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EU Households Shoulder 15% of Health Costs, But Burden Varies Sharply Across Europe

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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).

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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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One in Four Teenagers Worldwide Does No Weekly Exercise, Study Finds

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Around 240 million adolescents worldwide did not take part in physical activity on any day of the week in 2025, with girls falling further behind boys, according to a major global study published in The Lancet Global Health.

The research found that teenagers averaged 2.7 active days per week, a figure that remained unchanged between 2010 and 2025. Only 14 per cent, or about one in seven adolescents, reported being active every day.

The study analysed 389 surveys covering 3.2 million young people aged 11 to 17 across 140 countries. The data represented approximately 59 per cent of the global adolescent population.

Researchers defined an active day as one on which a teenager completed at least 60 minutes of moderate-to-vigorous physical activity. This follows the recommendation of the World Health Organization (WHO), which counts activity at school, during travel and in leisure time.

The findings raise concerns about progress towards the WHO’s target of reducing the proportion of adolescents who fail to achieve 60 minutes of daily activity by 15 per cent between 2010 and 2030. The researchers found that no country or region was currently on track to meet the goal.

A clear gender gap emerged from the data. Boys averaged three active days per week in 2025, compared with 2.4 days for girls. The difference widened as girls grew older, suggesting that existing opportunities and programmes were not reaching them equally.

Geographical differences were also substantial. Adolescents in Central and Eastern Europe and Central Asia, East Asia and the Pacific, and high-income Western countries averaged around four active days each week. In these regions, between 6.9 and 7.7 per cent of teenagers reported no physical activity at all.

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In contrast, young people in Latin America and the Caribbean, the Middle East and North Africa, Oceania, South and Southeast Asia, and sub-Saharan Africa averaged approximately two active days per week. The share reporting complete inactivity ranged from 22.7 to 33.1 per cent.

Finland, Canada and Serbia recorded the highest activity levels, with adolescents averaging between 4.5 and 4.8 active days weekly. Cambodia, Jordan and Madagascar were among the least active, averaging between 1.7 and 1.9 days.

The study’s authors linked these differences partly to structural conditions. Wealthier countries generally have more resources to support physical activity policies, provide public spaces and develop safe routes for walking and cycling.

The researchers said adolescence is an important period for establishing habits that influence health throughout adulthood. Regular exercise supports physical and mental wellbeing, but existing programmes are failing to reach large numbers of young people.

They called for stronger policies tailored to local conditions, with schools and neighbourhoods made more supportive of everyday activity. They also urged governments to address barriers affecting girls, including restrictive gender expectations, safety concerns and limited access to suitable sports and recreational activities.

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Health Groups Urge WHO to Tighten Drinking Water Nitrate Limits Over Cancer Risks

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A coalition of 85 international health and environmental organisations has urged the World Health Organization (WHO) to revise its drinking water standards for nitrate, warning that exposure to levels below the existing limit may be associated with colorectal cancer and premature births.

In an open letter sent on Tuesday, the groups called on the United Nations health agency to include nitrate in its forthcoHealth Groups Urge WHO to Tighten Drinking Water Nitrate Limits Over Cancer Risks

ming review of drinking water guidelines. Signatories include Greenpeace International, the World Organization of Family Doctors (WONCA) and the European Environmental Bureau.

The organisations argue that the WHO’s current nitrate limit is based on standards established decades ago and does not adequately reflect more recent scientific evidence about the potential effects of long-term exposure.

Nitrates and nitrites are naturally occurring compounds found in soil, water and food. However, human activities, including the use of agricultural fertilisers, manure runoff and poorly maintained septic systems, can increase nitrate concentrations in water supplies.

The current WHO guideline sets the maximum acceptable nitrate concentration at 50 milligrams per litre (mg/L), equivalent to 11.3 mg/L when measured as nitrate-nitrogen. The standard dates back to 1958 and was originally designed to prevent methaemoglobinaemia, commonly known as blue-baby syndrome. The condition reduces the blood’s ability to carry oxygen and can be fatal in infants.

The organisations say the existing threshold does not account for epidemiological research linking prolonged exposure to lower nitrate concentrations with other health risks, particularly bowel cancer and adverse pregnancy outcomes.

