Unmet health care needs statistics

Data extracted in January 2018. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: March 2019.

An overview of unmet needs for specific health care-related services among the population of the European Union (EU) is presented in this article. It presents a variety of reasons why needs for healthcare services are not met, for example because of cost (too expensive), distance (too far to travel) or timeliness (waiting lists) which makes it possible to identify causes of limitations in access to healthcare services.

This article is one of a set of statistical articles concerning healthcare activities in the EU which forms part of an online publication on health statistics.

Figure 1: Share of persons aged 15 and over reporting unmet needs for health care, by specific reason, 2014 or nearest year
(%)
Source: Eurostat (hlth_ehis_un1e)
Figure 2: Share of persons aged 15 and over reporting unmet needs for health care due to financial barriers, distance or transportation problems or long waiting lists, by age, 2014 or nearest year
(%)
Source: Eurostat (hlth_ehis_un1e)
Figure 3: Share of persons aged 16 and over reporting unmet needs for medical examination or treatment, 2016
(%)
Source: Eurostat (hlth_silc_08)
Table 1: Share of persons aged 16 and over reporting unmet needs for medical examination or treatment, by main reason, 2016
(%)
Source: Eurostat (hlth_silc_08)
Figure 4: Share of persons aged 16 and over reporting unmet needs for medical examination or treatment due to being too expensive, too far to travel or waiting lists, by age, 2016
(%)
Source: Eurostat (hlth_silc_08)
Figure 5: Share of persons aged 16 and over reporting unmet needs for medical examination or treatment due to being too expensive, by income quintile, 2016
(%)
Source: Eurostat (hlth_silc_08)
Figure 6: Share of persons aged 16 and over reporting unmet needs for medical examination or treatment due to being too expensive, too far to travel or waiting lists, by educational attainment level, 2016
(%)
Source: Eurostat (hlth_silc_14)
Figure 7: Share of persons aged 16 and over reporting unmet needs for dental examination or treatment, 2016
(%)
Source: Eurostat (hlth_silc_22)
Table 2: Share of persons aged 16 and over reporting unmet needs for dental examination or treatment, by main reason, 2016
(%)
Source: Eurostat (hlth_silc_22)
Figure 8: Share of persons aged 16 and over reporting unmet needs for dental examination or treatment due to being too expensive, too far to travel or waiting lists, by age, 2016
(%)
Source: Eurostat (hlth_silc_22)
Table 3: Share of persons aged 15 and over unmet needs for health care-related services due to financial reasons, 2014 or nearest year
(%)
Source: Eurostat (hlth_ehis_un2e)
Table 4: Share of persons aged 15 and over reporting unmet needs for specific health care-related services due to financial reasons, by level of educational attainment, 2014 or nearest year
(%)
Source: Eurostat (hlth_ehis_un2e)
Table 5: Share of persons aged 15 and over reporting unmet needs for specific health care-related services due to financial reasons, by age, 2014 or nearest year
(%)
Source: Eurostat (hlth_ehis_un2e)

Main statistical findings

The statistics reported in this article originate from two European surveys: the EU statistics on income and living conditions (EU-SILC) instrument, which collects information on an annual basis covering persons aged 16 and over, and the second wave of the European health interview survey (EHIS), conducted between 2013 and 2015 and covering persons aged 15 and over. The reference year for the second wave of EHIS is 2014, while the reference year for EU-SILC statistics is 2016.

It should be noted that the EHIS survey includes individual questions corresponding to the reasons behind unmet needs in health care, while the EU-SILC survey only asks for the main reason behind unmet needs for medical care. Moreover, the percentages reported for EU-SILC are calculated over the entire population aged 16 and over, while the percentages reported in the EHIS are calculated over the population aged 15 and over that were in need of health care in the previous 12 months prior to the survey.

