PULSE - Europe beyond the beat

Healthcare

Accessibility to hospitals in Europe: the situation in rural and urban areas

The analysis carried out by Eurostat by combining data on residents and location of hospital sites

by Davide Madeddu (Il Sole 24 Ore) and Ieva Kniukštienė (Delphi, Lithuania)

21 April 2025

4' min read

Fifteen minutes by car to reach a hospital. In 2023, 83.2% of the inhabitants of the EU countries were in this situation. That is, neither too close nor too far away from a health facility to be reached in an emergency where even a minute becomes essential. The figure comes from a Eurostat monitoring. In this case, the statistics were produced with Eurostat calculations 'based on TomTom Miultnet' taking into account the population grid and the location of hospital sites. Field tests, therefore, to establish times and distances and to ascertain the difficulties of users grappling, perhaps, with an emergency or urgent situation.

15 minutes from the hospital

In 2023, the percentage of the EU population living within a 15-minute drive of a hospital was 83.2%.

'Among the EU regions at level 3 of the nomenclature of territorial units for statistics (these are the small regions),' reads the Eurostat explanation, 'there were 124 regions where 100 per cent of the population lived within that 15-minute interval, and 96 of these were in Germany. Other areas in Belgium (6), the Netherlands (6, including the capital Groot-Amsterdam), Greece (4, all part of the capital), France (4, including Paris and 3 surrounding regions), Malta (both regions) and Spain, Italy and Poland (each 2 regions).

Distances are getting longer

However, it is not all straightforward because, in some cases, the road and infrastructure system becomes decisive, as well as the distances separating small towns from larger ones. The study then highlights 97 small regions in which less than 50 per cent of the population lived within a 15-minute drive of a hospital in 2023. Of these, 21 are in Romania, 15 in Greece, 9 each in Croatia and Spain, 8 in Poland and a further 6 each in Ireland, Portugal and Slovenia.

There is also a small group of 7 regions in which less than 10% of the population lives within 15 minutes' drive of a hospital. Four of these regions are in Greece (Lefkada 0.0%; Lesvos, Limnos and Thesprotia, each 7.7%, and Chalkidiki 9.8%), and three were in Romania (Covasna 6.9%, Tulcea 7.0% and Mehedinţi 7.2%).

The system in Italy

Then there is the Italian picture where 127 ASLs operate, 568 districts and an average population per district of 103,792 people. In 63 out of 107 Italian provinces, more than 80% of the population can reach a hospital within 15 minutes. In the provinces of Milan and Monza and Brianza this percentage reaches 100%, in Lodi and Varese, 99%. In the provinces of Nuoro and Potenza it drops to less than 50%. In Apulia, it goes from 97% in the province of Bari to 73.1% in the province of Foggia.

Only 5.8% take 30 minutes

And still in Italy, providing further elements on access to the emergency room and therefore the possibility of intervening quickly in cases of emergency is the Agenas (National Agency for Regional Health Services) report of 2023, which recalls that in 2022 there were 18.27 million accesses to hospitals with first- and second-level Emergency Rooms and Emergency and Acceptance Departments, with a 6% increase compared to 2022. The data on the accessibility of the Emergency-Urgency Network indicate that service coverage within 30 minutes 'is 94%, a quota that reaches 99% within 45 minutes'. The study noted that the population not able to reach emergency room facilities within 30 minutes is 5.8% of the population, or 3.4 million inhabitants.

The case of Lithuania: ongoing hospital reform and accessibility concerns

In Lithuania, the reorganisation of the hospital system is already underway, but it is proceeding in stages and has not yet been fully implemented. Some regions have already started processes of merging and rationalising services, but the path remains complex and much debated, especially with regard to the consequences in peripheral areas.

A case in point is Klaipėda, where, as of 1 January 2023, three hospitals - Klaipėda Maritime Hospital, Klaipėda University Hospital and Palanga Rehabilitation Hospital - were unified under the new Klaipėda University Hospital. However, the operation was not painless: the hospital started to suffer financial losses and about 50 doctors left.

Another case is that of Alytus, where an agreement was signed on 24 October 2024 to merge St. Kudirkos Hospital with the county hospital specialising in tuberculosis. The decision is linked to the decrease in tuberculosis cases and the need to optimise health services.

The year 2025 promises to be a difficult one, especially for obstetrics, surgery and paediatrics departments in small hospitals. The new rules provide for the closure of these departments if at least 600 deliveries per year are not registered, forcing many women to travel up to two hours to reach the nearest facility.

According to Violeta Grigienė, director of the palliative care hospital in Panevėžys, the centralisation of services in three large centres of excellence (Kaunas, Vilnius and Klaipėda), in five ex-county regions and in two republican hospitals in Šiauliai and Panevėžys, risks seriously compromising accessibility for residents of the most remote districts, and also worsening the quality of care.

A two-speed Europe also in healthcare

The picture that emerges, both at European and national level, is that of a divided Europe in health care: on the one hand, urban centres, where proximity to health care facilities remains high; on the other hand, rural areas, increasingly marginalised and forced to cope with distant hospitals, forced mergers and services that risk becoming less and less accessible.

*This article is part of the European collaborative journalism project 'Pulse'.