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“Studies now link nitrate in drinking water, at levels well below the current WHO limit, to bowel cancer and premature birth,” said Pratyush Kumar, chair of WONCA, in a joint statement.

Amanda Larsson, Greenpeace’s global project lead for agriculture, said access to safe drinking water should be treated as a basic guarantee rather than a privilege.

The coalition also cited a report commissioned by the Danish government last year, which concluded that the existing international standard was insufficient to protect public health. The expert panel recommended reducing the nitrate limit to 6.0 mg/L.

Denmark has committed to adopting the lower threshold, although it has not announced a timetable for implementation. The organisations said this creates a growing difference between international guidance and national drinking water policies.

Most governments use WHO recommendations as the basis for their own drinking water standards, making changes to the agency’s guidelines important for wider regulatory reform, the letter said.

The appeal was issued on World One Health Day, which highlights the links between human, animal and environmental health.

The signatories also called on governments to reduce pollution from intensive livestock farming and support producers in adopting more environmentally sustainable agricultural practices.

They said stronger protections against nitrate contamination were needed to safeguard drinking water supplies and reduce potential health risks, particularly for children and pregnant women.

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Breast Cancer Screening Gaps Across Europe Leave Women Facing Unequal Access to Early Diagnosis

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A breast biopsy can bring days of uncertainty, fear and difficult memories, particularly for women with a family history of cancer. For Euronews reporter Monica Pinna, a week-long wait for test results became a personal experience of the emotional strain involved in investigating a possible diagnosis, as well as the inequalities affecting breast cancer screening and care across Europe.

Pinna had delayed a routine breast examination for around two years before attending an appointment in France. Her mammogram appeared normal, but an ultrasound revealed a suspicious area that required a biopsy. She underwent the procedure two days later and waited seven days for the results.

During that period, she recalled relatives who had survived breast cancer and others who had died from the disease. Although the uncertainty disrupted her work and daily life, the doctor eventually confirmed that there was no cancer.

Her experience highlighted a wider problem: access to early detection and timely diagnosis varies considerably between European countries.

When breast cancer is detected before it spreads, five-year survival rates approach 100%, compared with 38% for women diagnosed at an advanced stage, according to figures cited in the report. The European Commission has allocated around €80 million through its Europe’s Beating Cancer Plan to strengthen screening, but access remains uneven.

Differences in screening arrangements, appointment availability, out-of-pocket costs and public awareness all affect women’s chances of receiving an early diagnosis. Research by the European Union and the Organisation for Economic Co-operation and Development (OECD) has also identified social inequalities as a factor.

The time between screening and diagnosis varies across the continent. A study cited in the report found median waiting times ranging from eight days in Denmark to 32 days in Romania.

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Maria Assunta, who lives in Sardinia, experienced a considerably longer process. At 46, a routine ultrasound identified a four-centimetre lump. She waited a month for a biopsy and another three weeks to receive her diagnosis. She is now in follow-up care, with examinations every six months, and describes the treatment she received as excellent.

Participation in organised screening programmes also remains inconsistent. In France, fewer than half of eligible women take part. Although screening rates increased in nine EU countries with available data compared with 2019, progress has stalled in many others.

Around 360,000 women in the EU are diagnosed with breast cancer each year, including approximately 61,000 in France. Estimates suggest that one in 11 women will develop the disease during their lifetime.

Access to psychological support is another concern. The OECD’s 2026 European Cancer Inequalities Report found that only 16 EU countries include psychological care in their cancer treatment pathways, alongside Norway and Iceland.

In Italy, a 2024 study of around 3,000 cancer patients found that only 20% had received psychological support. The Italian Federation of Voluntary Associations in Oncology estimates that specialised psycho-oncology services are available in only around 20% of hospitals.

Cancer survivors and medical volunteers have established initiatives to help address these gaps, offering activities such as yoga, Qigong and emotional support. However, provision remains limited and often depends on voluntary organisations.

Pinna’s experience ended with an all-clear, but she said it had changed her approach to screening. She hopes sharing her story will encourage women to attend regular examinations, while calling for faster diagnosis, wider access to treatment and psychological support across Europe.

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