Unmet needs for health care

More than one quarter of the EU-28 population had an unmet healthcare need in 2014 that was due to costs, distance or waiting lists

In 2014, a total of 26.5 % of the EU-28 population aged 15 and over in need of health care reported to have unmet needs for health care for reasons of financial barriers, distance or transportation problems, and/or long waiting lists (see Figure 1). This share ranged from 9.4 % in Cyprus to 40.6  % in Ireland, peaking at 41.8 % in Latvia. Focusing on the three types of reasons considered for not receiving health care when needed, long waiting lists (18.7 %) was the most frequently reported at EU-28 level, followed by finances (14.8 %) and lastly, distance or transportation problems (3.6 %). At national level, long waiting lists was the most frequently reported reason for an unmet health care need in 15 EU Member States, as well as Iceland. The corresponding share exceeded 25 % in Denmark (25.1 %), Poland (26.2 %), Malta (26.5 %), Ireland (27.2 %), Italy (29.9 %) and Luxembourg (31 %). Being too expensive was the most commonly reported reason given for unmet needs related to health care in Slovakia, Hungary, Romania, Bulgaria, Spain, Greece, Portugal, Estonia, Latvia and Ireland, as well as Norway and Turkey. The highest rates were recorded in Estonia, Ireland and Latvia (30 % or higher). Among the three reasons considered, distance or transportation was the least common factor affecting unmet needs in health care in all countries. The share ranged from 1.3 % in Slovakia to 9.1 % in Italy, with Cyprus reporting below this range (0.1 %). The respective share in Turkey was the highest among all reporting countries included, reaching 13.3 % —see Figure 1.

Middle aged people reported unmet healthcare needs for reasons of expense, distance or waiting lists more frequently

At EU-28 level, persons aged 45–64 who were in need of health care were, in general, more likely to report unmet needs for health care for reasons of expense, distance or transportation problems, or long waiting lists in 2014 (28.3 %), compared to the population aged 15–44 (26.3 %) and those aged 65 or over (24.2 %) (see Figure 2). A national analysis reveals that the share of the population aged 15 and over with unmet health care needs due to the three considered reasons was higher among those aged 45-64 in 11 EU Member States, with the respective rate ranging from 11.4 % in Cyprus to 46.3 % in Latvia. Exceptions to this pattern were Denmark, Germany, Luxembourg, the Netherlands and Sweden, as well as Iceland and Norway, where the share of population reporting unmet health care needs for the specified reasons decreased with increasing age. In contrast, the opposite pattern is observed in Bulgaria, the Czech Republic, Greece, Croatia, Cyprus, Malta, Poland and Romania with the lowest shares being recorded for younger people (aged 15-44). Especially in Bulgaria, Denmark, Germany, Croatia and Poland, differences in the shares recorded between the younger and the older age groups were 12 percentage points or more. Ireland and Finland diverged from all three observed patterns since the highest share was recorded for those aged 65 or over, followed by the younger (aged 15-44) and middle (45-64) age groups.

Unmet needs for medical examination or treatment

More than 4 % of the EU-28 population aged 16 and over had an unmet need for a medical examination or treatment in 2016

In 2016, 4.5 % of the population aged 16 and over in the EU-28 reported that they had unmet needs for a medical examination or treatment, a share that ranged from about 2 % in the United Kingdom to 14.5 % in Greece, with Germany, Spain, Cyprus, Austria, the Netherlands and Slovenia below this range and Estonia above it (see Figure 3). Norway and Switzerland also reported relatively low shares, while the opposite holds for Serbia. As regards reasons related to the organisation and functioning of health care services — financial reasons (too expensive), transportation (too far to travel), or timeliness (long waiting lists) — 2.6 % of the EU-28 adult population reported they had unmet needs, a share that ranged from 0.5 % in Spain to 8.2 % in Latvia, with Germany, the Netherlands, Austria and Slovenia below this range and Greece and Estonia above it.

Being too expensive is the most common main reason for unmet medical treatment needs in 2016

Overall in the EU-28, the most common main reason for not having a medical examination or treatment was that it was too expensive; this reason alone accounted for more than one third of all the people who reported an unmet need for medical care, equivalent to 1.7 % of the population (see Table 1). The next most common main reasons given were waiting lists or wanting to see if the problem got better on its own: these two reasons were each reported by about 1 % of the population. Less common reasons were lack of time, a fear of doctors, hospitals, examination or treatment, that it was too far to travel, or that the person did not know a good doctor or specialist, each of which were reported by between0.1 % and 0.5 % of the population. Aside from these seven specified main reasons, a further 0.4 % of the population indicated another (unspecified) reason for an unmet need for a medical examination or treatment.

