Accessible healthcare requires affordable services and an adequate workforce, but other factors also play a role. Even assuming there are enough healthcare professionals overall, there might still be local shortages and waiting lists because services are not well distributed. In areas that are less densely populated, have no major roads or have no well-developed public transport, it may take quite a while to reach the closest hospital.
Geographic accessibility remains a little-explored dimension of access to healthcare, despite its direct impact on the speed with which patients can receive care in emergency situations.
In this report, geographic accessibility has been measured through the following indicators:
- People with self-reported unmet needs for medical (A-13a) or dental (A-14a) care due to geographic reasons (excessive distance or no means of transport) (% of respondents)
- Population living within 20km of the nearest hospital (% of the population) (A-18)
Excessive waiting lists and waiting times (or, ideally, the absence thereof) are another crucial factor that influences a timely access to care.
In this report, this aspect has been measured through the following indicators:
- People with self-reported unmet needs for medical (A-13b) or dental (A-14b) care due to waiting times (% of respondents)
- Patients who experienced a waiting time of more than two weeks to get an appointment with a specialist (% of respondents asking for an appointment in the past year) (A-15)
- Patients who experienced a waiting time of one day or more to get an appointment with a GP (% of respondents asking for an appointment in the past year) (A-16)
- Deaths among people on waiting lists for organ donations (% of people on waiting list) (A-17)
- In the section on mental healthcare indicators: the waiting time before a first appointment at a mental healthcare facility (MH-3)
* Eurotransplant countries
Self-reported unmet needs for medical (A-13) or dental (A-14) care due to excessive distance or waiting times
European countries overall are faced with an increasing demand for healthcare services and increasing healthcare costs. To keep the latter under control, governments also try to limit resource use by organising care as efficiently as possible. In 1997, the Belgian government decided to limit the number of medical students allowed to specialise (see the technical sheet for indicator S-4 for further details). This system might, however, have a negative impact on health services accessibility if healthcare providers become too scarce and/or if they aren’t properly distributed.
One way to assess whether the distribution of healthcare services is adequate is to ask healthcare users whether they are giving up on necessary care because they struggle to make their way to the nearest facility or because they have to wait too long to get an appointment.
In EU-SILC, our first source of data for these two indicators, an unmet need for medical/dental care is defined as the occurrence of at least one situation when the person did not receive a medical/dental examination or treatment for a health problem when s/he really needed it. Please note this source only takes into account foregone care (care which has not been delivered), not care that is simply delayed, and only registers the main reason for giving up on care. The national Health Interview Survey conducted by Sciensano (HIS), our second source of data, examines delayed healthcare and can register multiple reasons. This explains why there are differences in data between the two sources.
Results
People with self-reported unmet needs for medical care due to geographic reasons (excessive distance or no means of transport) (% of respondents) (A-13a)
- For the 2018-2022 period, no respondents reported foregone medical care due to geographic reasons in Belgium – a slight improvement compared to the 2014-2017 period, where this value was 0.2%. This is better than both the EU-14 (0.06%) and the EU-27 average (0.1%) for 2022. (Source: EU-SILC)
- The percentage of people who had to delay healthcare due to distance or transport problems has increased from 1.2% to 1.6% between 2013 and 2018, but remains low compared to other EU countries. It is highest in Wallonia (2.6% in 2018) and Brussels (2.0%) and lowest in Flanders (0.9%). (Source: HIS and EHIS)
- Delayed healthcare due to distance or transport problems seems more common in low-income respondents (3.8% in the lowest income group vs. 0.6% in the highest income group) and in households with singles (2.4% compared to 1.0% in couples with children). (Source: HIS)
People with self-reported unmet needs for medical care due to waiting times (% of respondents) (A-13b)
- Likewise, for the 2017-2020 period, no respondents reported foregone medical care due to waiting times in Belgium. In 2021, there was a small increase to 0.5%, probably due to the COVID-19 pandemic, but this was still better than the EU-14 (1.0%) and EU-27 average (1.4%). The 25-34 age group seemed the least affected (0.1%). In 2022, this percentage fell back to 0%. (Source: EU-SILC)
- In 2018, the percentage of people who had to delay healthcare because it took too long to get an appointment reached 6.6% for Belgium, 9.2% in Brussels, 7.1% in Wallonia and 5.9% in Flanders. This is less than in most other EU countries. (Source: HIS and EHIS)
Link to the technical sheet and detailed results
People with self-reported unmet needs for dental care due to geographic reasons (excessive distance or no means of transport) (% of respondents) (A-14a)
- For the 2013-2022 period, the percentage of respondents reporting foregone dental care due to geographic reasons in Belgium averaged 0 to 0.1%. In 2022, no respondents reported having to forego dental care for this reason. This is better than EU-14 and EU-27 averages for 2022, though this percentage is also nil in many other European countries. (Source: EU-SILC)
People with self-reported unmet needs for dental care due to waiting time (% of respondents) (A-14b)
- Foregone dental care due to waiting times averaged 0 to 0.1% between 2013 and 2020, with a slight increase to 0.6% in 2021, presumably due to the COVID-19 pandemic. This percentage fell back to 0.1% in 2022. (Source: EU-SILC)
Link to the technical sheet and detailed results
Waiting time to get an appointment with a specialist (A-15) or a GP (A-16)
This section includes two self-reported indicators pertaining to the waiting times to get an appointment with a medical specialist or a GP. They are both “patient experience” indicators which can help us assess whether health services distribution is adequate.
