Insights into prevalence and key determinants of unmet healthcare needs in Europe

Abstract Background Unmet healthcare needs (UHN) serve as a critical indicator of healthcare system accessibility and equity. Despite their importance, comprehensive cross-country analyses are limited. This study investigates the prevalence and determinants of unmet healthcare needs across 29 European countries, focusing on long waiting lists, distance, and financial affordability. Methods Based on data from over 200,000 individuals aged 15+ from the European Health Interview Survey (EHIS, Wave 3, 2018-2020) the age-standardized prevalence rates were calculated. Further binary logistic regression was used to explore associations between UHN and variables including sex, age, education, income, urbanization, and self-rated health. Finally educational inequalities in UHN were estimated within each country. Results Prevalence rates for unmet healthcare needs were highest for long waiting lists (18.2%), followed by financial affordability (6.1%) and distance (3.7%) with significant variation across countries, with UHN due to affordability most prevalent in Eastern Europe and waiting lists dominating in Western Europe. Women, individuals with lower income, and those in poorer health were more likely to experience unmet needs. Urban-rural disparities were prominent, particularly for distance-related barriers. Educational inequalities were country-specific; in many Western and Northern European countries, individuals with higher education were paradoxically more likely to report unmet healthcare needs due to long waiting lists. Conclusions Unmet healthcare needs are influenced by social, economic, and spatial inequalities. Addressing these disparities requires targeted policy interventions, including digital health solutions and equitable healthcare system reforms. Future efforts should prioritize accessibility for vulnerable groups to mitigate the impact of unmet healthcare needs across Europe. Key messages • Inequalities in unmet healthcare needs may be tackled by innovations and new digital technologies. • Promoting the use of telemedicine and remote care may improve healthcare access in remote and underserved areas.