A waiting list hindering a medical examination or treatment was the most frequent reason given for unmet medical needs in Estonia, Poland, Finland, Lithuania and the United Kingdom. Patients wanting to wait and see whether their problem resolved itself was the most common reason in the Czech Republic, Denmark, France, Croatia, Luxembourg, Hungary, Austria, Slovakia and Sweden. A group of unspecified other reasons were more common than any of the seven specific main reasons shown in Table 1 in Malta and the Netherlands, as well as in Norway. Due to the very low overall prevalence of unmet needs in Cyprus, the Netherlands, Austria and Slovenia, there were no big differences in the reported rates for the main specific reasons. In more than one third of the EU Member States the expense of a medical examination or treatment was the most common reason for unmet medical needs.

Among all of the reasons for unmet needs for a medical examination or treatment, expense was the main reason for 60 % or more of all people reporting an unmet need in Ireland, Romania, Cyprus, Belgium, Greece and Italy. In another two EU Member States, at least one quarter of the people reporting unmet needs for a medical examination or treatment cited expense as the main reason. In contrast, in the Czech Republic, Sweden, Denmark and Finland less than 5 % of people reporting unmet needs for a medical examination or treatment gave expense as the main reason.

Member States with high shares of unmet needs for medical care due to high costs, distance or waiting lists displayed relatively high shares for older people

In many of the EU Member States, age was a factor linked to unmet needs for medical care due to treatment being too expensive, too far to travel to or because of waiting lists, although there was not a universal pattern (see Figure 4). Among the five EU Member States (Romania, Poland, Latvia, Greece and Estonia) where there was a relatively high proportion of the population reporting an unmet need for medical care due to high costs, distance or waiting lists, younger people (aged 16–44) were generally less likely to report an unmet need, while older people (aged 65 and over) were more likely to do so, although in Poland, there was not a big difference in the shares for the middle age group (persons aged 45–64) and older persons (aged 65 and over). A similar pattern was also observed among some of the Member States with somewhat lower overall shares, for example Portugal.

In contrast, the reverse situation was observed in a few Member States, with the lowest shares being reported for older persons and the highest for younger people: France and Sweden are examples. The same also holds for Iceland, Norway and Switzerland. A further exception to the general pattern was observed in several Member States where the highest share was reported for people in the middle age group (persons aged 45–64), for example in Belgium and Ireland.

The frequency of reporting unmet needs for a medical examination or treatment for reasons of expense decreased with increasing income

Focusing only on expense, the most common reason for unmet needs for a medical examination or treatment in the EU-28, and its relation to levels of income, it can be seen that the frequency of reporting such unmet needs for reasons of expense decreased with increasing income. In 2016, 4.3 % of the population in the first income quintile group (the 20 % of the population with the lowest income) in the EU-28 reported unmet needs for a medical examination or treatment due to expense, compared with 2.1 % in the second quintile group, 1.4 % in the third quintile group, 0.6 % in the fourth quintile group and 0.3 % in the fifth income quintile group (the 20 % of the population with the highest income).

Figure 5 shows the share of people aged 16 and over reporting unmet needs for a medical examination or treatment due to expense and its relation to three of the income quintile groups – the highest, middle and lowest quintiles. In eight of the nine EU Member States (with the exception of Ireland (2015)) where the overall share of people reporting unmet needs for a medical examination or treatment due to expense was at least 2 %, a similar pattern was observed: the lowest shares were recorded for the fifth income quintile group, the highest shares for the first income quintile group, and shares for the third income quintile group lay between these two. Among the remaining EU Member States, those where the overall share of people reporting unmet needs for a medical examination or treatment due to expense was relatively low, differences recorded across income groups were quite small.

Generally, the frequency of reporting unmet needs for medical treatment for reasons of high expense, distance or waiting lists increased with decreasing educational attainment

The final analysis for the share of the population reporting unmet needs for a medical examination or treatment due to high costs, travel distance or waiting lists is based on three groupings showing the highest level of completed education (see Figure 6). In the EU-28, 1.3 % of the persons having completed tertiary education reported unmet needs for a medical examination or treatment due to it being too expensive, too far to travel to or because of waiting lists in 2016; this share reached 2.3 % for people having completed upper secondary or post-secondary non-tertiary education and 4 % for people having completed at most lower secondary education.