The first of those indicators (A-15) measures how many respondents reported not being able to obtain a face-to-face appointment with a medical specialist within two weeks, the second (A-16) how many how many respondents reported not being able to obtain a face-to-face appointment with a GP within a day. Patients were also asked whether they experienced those waiting times as problematic.
Because primary care is one of the cornerstones of the Belgian health system, fast and easy access to a GP is crucial to ensure patients are treated and/or referred in a timely manner. Unfortunately, it appears an increasing number of GPs do not accept new patients. This important issue has been included in this report as a subindicator of A-16, based on a report published in 2023.
Results
Patients who experienced a waiting time of more than two weeks to get an appointment with a specialist (% of respondents asking for an appointment in the past year) (A-15)
- 48% of patients who consulted a medical specialist in 2018 had to wait more than two weeks for their appointment, an increase of 10 percentage points compared to 2013 (38%).
- In 2018, this percentage was highest in Wallonia with 56%, vs 46% in Flanders and 43% in Brussels. Overall, it was notably lower among those aged 75 or over (32%).
- In 2018, 13.5% of patients experienced the waiting time to see a specialist as problematic (22% among those who had to wait 2 weeks or more). This percentage had increased in all regions except Brussels compared to 2013. (Source: HIS)
Link to the technical sheet and detailed results
Patients who experienced a waiting time of one day or more to get an appointment with a GP (% of respondents asking for an appointment in the past year) (A-16)
- 42% of patients who consulted a GP in 2018 had to wait a day or more for their appointment, compared to 30% in 2013. On average, this percentage was somewhat higher in patients aged 45 or more.
- This percentage was higher in Flanders (45%) than in Brussels (44%) and in Wallonia (36%), with an increase in all regions compared to 2013.
- In 2018, about 4% of patients experienced the waiting time to see a GP as problematic (25% among patients who had to wait just under a week or longer).
- In 2023, 17% of GPs did not accept new patients. This percentage was lowest in West-Vlaanderen (8%) and highest in Hainaut (27%). 58% of GPs only accepted new patients under certain conditions. (Source : IM Associates, at the request of the FPS for Public Health)
Link to the technical sheet and detailed results
Deaths among people on waiting lists for organ donations (A-17)
At the end of 2022 in Belgium, there were 1 504 persons on a waiting list for organ donation. However, not all of them will eventually get an organ transplant; the probability of dying while on the waiting list increases with the waiting time. This indicator assesses the mortality rate in this population based on data from Eurotransplant, an international collaborative framework responsible for the allocation of donor organs in seven European countries.
Results
- In 2022, the mortality rate among people on a waiting list for organ donation was 6.3% in Belgium. Though this is currently the lowest figure in the Eurotransplant framework, efforts to reduce it further are still necessary.
Link to the technical sheet and detailed results
Link to the technical sheet and detailed results
Population living within 20km of the nearest hospital (A-18)
This indicator assesses how many people live within 20 km of emergency and hospital care, which provides information on the adequacy of the geographical distribution of health services. Data on the time it takes to reach a hospital (considering other factors like the road network, traffic, etc.) would have been even more interesting, but these are not available for hospitals in general. In our KCE report 323, we have, however, analysed this aspect for maternity services.
Results
- In 2021, 99.23% of the Belgian population lived within 20km and 87.3% within 10km of the nearest hospital with an ER department.
- In 6 provinces out of 10, 100% of the population lived within 20km of the nearest hospital. The most striking exception was Luxembourg, where only 81% of the population lived within 20km and 36% within 10km of the nearest hospital in 2021.
- In 2019, 99.8% of women aged 15 to 49 lived within 30 minutes of one or more maternity service(s) and 100% lived within 45 minutes of the nearest maternity service, based on the average travel time by car on a normal weekday.