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Most financial barriers were observed in Australia and New Zealand. Frequent users with some level of unmet healthcare needs are prevalent in all four countries. CONCLUSIONS Four main groups of patients with different patterns of access were identified (i) good access; (ii) geographical and time barriers; (iii) financial barriers; and (iv) frequent users with unmet healthcare needs. Differences in access between the four countries are substantial. © The Author(s) 2019. Published by Oxford University Press in association with the Interna