This general pattern of increasing unmet needs with decreasing educational attainment was observed in the majority of the EU Member States, clear examples being Greece, Italy, Latvia, Poland and Romania. Estonia was the most notable exception to the general pattern as the reverse situation was observed with the highest share among people having completed a tertiary education and the lowest among people having completed at most lower secondary education. A less prevalent pattern is observed in five countries, where the share for persons with upper secondary or post-secondary non-tertiary education was higher than for people with either of the two other education levels, in Ireland (2015) and Denmark for example.

Unmet needs for dental examination and treatment

In 2016, close to 6 % of the EU-28 population had an unmet need for dental examination or treatment

In 2016, some 5.6 % of the population aged 16 and over in the EU-28 reported that they had unmet needs for a dental examination or treatment; as such, the share of the population with unmet needs was greater for dental care than for medical care. For dental care, the proportion of the population with unmet needs ranged from 1 % in Austria to 15 % in Greece, with the Netherlands below this range and Latvia and Portugal above it (see Figure 7). If considering only reasons related to the organisation and functioning of health care services - financial reasons (too expensive), transportation (too far to travel), or timeliness (long waiting lists) - 4.1 % of the EU-28 adult population reported they had unmet needs, a share that ranged from less than 1 % in the Netherlands, Austria, Germany and Slovenia to 10 % or more in Estonia, Greece, Latvia and Portugal.

Being too expensive was by far the most common main reason for unmet dental examination and treatment needs

Overall in the EU-28, the most common main reason for unmet needs for dental a examination or treatment was that it was too expensive; this reason alone accounted for almost two thirds of all the persons who reported an unmet need for dental examination or treatment, equivalent to 3.7 % of the whole population — see Table 2.

After expense, the next most common main reasons reported for unmet needs for a dental examination or treatment were fear (of dentists, hospitals, examination or treatment) cited by 0.5 % of the population, followed by lack of time and waiting lists, both reported by 0.3% of the population. Less common main reasons were due to waiting to see if the problem resolved itself, or that the person did not know a good dentist or specialist, reported by 0.2 % and 0.1 % of the population, respectively. The proportion of the population that cited as main reason that it was too far to travel to was not significant. Aside from these seven specified main reasons a further 0.4 % of the population indicated another (unspecified) main reason for an unmet need for a dental examination or treatment.

A waiting list hindering a dental examination or treatment was the most frequent main reason given in Finland, whereas in Malta another (unspecified) reason was the most frequently reported reason for an unmet need for a dental examination or treatment. In all the remaining 26 EU Member States, the expense of a dental examination or treatment was the single most common main reason for unmet needs.

In Bulgaria, Estonia, Greece, Spain, Italy and Latvia as well as Iceland, at least four in five people with unmet needs for a dental examination or treatment said that it was because a dental examination or treatment was too expensive. In 11 other EU Member States, at least half of the people reporting unmet needs for a dental examination or treatment cited expense as the main reason. The same also holds for Norway, Switzerland as well as Serbia. In contrast, in the Czech Republic, Croatia and Malta just one in four people reporting unmet needs for a dental examination or treatment gave this main reason, while in Finland this share was as low as 5 %.

Generally, unmet needs for dental care due to high costs, distance or waiting lists were most often reported by people aged 45–64

The middle age group (persons aged 45–64) was the most likely to report unmet needs for a dental examination or treatment due to high costs, travel distance or waiting lists in all but four EU Member States. In Romania, the reporting of unmet needs gradually increased with increasing age. In the Netherlands, Sweden and the United Kingdom, as well as in Iceland, Norway and Switzerland, older people (aged 65 or over) reported unmet needs less frequently than people aged 16–44 or 45–64, as shown in Figure 8.

