Opinion of the European Economic and Social Committee – Tackling inequalities in people’s access to healthcare (own-initiative opinion)
Date: 2025-07-16
Institutions: European Economic and Social Committee
Subjects: equal treatment, health care, health care system, public health, right to health








C_202505142EN.000101.fmx.xml












Official Journal of the European Union


EN
C series













C/2025/5142


28.10.2025






Opinion of the European Economic and Social Committee
Tackling inequalities in people’s access to healthcare
(own-initiative opinion)
(C/2025/5142)


Rapporteur: 
Pietro Vittorio BARBIERI






Advisor


Carlo GIACOBINI (to the rapporteur)




Plenary Assembly decision


23.1.2025




Legal basis


Rule 52(2) of the Rules of Procedure
(own-initiative opinion)




Section responsible


Employment, Social Affairs and Citizenship




Adopted in section


27.6.2025




Adopted at plenary session


16.6.2025




Plenary session No


598




Outcome of vote
(for/against/abstentions)


176/0/4




1.   Conclusions and recommendations









1.1.


The European Economic and Social Committee (EESC) highlights the urgent need to address growing inequalities in access to healthcare within the EU, which are exacerbated by the current cost-of-living crisis, the effects of high inflation and the risk of poverty.












1.2.


The EESC points out that economic difficulties lead to limited access to healthcare, which disproportionately impacts the most vulnerable sections of the population, including people with disabilities, children and older people. There is therefore a need for measures to reduce or reimburse health costs and long-term care costs that are borne by low-income individuals and households, in accordance with national rules.












1.3.


The EESC reiterates the importance of ensuring and promoting the practical implementation of principles 16 and 18 of the European Pillar of Social Rights, which guarantee the right to timely access to preventive and curative health care and to affordable long-term care services of good quality, which should be backed by adequate public finance.












1.4.


The EESC believes that the right to healthcare is a fundamental right, that access to social protection is intrinsically linked to guaranteeing fundamental rights and that it must be ensured through improved transparency around national rights and benefits.












1.5.


The EESC welcomes EU initiatives and strategies such as the EU4Health programme and the Pharmaceutical Strategy for Europe, which aim to reinforce health systems and ensure access to medicine. However, it recommends measures for monitoring practical and uniform application in the European Union, and for revised pharmaceutical legislation, cooperation on pricing policies and greater transparency to mitigate the high costs of medicine.












1.6.


The EESC stresses the importance of providing a clearer, more effective and transparent framework for cross-border healthcare services, consolidating subsidiarity in healthcare based on the respective regulations with the need for a consistent modus operandi when it comes to cross-border treatments.












1.7.


The EESC recommends promoting initiatives that can support the exchange of good practices on inclusive health and social care policies, including by considering the possibility of establishing a basic common classification of health and social services to address semantic issues, to allow for easier comparisons to be made and to lay the foundations for joint analyses, in order to establish shared guidelines.












1.8.


The EESC highlights the need for stronger actions to translate the principles and strategies into real results by once again proposing a European Care Guarantee to ensure that all EU residents have permanent access to affordable and quality healthcare and care services, to address care shortages and promote decent working conditions and training opportunities.












1.9.


The EESC recommends:






—


monitoring the implementation of the principles of the European Pillar of Social Rights and ensuring that Member States assume their responsibilities;










—


ensuring adequate investment in public healthcare systems and that EU funding and initiatives are specifically targeted towards reducing economic barriers to access to healthcare;










—


conducting research to understand regional differences when it comes to health policy effectiveness;










—


developing guidelines at EU level to address specific barriers to access, including financial, organisational and discriminatory barriers; and










—


promoting the social economy and social innovation to improve access to healthcare.
















1.10.


The EESC stands ready to contribute actively to making these goals a reality, with the involvement of the social partners and civil society organisations.




2.   General comments









2.1.


High inflation and the cost-of-living crisis have eroded the purchasing power of EU households, raising the cost of living by 10 %. This makes it difficult to cover essentials, including healthcare, due to both direct (co-payments, medicines) and indirect costs (transport, loss of pay) – a difficulty compounded by the shortage of trained healthcare workers. Eurostat data from 2023 reveals that 3,8 % of the EU’s population has unmet healthcare needs, with cost being the leading factor for 2,4 %, particularly in countries where treatment must first be paid by the patient and then reimbursed by the social security system (1). This could lead to delays in seeking help or to refusing necessary treatment, with long-term negative consequences for health (2).












2.2.


There is a clear correlation between income and access to healthcare: in 2023, 2,2 % of the lowest income quintile reported unmet medical needs due to increased expenses, compared to 0,2 % of the highest quintile. This shows that health systems fail to adequately protect the most vulnerable, with inflation further exacerbating this situation, leading to delays in treatment or to refusing treatment (3).












2.3.


People with disabilities are particularly at risk: in 2023, 28,8 % of people with disabilities in the EU were at risk of poverty or social exclusion, compared with 18 % of people without disabilities. They are forced to face additional costs as a result of their condition, with the cost-of-living crisis exacerbating these inequalities, compromising their access to care and worsening their health conditions (4).












