assistance

Technical resources

Technical resources
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Have your say

Would you like to share promising policies or practices carried out by your public health institute, which support the implementation of this EPSR principle?

Feel free to reach out to our EuroHealthNet colleague Silvia Ganzerla.

What's next?

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EuroHealthNet is the Partnership of public health agencies and organisations building a healthier future for all by addressing the determinants of health and reducing inequalities. Our focus is on preventing disease and promoting good health by looking within and beyond the health system.

Structuring our work over a policy, a practice, and a research platform, we focus on exploring and strengthening the links between these areas.

Our approach focuses on integrated concepts to health, reducing health inequality gaps and gradients, working on determinants across the life course, whilst contributing to the sustainability and wellbeing of people and the planet.

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