Unmet needs for mental healthcare services and prescribed medicines

About 5 % of the EU-28 population aged 15 and over could not afford prescribed medicines in 2014

Table 3 presents the share of persons aged 15 and over in need of mental health care and prescribed medicines reporting unmet needs due to financial barriers. In 2014, about 3 % of the EU-28 population aged 15 and over who needed to use mental health care services reported that they could not afford it. In 15 Member States, as well as Iceland and Turkey, the respective share was higher than the EU-28 average. It exceeded 9 % in Greece (9.7 %), Denmark (13.3 %), Portugal (31.1 %) and Ireland (51 %), as well as Iceland (33.1 %). With regard to prescribed medicines, the proportion of people with unmet needs because of financial difficulties was, on average, 4.6 %. Large variations were observed across Member States, with the lowest rates recorded in the United Kingdom (1.3 %), the Netherlands (1.9 %) and Cyprus (2.2 %) and the highest rates in Portugal (10 %), Finland (10.6 %), Greece (14.9 %), Latvia (17.3 %) and Ireland (19.4 %). Iceland and Turkey also recorded relatively high rates (9 % or higher).

Women in need of mental health care services and prescribed medicines reported unmet needs due to finances more frequently than men

On average, women aged 15 and over who needed to use mental care services or prescribed medicines reported more frequently than men that they had unmet needs for those health care related services due to financial barriers (see Table 3). For unmet needs for mental health care, the difference between the sexes was more than 13 percentage points in Portugal, as well as in Iceland. By contrast, the gender gap was close to 0.5 percentage points in the Czech Republic, Germany, Spain and the United Kingdom. In Croatia, Cyprus, Lithuania and Slovakia, men were more likely to report unmet needs for mental health care than women. For unmet needs for prescribed medicines, the difference between sexes ranged from 7 percentage points in Latvia down to less than 0.5 percentage points in the Netherlands, Cyprus and Slovakia. Only in Denmark, Ireland, Luxembourg and Finland, was the share of men reporting unmet needs for prescribed medicines due to finances higher than the respective share for women.

The share of people with unmet needs for prescribed medicines and mental health care services due to financial reasons was highest among those with at most lower secondary education

In the EU-28, 2.2 % of persons having completed tertiary education reported unmet needs for mental health care in 2014 due to financial barriers; this share reached 2.6 % for those having completed upper secondary or post-secondary non-tertiary education and 3.1 % for people having completed at most lower secondary education. This general pattern of increasing unmet needs for mental health care with decreasing educational attainment was observed in more than half of the EU Member States (see Table 4). In Denmark, Slovenia and Sweden, the reverse pattern was observed as the lowest prevalence of unmet needs for mental health care was reported by people having completed at most lower secondary education. In Spain, Italy, Luxembourg, as well as in Iceland, the lowest share of unmet needs was recorded for persons having completed tertiary education, while the highest share was generally recorded for persons having completed upper secondary or post-secondary non-tertiary education. In Ireland, Cyprus and Portugal there was a notably higher prevalence of unmet needs among people having completed at most lower secondary education. With focus on prescribed medicines, on average 6.8 % among the population in the lower secondary educational level or less reported being in need of prescribed medicines but not being able to afford it. The corresponding share was 2.3 percentage points lower among the population having completed upper secondary and post-secondary non-tertiary education and 4.6 percentage points lower for those having attained tertiary education. The pattern is similar across the majority of the EU Member States with the following exceptions: Lithuania, Luxembourg and the United Kingdom, where the share was higher among those with upper secondary and post-secondary non-tertiary education, although the differences were not substantial.

Ireland recorded the highest percentage of unmet needs for mental health care and prescribed medicines due to financial barriers across all age groups

At EU-28 level, unmet needs in mental health care services due to financial barriers were reported by nearly 3 % of people aged 15–44 that needed to use such services, followed by those aged 45–64 and those aged 65 and over (Table 5). Also at national level, it is noted that in many EU Member States, the respective share was higher among those aged 15–44 as compared to the older age groups. In eight Member States, although the differences are not significant (with the exception of Portugal), the prevalence of those reporting unmet needs for mental health care due to financial barriers was higher among middle aged (45–64 years) compared to the younger and the older age groups. On average, persons aged 65 or over in need of prescribed medicines were slightly more likely to report that they could afford it as compared to those aged 45–64. Younger people (aged 15–44) reported less frequently unmet needs for the health care service in question due to financial barriers, with the following exceptions: Germany, Cyprus, the Netherlands and the United Kingdom, as well as Iceland, Norway and Turkey, in which the highest proportion was reported for those aged 15–44. In addition, the corresponding share in Estonia, Ireland, Spain, Italy, Hungary, Austria, Portugal and Slovenia was highest among the middle age group. Bulgaria, Ireland, Lithuania, Poland, Portugal and Finland recorded relatively high shares of unmet needs for prescribed medicines due to financial barriers across all the three age groups, presented in Table 5.

