Health
EU Households Shoulder 15% of Health Costs, But Burden Varies Sharply Across Europe
A new analysis by Euronews Health, using Eurostat data, reveals that European households are directly paying for a significant share of their medical costs — but the financial burden varies dramatically from country to country.
Across the European Union, household out-of-pocket payments account for about 15 per cent of total health care spending. That means families, on average, pay €15 out of every €100 in medical expenses directly from their own pockets. While mandatory health insurance covers just over half (51 per cent) of total costs and governments contribute about 30 per cent, households still fill the gap — with sharp regional disparities.
At one end of the scale, Luxembourg has the lowest share of household out-of-pocket payments, at just 8.5 per cent, followed closely by France (8.9 per cent) and Croatia (9.4 per cent). At the other, Bulgaria tops the list with 35.5 per cent, while Latvia (35.1 per cent), Greece (34.3 per cent), and Serbia (32.1 per cent) also record high levels.
Dr. Joseph Piscopo, a health economist with Malta’s health ministry, said economic strength plays a key role. “Stronger economies can allocate more financial resources to their health systems and, consequently, achieve lower levels of out-of-pocket health expenditure,” he explained.
Among the EU’s largest economies, Italy shows the highest household contribution at 22.3 per cent, followed by Spain at 20.9 per cent. France and Germany rank among the lowest, while the United Kingdom — with data from 2019 — sits near the EU average at 15.9 per cent. In the Nordic region, out-of-pocket shares are below average in Sweden (13.4 per cent), Denmark (13.9 per cent), and Norway (14.1 per cent).
Experts say national health coverage policies are the main factor behind the differences. Jonathan Cylus of the London School of Economics noted that “who is covered, what services are covered, and how much of the cost is covered” are crucial determinants. He added that in countries such as Bulgaria, people who fail to pay their social insurance contributions are excluded from public coverage, forcing them to pay entirely out of pocket.
Pascal Garel, head of the European Hospital and Healthcare Federation (HOPE), said countries with extensive public or social health insurance schemes — such as France, Germany, and Sweden — tend to offer comprehensive benefits and strong protection for vulnerable groups. In contrast, countries like Bulgaria and Greece have limited benefit packages and weaker safeguards against catastrophic expenses.
Eurostat data also highlight how much people spend each year. On average, EU residents paid €542 out of pocket for healthcare in 2023. The figure ranged from just €136 in Croatia to €1,176 in Belgium, and a staggering €2,396 in Switzerland.
France recorded the lowest amount among Europe’s five biggest economies, at €410 per person annually, while Italy topped the group at €718. Garel noted that wealthier and older populations — particularly in Italy and Germany — drive higher spending due to greater demand for long-term and chronic care.
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