2.4.


Inflation also weighs on health systems’ budgets, with the risk that providers could increase prices or reduce the availability of public treatment. It is vital for Member States to develop long-term strategies to deal with the effects of inflation on healthcare systems and guarantee the quality and availability of services, otherwise affordability will be compromised (5).












2.5.


In 2022, almost 25 % of people at risk of poverty in the EU reported that they had moderate or severe mobility impairments, and 19 % had problems covering medical costs. These statistics show how those living in precarious socio-economic conditions are disproportionately affected by health problems and encounter more financial barriers in obtaining the assistance they need (6).












2.6.


The situation varies widely across Member States. In 2022, the percentage of those at risk of poverty that had difficulties covering medical costs varied from 43 % in Bulgaria to 3,4 % in Estonia. These disparities highlight the crucial role that policies and national health systems play in mitigating or exacerbating the impact of poverty on access to healthcare (7).




3.   Principles and guidelines









3.1.


Principle 16 of the European Pillar of Social Rights guarantees timely access to affordable, preventive and curative healthcare of good quality for everyone. This means that costs and waiting lists must not prevent access to treatments, and provides a basis for health policies at EU and national levels.












3.2.


Principle 18 of the European Pillar of Social Rights provides for the right to affordable long-term care services of good quality, in particular home-care and community-based services. These services support people with disabilities, chronic illnesses or vulnerabilities who need intensive support to carry out daily activities. Adequate public financing must ensure the costs of such services are not an obstacle.












3.3.


The EU4Health (2021-2027) programme aims to build stronger, more resilient and more accessible healthcare systems; it provides financial support to the health sector and helps to address long-term healthcare challenges. The programme demonstrates the EU’s commitment to investing in health systems, while also improving accessibility (8).












3.4.


The primary objectives of the Pharmaceutical Strategy for Europe are to guarantee access to affordable medicine and to ensure the financial sustainability of health systems. The strategy acknowledges the growing challenge posed by expensive medicine and proposes actions such as a revision of pharmaceutical legislation, cooperation on pricing policies and greater transparency to mitigate the high costs of medicine (9).












3.5.


The Council Recommendation on access to affordable high-quality long-term care (2022) addresses the suitability and quality of long-term care services but – given its legal nature – it fails to establish a common classification for such services. Even in specific areas such as long-term care, where there are cross-border issues such as labour mobility, the focus remains on quality and on affordability. This is explained by the division of competences and the differences in the way long-term care is organised and provided in the Member States, which is influenced by cultural and demographic factors. Nevertheless, the EESC notes that for the purposes of the recommendation, ‘long-term care’ means a ‘range of services and assistance for people who, as a result of mental and/or physical frailty, disease and/or disability over an extended period of time, depend on support for daily living activities and/or are in need of some permanent nursing care. The daily living activities for which support is needed may be the self-care activities that a person must perform every day, namely activities of daily living, such as bathing, dressing, eating, getting in and out of bed or a chair, moving around, using the toilet, and controlling bladder and bowel functions, or may be related to independent living, namely instrumental activities of daily living, such as preparing meals, managing money, shopping for groceries or personal items, performing light or heavy housework, and using a telephone’ (10).












3.6.


EESC opinion on the Health Workforce and Care Strategy for the future of Europe (11) proposes a European Care Guarantee aimed at ensuring that all EU residents have access to affordable and quality healthcare and care services, addressing shortages and promoting decent working conditions.












3.7.


EESC opinion on Combatting poverty and social exclusion: harnessing the power of the social economy and socio-economic innovations (12) highlights the interconnection between access to healthcare and the fight against poverty, emphasising the need for integrated solutions. Ensuring equitable access to services such as healthcare means addressing poverty and the risk of falling into poverty (13).












3.8.


EESC opinion on Forging a European Flagship Initiative for health (14) calls for an initiative based on the principles of universality, quality, accessibility, solidarity and inclusivity, proposing the establishment of a European care and healthcare guarantee.












3.9.


EESC opinion on a Proposal for a Directive of the European Parliament and of the Council on the application of patients’ rights in cross-border healthcare (15) welcomed the objective of establishing a clear framework for cross-border healthcare, but stressed the need to reconcile subsidiarity with the need for a consistent modus operandi and the integration of a European charter on patients’ rights into national laws. The ensuing Directive 2011/24/EU of the European Parliament and of the Council (16) was adopted taking into account the opinions of the institutions, including that of the EESC.












3.10.


The Directive of the European Parliament and of the Council (PE-CONS 49/24) (17) establishing the European Disability Card and the European Parking Card for persons with disabilities establishes the portability of the right to ‘specific services based on a disability in the Member State to which they travel or which they visit’, which it defines as ‘personal assistance’.




4.   Identifying and addressing inequalities









4.1.


The implementation of principles 16 and 18 of the European Pillar of Social Rights must be monitored, and ensure Member States assume their responsibilities so that affordable access to health and long-term care can be guaranteed. This requires adequate financing of public health care provision and infrastructure.












4.2.