Data sources and availability

Unmet needs for medical and dental examination and treatment

The data used in the article concerning self-reported unmet needs for a medical or dental examination or treatment are derived from EU statistics on income and living conditions (EU-SILC). This source is documented in more detail in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

The general coverage of EU-SILC is all private households and their members (who are residents at the time of data collection); this therefore excludes people living in collective households. Data refer to the population aged 16 years or over.

Questions included in EU-SILC on medical and dental examination or treatment refer to persons’ own assessments of whether they needed examination or treatment for the specific types of health care, i.e. medical and dental, in the previous 12 months but did not have it or did not seek it.

Unmet needs for health care

The data concerning unmet needs for health care come from the second wave of the European health interview survey (EHIS). The second wave of the EHIS was conducted in all EU Member States during 2013–2015 according to European Commission Regulation (EU) No 141/2013 and its subsequent amendment to take account of the accession of Croatia to the EU (European Commission Regulation (EU) No 68/2014).

The general coverage of the EHIS is the population aged 15 or over living in private households residing in the national territory. This source is documented in more detail in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

The variables on unmet needs for health care are used to assess equity to health care services. They refer to the proportion of persons aged 15 or over that felt they needed health care in the previous 12 months but did not receive it for reasons of financial barriers, long waiting lists and transportation problems.

Health care is defined according to the System of Health Accounts (SHA) as individual health care goods and services (that is provided directly to and consumed by individual persons). It covers curative care, rehabilitative care, long-term health care, ancillary services and medical goods provided to outpatients. Care provided for different purposes (curative, rehabilitative, long-term health care) and by different modes of provision (inpatient, outpatient, day, home) is included.

Note on tables: When 0 with decimal places is displayed, values are not significant.

Limitations of the data

The indicators presented in this article are derived from self-reported data so they are, to a certain extent, affected by respondents’ subjective perception as well as by their social and cultural background.

EU-SILC and the EHIS do not cover the institutionalised population, for example, people living in health and social care institutions whose health status is likely to be worse than that of the population living in private households. It is therefore likely that, to some degree, both of those data sources under-estimate health problems in general. By contrast, the exclusion of health and social care institutions, where medical care is likely to be readily available, may lead to an over-estimation of unmet needs for health care. Another factor that may influence the results shown is the different organisation of health care services, be that nationally or locally. Furthermore, the indicators presented are not age-standardised and thus reflect the current national age structures. Finally, the implementation of EU-SILC and the EHIS were organised nationally, which may impact on the results presented, for example, due to differences in the formulation of questions or their precise coverage.

Context

Good health is an asset in itself. It is not only of value to the individual as a major determinant of quality of life, well-being and social participation, but it also contributes to general social and economic growth. Many factors influence the health status of a population and these can be addressed by health policies regionally, nationally or across the EU.

Barriers to accessing health services include cost, distance, waiting times, lack of cultural sensitivities and discrimination. For non-native speakers, language can be an obstacle for those seeking to access services, while barriers to health care may result from poor understanding or a lack of knowledge with respect to a patient’s rights and the administrative practices and requirements of health systems.

A European Commission Communication ‘Towards social investment for growth and cohesion’ (COM(2013) 83 final) and its accompanying document on ‘Investing in health’ (SWD(2013) 43) highlight the need to invest in sustainable health systems which can improve cohesion and boost economic growth by reducing health inequalities, enabling people to remain active longer and in better health. Investment designed to reduce health inequalities should contribute to increased social cohesion and may help break the spiral of poor health that both contributes to and results from poverty and exclusion. Health inequalities represent a considerable burden both in terms of their effect on an individual’s health, as well as productivity losses and costs associated with social protection systems.

An indicator on the equality of access to health care service, defined as the total self-reported unmet need for medical care for the reasons of financial barriers, waiting times and too far to travel, is included in the health services chapter of the European core health indicators (ECHI).

See also

Online publications

Healthcare

Methodology

General health statistics articles

Further Eurostat information

Publications

Database

Unmet needs for health care (hlth_unm)

Dedicated section

Methodology / Metadata

Source data for tables and figures (MS Excel)

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