Far too often, it turns out, and not only for those on below-average incomes. There are several other reasons, such as a lack of healthcare providers, distance to the nearest health centre and excessive waiting times. But high cost is the most prevalent reason among adults with low socioeconomic status-whether as a result of income, lack of insurance coverage, or even racial or ethnic factors.

Nearly 10 times more people on below-average incomes in the US report unmet healthcare needs compared with the Netherlands, and all because of cost (see chart). In the US, having health insurance is often the determinant factor: adults with below-average incomes who have health insurance report significantly fewer cost-related problems in accessing healthcare than do their uninsured counterparts. Nearly 100 million Americans have either no or insufficient health cover, according to recent reports, whereas in the Netherlands, social security and medical insurance coverage is effectively universal.

©OECD Observer No 273 June 2009