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Background A vignette is a short description of a person or situation designed to simulate key features of a real- world scenario. Usually this vignette is then presented to relevant professionals to solicit their hypothetical response or behaviour. In medical literature, vignettes are mostly used to study clinical judgments, compare hospital prices, self-assess health or examine how age, sex, socioeconomic or insurance status affects chosen treatment. Methods We aimed to develop a method to utilize case vignettes to gain a better understanding of health access challenges. To this end, we studied available access indicators and frameworks and vignette applications as well as possible ways to include internationally recommended care plans to increase comparability of results across countries. Results We developed a five-step approach consisting of (1) selection of vignettes, (2) drafting of vignettes and a questionnaire based on available access framework and best practice guidelines for treatment, (3) expert validation, (4) application of vignette in country context, and (5) systematic analysis of country feedback. Four detailed pilots were carried out for dental care, stroke, depression and palliative care, in up to 12 European countries. Conclusions The vignette approach has the potential to identify gaps in coverage and access as well as differences in treatment and quality. Four detailed pilots have provided valuable insights in the challenges and limitations of the method that can be addressed in future applications. These include suggestions to improve user friendliness, scope, expert selection and complementing the survey with more specific and quantitative questions.

Using the vignette methodology to measure access