Promoting the social economy and social innovation could offer new approaches to improving access to healthcare for the most vulnerable of the population. Adequate public investment must be ensured; however, exploring alternative models of healthcare provision and funding could help overcome traditional barriers.












4.3.


Financial resources are key to improving health infrastructure and services. It is important to ensure that funding and initiatives under the EU4Health programme (2021-2027) are targeted towards reducing economic barriers to access to healthcare and to solutions that ensure its long-term sustainability.












4.4.


Given the significant regional differences, it would appear important to develop research to identify the causes behind and to understand why policies in certain countries are more effective than those in others, even where poverty levels are the same.












4.5.


It would be useful to promote the exchange of good practices on developing and implementing inclusive health and social care policies. In this regard, the possibility of establishing a basic common classification of health and social services to address semantic issues should be considered, in order to allow for easier comparisons to be made and to lay the foundations for joint analyses to establish shared guidelines.












4.6.


One reference model for achieving a uniform common classification could be the Public Employment Services (PES) Network, which encourages comparison between various countries, identifies good practices based on scientific evidence and promotes mutual learning between European public employment services, in order to boost the efficiency of public employment services. All EU Member States, as well as Norway, Iceland and the European Commission, are part of this network.












4.7.


It would be useful to develop guidelines or recommendations at EU level to address specific barriers to access, such as financial difficulties, organisational and discriminatory barriers and personal circumstances. With the help of the Commission, Member States should be guided towards policies designed to:






—


ensure adequate investments in public health systems in order to provide universal and affordable access to quality care;










—


strengthen social security safety nets, including minimum income schemes and unemployment benefits to reduce poverty and the risk of falling into poverty, which impacts on access to health and care services;










—


implement measures to reduce or reimburse health costs and long-term care costs that are borne by low income individuals and households, in accordance with national rules;










—


improve the accessibility and availability of social services, including long-term care, housing support and services for families with children;










—


address barriers to access to healthcare, such as long waiting times, labour shortages and lack of coordination between different levels of care; and










—


implement awareness-raising programmes to connect vulnerable members of the population with available health and social services.
















4.8.


To help achieve these objectives, the EESC can play its role as the facilitator of positive processes by involving civil society in promoting analyses and research.






Brussels, 16 July 2025.


The President


of the European Economic and Social Committee

Oliver RÖPKE
               





(1)  Eurostat, 2024, https://ec.europa.eu/eurostat/statistics-explained/index.php/Unmet_health_care_needs_statistics.

(2)  Eurohealthnet.eu, https://eurohealthnet.eu/wp-content/uploads/publications/2023/2305_policyprecis_col.pdf.

(3)  Eurostat, 2024, https://ec.europa.eu/eurostat/statistics-explained/index.php/Unmet_health_care_needs_statistics.

(4)  
            ‘Disability statistics – poverty and income inequalities’ (Eurostat, 2024), https://ec.europa.eu/eurostat/statistics-explained/index.php/Disability_statistics_-_poverty_and_income_inequalities.

(5)  EuroHealth Observatory, 2024, https://eurohealthobservatory.who.int/publications/i/health-system-effects-of-economy-wide-inflation-how-resilient-are-european-health-systems.

(6)  Eurostat, 2024, https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Health_problems_and_financial_burden_of_care.

(7)  Eurostat, 2024, https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Health_problems_and_financial_burden_of_care.

(8)  
            https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uriserv:OJ.L_.2021.107.01.0001.01.ITA.

(9)  
            https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:52020DC0761.

(10)  
            https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:32022H1215(01).

(11)  Opinion of the European Economic and Social Committee on Health Workforce and Care Strategy for the future of Europe (own-initiative opinion) (
OJ C 486, 21.12.2022, p. 37).

(12)  Opinion of the European Economic and Social Committee on Combatting poverty and social exclusion: harnessing the power of the social economy and socio-economic innovations (exploratory opinion) (
OJ C, C/2024/2097, 26.3.2024, ELI: http://data.europa.eu/eli/C/2024/2097/oj).

(13)  Opinion of the European Economic and Social Committee on Combatting poverty and social exclusion: harnessing the power of the social economy and socio-economic innovations (exploratory opinion) (OJ C, C/2024/2097, 26.3.2024, ELI: http://data.europa.eu/eli/C/2024/2097/oj).

(14)  Opinion of the European Economic and Social Committee – Forging a European Flagship Initiative for health (Own-initiative opinion) (OJ C, C/2025/105, 10.1.2025, ELI: http://data.europa.eu/eli/C/2025/105/oj).

(15)  Opinion of the European Economic and Social Committee on the Proposal for a Directive of the European Parliament and of the Council on the application of patients' rights in cross-border healthcare (OJ C 175, 28.7.2009, p. 116), https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52008AE1927.

(16)  Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare (OJ L 88, 4.4.2011, p. 45), https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32011L0024&rid=1.

(17)  
            https://data.consilium.europa.eu/doc/document/PE-49-2024-INIT/en/pdf.


ELI: http://data.europa.eu/eli/C/2025/5142/oj
ISSN 1977-091X (electronic edition)