The EU Pillar of Social Rights recognises the fundamental right of all individuals to access good-quality preventive healthcare and medical treatment. Care should be timely, affordable, appropriate, and effective. Preventing unmet healthcare needs for children is one of the key pillars of the EU Child Guarantee, with a particular focus on those from vulnerable and disadvantaged backgrounds. In 2024, nearly 19.5 million children in the EU were at risk of poverty and social exclusion (AROPE) (Eurostat, 2025a). Barriers to essential services, such as early childhood care and education (ECEC), housing, nutrition, and healthcare, are major factors contributing to social exclusion, hindering children’s well-being and the development of their social, cognitive, and emotional skills.
While the EU has made significant strides toward achieving universal access to healthcare for children, this goal has not yet been fully realised. In 2024, 3.2% of children under 16 in the EU reported having unmet medical needs1. The shares differ across Member States, as seen in Figure 1. The countries with the highest numbers of children with reported unmet needs are Finland (9.4%) and France (5.7%), while the ones with the lowest numbers are Croatia and Malta (both 0.1%), followed by Cyprus (0.6%) (Eurostat, 2025b).
Figure 1. Source: Eurostat, 2025b
Children at risk of poverty and social exclusion (AROPE) are more likely to have unmet medical needs. In fact, in 2024, 4.9% of AROPE children in the EU reported unmet needs, 2.2 percentage points higher compared to their peers. Also in this case, shares differ across EU countries (Figure 2). The highest rates of disadvantaged children who reported having unmet medical needs were recorded in Finland (10.7%) and France (8.7%), while the lowest ones in Croatia (0.0%), Malta (0.3%), Luxembourg and Germany (both 1.5%). However, exceptions to this pattern were observed in Lithuania, Ireland and Croatia, where AROPE children showed lower unmet medical needs than those not at risk. It should be noted that because data are based on self-reported needs, the reliability of this indicator as a measure of healthcare inaccessibility depends on how individuals perceive ‘need’ and ‘unmet’. These perceptions are influenced by personal sensitivity, psychological factors, and social conditions (Eurostat, 2025b).
Figure 2. Source: Eurostat, 2025b
The main barriers to healthcare access for children include both demand- and supply-side challenges. On the supply side, financial constraints and the burden of out-of-pocket (OOP) payments for both preventive care and treatment are crucial limitations. In 2023, household OOP payments accounted for 14.9% of healthcare funding in the EU, making them the third-largest source of healthcare financing (Eurostat, 2025c). Across EU countries, the availability of free or subsidised medication for children varies. In 2024, only nine EU countries were offering free prescribed medication for primary care: Bulgaria, Croatia, the Czech Republic, Cyprus (hospital prescriptions only), the Netherlands, Romania, Slovakia, Sweden, and Portugal (children under 12). In Denmark, no fees apply for families with low income (hospital prescriptions only). Ireland and Malta also have specific policies regarding fee waivers for low-income families (Rigby, 2021).
Goods and services are not the only expenses to consider in the OOP costs. In fact, other factors contribute to the overall financial burden, including transportation expenses, such as fuel, parking fees, or the cost of alternative travel methods. Additionally, time off work can result in a loss of earnings, as parents may need to miss paid hours to take their child to medical appointments. There may also be extra childcare costs if appointment times conflict with school or preschool pick-up times, leading to additional fees for childminders or after-school care. These supplementary costs can significantly increase the financial strain, particularly for disadvantaged families (Rigby, 2021).
Examples of measures tackling supply-side barriers include policies that provide medicines and healthcare services free of charge or reimburse their costs, aiming to improve healthcare access at the system and/or individual levels. Such policies may be universal or targeted at specific groups in need. The main barrier they seek to overcome is usually the direct financial cost of healthcare. Other types of measures aim to enhance the availability of services, for example by expanding the number of hospitals or implementing measures to increase healthcare staff (Eriksen et al., 2025).
On the other hand, demand-side barriers encompass socio-economic and cultural factors that affect families’ willingness to seek healthcare for their children. These can include a lack of trust in the healthcare system or insufficient health education. Policies tackling demand-side barriers are efforts aimed at enhancing trust and knowledge among the population, as well as helping accessing healthcare services. Even in this case, these measures can be either universal or targeted to specific groups (Eriksen et al., 2025). Some countries have policies aimed at encouraging parents to ensure their children attend preventive health programs, effectively imposing a financial consequence for not using free services. For instance, in France, authorities can impose cuts to the child welfare benefits or even criminal fines for non-compliance with immunisation requirements (Rigby, 2021).
Other efforts focus on health education and awareness campaigns, or the involvement of health mediators. Health mediators act as intermediaries that facilitate access to health and social services for disadvantaged groups. In Bulgaria, health mediators were launched by the Ethnic Minorities Health Problems Foundation in 2001, initially to support Roma communities. Originally a community-level initiative, health mediation gained recognition over time and became integrated into the national healthcare policy, formalised within the broader public health system in 2007. Health mediation is used in several other EU countries, including the Netherlands, Slovakia and Italy (Schaaf, 2011).
Author: Paola Civitelli
SOURCES:
Eurostat, 2025a:
https://ec.europa.eu/eurostat/web/products-eurostat-news/w/ddn-20250528-1
Eurostat, 2025b:
https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Health_statistics_-_children
Eurostat, 2025c:
Rigby, 2021:
https://academic.oup.com/eurpub/article/31/5/943/6288117?guestAccessKey=
Schaaf, 2011:
The health mediation in Bulgaria | ASSET
Eriksen et al., 2025: