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This report brings together for the first time data on unmet need and financial hardship to assess whether people living in Europe can afford to pay for health care. Drawing on contributions from national experts in 24 countries, the report shows that financial hardship varies widely in Europe, and that there is room for improvement even in high-income countries that provide the whole population with access to publicly financed health services. Catastrophic health spending is heavily concentrated among the poorest households in all of the countries in the study. Where financial protection is relatively weak, catastrophic spending is mainly driven by out-of-pocket payments for outpatient medicines.