The recently published survey data from the European Social Survey (ESS) on health inequalities in Europe provide insight into the barriers preventing people from accessing necessary medical care. In a policy brief, VUB researcher Maarten Hermans from the Brussels Institute for Social and Population Studies (BRISPO) examines these obstacles for Belgian employees and compares their situation to that of workers in other European countries.
“The analysis of the 2023-2024 ESS data reveals that for 21% of Belgian employees, it is impossible at least once a year to obtain a necessary medical consultation or treatment,” says Hermans. “This percentage is higher than in the general Belgian population (16.6%), as employees more often report that their work acts as a barrier.”
Among employees who missed out on medical care, 17% stated that they could not take time off work. Other reasons—similar to those in the general population—mainly relate to shortages in healthcare services, such as long waiting lists (35%), inability to get an appointment (29%), or no treatment available nearby (8%). Additionally, affordability (14%) and conflicts with other obligations (5%) were cited as obstacles. Belgium has one of the highest proportions in Europe of employees unable to access medical care due to an inability to take leave from work.
“We observe that employees in more precarious positions in society and in the workplace, as well as those exposed to unhealthy working conditions, are more likely to miss out on medical care—specifically because they cannot take leave to see a doctor,” says Hermans. “This double inequality undermines preventive healthcare policies and increases the risk of more severe health issues and (long-term) absence from work. Addressing this lack of medical follow-up for employees requires strengthening existing legislation on workplace absences for medical reasons, while considering the barriers and inequalities that prevent people from making use of these rights.”
Another notable finding: employees who are union members receive better medical follow-up. “Non-unionised employees are 2.6 times more likely to report missing medical care because they could not take time off,” says Hermans. “This suggests that unionised workers may be better informed about their rights and options or feel more empowered to assert them. There may also be an indirect effect of a stronger unionised work environment, where additional workplace agreements or collective labour agreements (CLAs) on medical absences are more common.”
“Jobs that offer employees less flexibility and control over their own work and working hours also tend to have lower overall job quality, including lower wages and poorer working conditions,” Hermans explains. “This creates a double health inequality: workers exposed to unhealthy conditions are also more likely to struggle to access medical care. Within the group of employees who miss out on medical care, those exposed to specific health risks are more likely to cite an inability to take leave as the reason. For example, employees exposed to chemical products or risks related to musculoskeletal disorders—such as lifting patients or heavy loads, machine vibrations, etc.—are between one-third and 2.6 times more likely to miss necessary medical care specifically because they cannot take time off.”
According to the researcher, this double inequality weakens preventive healthcare policies and increases the likelihood of serious health problems and long-term work absences. Approximately one-third of long-term sick employees are off work due to musculoskeletal disorders—the most common work-related health issue, with an economic cost of €5 billion. “The fact that employees most at risk of such conditions are also the ones struggling to access necessary medical care hinders effective and preventive approaches to long-term illness."*
Reference:
Hermans M. (2025). No time for the doctor: barriers to medical care among Belgian employees. BRISPO Policy Brief N° 2025/01. Brussels Institute for Social and Population Studies. https://doi.org/10.5281/zenodo.14738044
*This is a machine translation. We apologise for any inaccuracies.