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Access to Healthcare / Health Inequalities

The economic crisis has affected strongly our society. Millions of people have lost their jobs, and their security and well-being have been negatively influenced. The crisis has also put health systems under severe pressure while they are already facing the pressure of growing demand for healthcare due to an ageing population, among other issues. Access to quality healthcare is a basic EU citizen’s right – yet it is still not a reality for all of us, a situation made worse by the economic crisis.

EPF’s Position

EPF supports the principle of ‘equity and health in all policies’, and our core value of equitable access to high-quality healthcare for all patients informs our policy work on health inequalities.

As a representative organisation of patients of chronic illness and their families, we focus on chronic disease as a factor leading to health and social inequalities and patient-centred disease management as a crucial part of the continuum encompassing prevention and health promotion.

In our view, patient empowerment and health literacy are among the fundamental aspects of tackling health inequalities, and we will continue to incorporate these aspects in our work in this area and the wider perspective on chronic disease.

Key Steps


EPF position paper on Defining and Measuring Access to Healthcare! Together with its members, EPF published a statement on the definition and measurement of Access to healthcare from the perspective of the patients. This paper details our 9 key recommendations for indicators for access to healthcare, underlining our vision that all patients with chronic and/or lifelong conditions in the EU have access to high quality, patient-centred equitable health and social care.

In August, EPF launched a survey on access to healthcare in the EU. Designed by patients and patient representatives from within our membership, the questionnaire aimed to gather experiences of patients across diseases and Member States.

The survey was open to patients with chronic or long term condition, and informal/family carers. It looked at 5 dimensions of access to healthcare:

  • Availability – whether a healthcare service or product is available in the healthcare system of your country
  • Affordability – whether seeking healthcare causes financial hardship to patients.
  • Accessibility – Whether there are barriers, other than financial (e.g. waiting lists, geographical barriers…), that stop patients from accessing healthcare
  • Adequacy – the quality of healthcare and involvement of patients in shared decision making with their healthcare professionals
  • Appropriateness – whether healthcare meets the need of different groups in the population

The report of the survey is available here. The results are an important tool providing data for advocacy on access to healthcare, and can help inform policy responses towards access barriers and health inequalities.

Strengthening our position as central player on this topic, this survey has also helped us in building our campaign on Access to Healthcare and Universal Health Coverage


We are supporting the launch of the Interest Group on Access to healthcare in the European Parliament on 27 January 2015. This is in line with our strategic goal and with the implementation of the Patient Access Partnership that we are setting up with our Bulgarian member, the National Patient organisation. 

In November EPF provided comments to the preliminary opinion on ‘Access to health services in the European Union’ of the expert panel on Effective Ways on Investing in health. EPF welcomes the expert panel opinion which makes recommendations on multiple dimensions of access to healthcare that are important to EU patients.


Previous work on health inequalities led us, with our Bulgarian member, the National Patient Organisation (NPO), to set up the Patient Access Partnership. It consists in a structured partnership approach at the European level with the participation of all stakeholders for finding innovative solutions to reduce inequities in access to quality healthcare in Europe.

EPF also released our 2014-2020 Strategic Plan, where we added a new goal of non-discrimination. We aim to promote the development of EU and national policies that address prejudice faced by patients in health and social care, as well as in domains like education and employment.


The “Consensus Meeting on Access and Equity for Patients”, organised by our member organisation, the Federation of Polish Patients (FPP) on 3 December 2013 in Warsaw, Poland, continued the dialogue surrounding this multi-stakeholder platform on access (see report below).

We organised the second Conference on Health Inequalities with our Bulgarian member, the National Patient Organisation (NPO), at the European Parliament on 26 June 2013. It produced high-impact results. The meeting also laid the foundations for the establishment of an EU partnership on patient access and equity (see report below).


On 20-21 September, the first Conference on “Health inequalities in the New Member States” was held in Sofia, Bulgaria organised by our member the National Patient Organisation (NPO) in collaboration with EPF (see report below).

In our response to the European Commission’s stakeholder consultation on the reflection process on chronic diseases, EPF strongly highlighted health inequalities as an essential aspect to be tackled.

We welcomed the Commission’s proposal in October on the so-called “Transparency Directive” as a step forward for more transparent and effective processes on pricing and reimbursement of medicines. However, further steps are still needed to improve patients’ access to therapies.


EPF achieved recognition in the European Parliament following our 2010 paper via the report of MEP Edite Estrela (S&D, Portugal) which stated that “patients with chronic diseases form a specific group suffering inequalities in diagnosis and care, social and other support services, and disadvantages including financial, employment, and social discrimination, whose needs should be addressed”.


We released a position paper in December (see paper below) to set out our specific comments on the Estrela report with a view to ensuring that the needs of patients with chronic conditions are included in action on health inequalities.

Equity is a crucial component of EPF’s future vision for health, and EPF therefore welcomes the Draft Report on Reducing Health Inequalities in the EU, drafted by Mrs Edite Estrela MEP following the Commission’s Communication in October 2009 titled “Solidarity in health: reducing health inequalities in the EU”.


The European Commission launched a public consultation as part of the EU Health Strategy, “Together for Health”. EPF developed a response framed around our vision of high-quality, equitable healthcare and our strategic goals on equity, empowerment and inclusion (see our response below).

Based on the public consultation, the Commission published a Communication titled “Solidarity in health: reducing health inequalities in the EU”. From our perspective, the text lacked a reference to the particular needs of patients or the importance of health literacy.


We Care project (2013-2015)

Since 2013, EPF participates in the consortium titled We Care –“Towards a Sustainable and Affordable Healthcare”. This two-year European project will investigate how quality healthcare services can be preserved in the EU while ensuring their viability in terms of costs.

InterQuality (2010-2014)

Spend not more, but smarter! The InterQuality project explored the effects of financing systems based on the quality of healthcare. It aims ultimately to provide models for member states to choose the right financing mechanisms in different areas of the healthcare system, according to their own needs and possibilities.