Joint Research Centre – European Commission & OECD 
OECD Rural Studies Access and Cost of Education and Health Services Preparing Regions for Demographic Change [EPUB ebook] 

Current population trends and the COVID-19 pandemic reinforce the need for efficient public service provision while guaranteeing good access to all. Population decline and ageing in rural regions affect the provision of services through lower economies of scale and scope, professional shortages and longer distances. Reliable estimates of the costs and access arising from demographic and geographical differences can help adapt the provision of services to different territorial realities. This report provides internationally comparable fine-grained present and future estimates of the cost and physical access to education (primary and secondary) and health services (cardiology, maternity and obstetrics) in European countries. The report finds that demographic change in the next decades will likely further strain the trade-off between costs and access, especially in remote rural areas. Adapting to changes in demand following lower fertility rates and ageing implies that services will need to become more widely available, while others will have to concentrate more. This report aims to support evidence-based policy decisions to ensure service provision allows for both cost efficiency and a sufficient level of access in all territories.