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Health care systems in the EU – A comparative study (Public Health and Consumer Protection Series SACO 101); also in German and French

Jakubowski E, Busse R

Luxembourg: European Parliament




The following report provides essential facts on health and health care in the 15 EU Member States. This new study of the health care systems of the 15 European Union (EU) Member States replaces two existing studies carried out in 1990 and 1993.

The 1991 Maastricht Treaty gave the Union new competences in public health and more scope for international cooperation. Joint action with the Member States was identified for health promotion and health protection, the subsidising of medical and health policy research, and the establishment of international information systems. The Commission has already developed specific policies in fields such as AIDS, tobacco and alcohol abuse, and environmental causes of ill-health. The 1997 Treaty of Amsterdam provides for a new direction of Community action towards illness and diseases, and alleviating sources of danger to human health. The single European market and increasing migration within the Union are encouraging further policy convergence and new routes for the exchange of medical technology, health services and manpower resources.

However, health policy-making is firmly guided by the principle of subsidiarity. The harmonisation of national laws is specifically excluded in Article 129 of the European Union Treaty.

Health care systems stem from specific political, historical, cultural and socio-economic traditions. As a result, the organisational arrangements for health care differ considerably between Member States - as does the allocation of capital and human resources.

The principal forms of health care organisation in the European Union are the tax-financed national health service systems and those operating with social insurance in which insurance funds may be independent of the government.

However, this fundamental division between the systems is weakening. Countries such as the United Kingdom have opened up their NHS to internal competition to diversify supply and increase purchasing power. In contrast, in some traditional social insurance systems sickness funds are being merged and cost control increased on the part of the central government. This trend towards convergence is an attempt to retain the relative advantages of each system.

Health care in the EU is at a cross-roads between challenges and opportunities. The Member States are facing common challenges in delivering equal, efficient and high quality health services at affordable cost in times when the amount of care to be delivered is starting to exceed the resource base. The demand for health care in Europe - as elsewhere among industrialised countries - is growing as a result of ageing populations and rising public expectations. The combination of demographic changes and technological developments increases the cost of provision.

In consequence, the systems face the same problems of rationing services in order to cut costs owing to an increasing demand and a decreasing tax base to pay for that demand. At the same time, it is increasingly difficult to develop widely accepted health policies and maintain public consent.

On the other hand, there are new opportunities to secure substantial improvements in health. There is growing interest in disease prevention and health promotion, clinical advances are enabling more effective and efficient use of resources, and information on health and health care can be circulated more rapidly.

Strategies employed by the Member States to meet the challenges and opportunities in health differ. For one thing they reflect substantial differences in the organisational framework in which health services are financed and delivered. Furthermore, definitions of what constitutes health and health care differ from country to country and different levels in health outcomes reflect different problems to be tackled. Each system has its own strengths and weaknesses and none of the systems provides a wholly successful solution. Hence each has something to learn from the experience of the other fourteen.

In essence, the fifteen health care systems in the EU reflect a variety of different philosophies and approaches and retain their own peculiarities. Comparative studies of these systems aid the process of learning from one another to improve the health of all citizens of the Union.

This report aims to provide up to date comparable information on health care systems in the European Union.

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