The risk of unmet medical needs increases as certain medical examinations and treatments can be accessed only in the biggest hospitals, resulting in late diagnosis and worsening chronic conditions for those living in rural and remote areas across Europe.

Accessing treatment from a ‘medical desert’ is a challenging reality for many Europeans.

“There are significant differences in the performance of health systems and the quality of their outcomes across the EU,” Croatian centre-right MEP Tomislav Sokol told EURACTIV.

The European Environment Agency (EEA) visualised how long it took to travel to the nearest hospital on average in different EU countries’ regions, varying from five minutes or less in some of the German or French regions to over 40 minutes in some areas in Romania or Poland.

Slightly more than 1 in 10 regions had their total population estimated to be living within 15 mins driving time of a hospital, according to 2020 data from the EU’s statistical service Eurostat. These areas were mostly capitals or urban regions with relatively high population densities .

At the other end of the scale, 89 regions had less than half of their population living within 15 minutes of driving time of a hospital. Most of these were sparsely-populated regions often around the periphery of the EU, for example, in southern and eastern EU member states.

Eleven regions located in Poland, Romania and Sweden, had less than 10% of their population living within 15 minutes of driving time of a hospital.

Increased journey distance to hospitals increases the risk of mortality, according to a US study: a 10‐km increase in straight‐line distance was associated with around a 1% absolute increase in mortality.

This data illustrates how easily basic services can be reached and how distance to emergency care increases the risk of mortality. When it comes to specific diagnostics that would require advanced medical technologies, the outcome might be late diagnosis and worsening conditions.

“Ensuring diagnostics and treatment, especially in rural areas is a challenge,” German liberal MEP Andreas Glück said.

He added that regardless of population size, in certain areas medical infrastructure has to be ensured. When access has not been ensured the risk of late diagnosis as well as worsening of already existing conditions increases.

Cross-border health but beneficial only for some

According to the Commission’s vice president for demography Dubravka Šuica, the directive on patient rights in the cross-border healthcare legislative framework one the EU can offer its member states to improve the situation.

The directive sets out the conditions under which a patient may travel to another EU country to receive medical care and reimbursement. It covers healthcare costs, as well as the prescription and delivery of medications and medical devices.

“However, this is difficult to generalise as a solution for rural areas,” Šuica told EURACTIV, explaining that this might be beneficial for the rural areas located in border regions and when a suitable provider of healthcare or medical devices is available in the vicinity but located in a different EU member state.

“Normally in this situation, member states have bilateral agreements also based on the regulation on social security coordination. The latter avoids people having to pay upfront for the delivery of care,” she said.

Other initiatives mentioned were under the Long-Term Vision for Rural Areas, which include start-Up villages, an initiative that is “geared towards finding innovative solutions for the challenges of EU’s rural areas,” Šuica said.

“The Rural Pact also allows for actors at all levels to come together and propose solutions for the benefit of these areas,” she added.

How to make healthcare more accessible

Innovative solutions, which are also part of the Start-Up Villages initiative, might change the situation in rural and remote areas: remote patient monitoring (RPM) solutions, which represent tools that allow patients and healthcare professionals to monitor the onset of disease and symptom progression remotely.

RPM enables more accessible and faster engagement through virtual means to modify care plans and provide or receive education on self-care based on changes in the patient’s condition.

For example, obstructive Sleep Apnoea (OSA), a condition in which breathing stops involuntarily for brief periods during sleep, affects around 175 million people in Europe.

The management of the treatment for sleep apnoea is being performed in a sleep lab, that has limited access for patients living in rural areas. Using RPM solutions such as telemonitoring software would allow viewing sleep patterns from a distance and treatment could be monitored remotely.

“We have to take the chances of digitalisation and telemedicine,” the lawmaker Glück said,

While telemedicine is one way, another aspect he mentioned is mobile medical units.

“Medical units contribute to patient access to state-of-the-art diagnostics and treatments. For example, mobile units on trucks for mammographies are being used for years. This approach could also be relevant in other medical fields,” the German MEP said.

Mobile units used for example, for cancer screening, were called a ‘really good solution’ also by Sokol, who also stressed that the EU’s cohesion policy could fund this.