Comparing Health Insurance Systems In Europe: A Comprehensive Overview

Comparing Health Insurance Systems In Europe: A Comprehensive Overview – The provision of private health services in European countries: Recent evidence and lessons for universal health coverage in other settings

Universal health coverage (UHC) exists in all countries in Europe, despite differences in the ownership structure of healthcare delivery systems. As countries around the world seek to develop UHC and manage the private sector within their health systems, the European experience can offer useful insights. We found four distinct models of health care delivery, with the private sector predominating in some countries and of minimal importance in others. European experience shows that UHC can be effectively delivered with or without large-scale private sector provision in hospital, specialist and primary health care, and that it can also be delivered with high levels of patient satisfaction. These findings suggest regulatory models for countries in other regions to review as they advance UHC.

Comparing Health Insurance Systems In Europe: A Comprehensive Overview


Comparing Health Insurance Systems In Europe: A Comprehensive Overview

There is a global movement to provide affordable health care for those in need, achieving universal health coverage in all countries by 2030. While striving for this, many low- and middle-income countries (LMICs) continue to struggle with how and how much to integrate private providers into the formal government-regulated and funded health care system. This is a very immediate issue in countries such as Nigeria, India and Myanmar, where well over 50% of all services provided are private and quality assurance is a challenge, but it is also relevant in countries such as Ethiopia or Vietnam, where private care is under 25%, and policymakers should wonder whether higher rates would accelerate investments in coverage and availability of care (1–3).

Why Can European Countries Afford Universal Health Care But Not The U.s.?

Ministerial platforms such as the Joint Learning Network use case studies to provide examples to health officials on key policies related to financing and management that can contribute to universal health coverage (4, 5). Case studies of health reforms have been used to demonstrate important lessons about regulatory and system changes and the resulting health outcomes (6). Researchers hope to understand how divisions in public-private ownership of services affect critical health system indicators such as efficiency, morbidity, mortality, and equity. This descriptive paper seeks to create a categorization of systems and provide a foundational first step for future research in OECD and LMIC settings. Health services in Europe are efficient, valued by its citizens and delivered with many different models and degrees of private participation (7, 8). In the push for UHC, Europe can provide insights into the different experiences with private provision in the context of nationally managed systems. This study provides an up-to-date overview of private provision in different sectors in countries across Europe. Experiences are suitable for many settings.

Health care delivery operates independently of funding, and there is more competition, more variation, and more change in the ownership, incentives, and regulation of care delivery than is the case with funding. Nevertheless, funding sets the context for ownership, along with policy and regulatory guidelines, directly or indirectly determining what mix of ownership can develop.

Universal health coverage (UHC) exists in all the European countries we studied. In contrast to LMICs, health financing in Europe is almost universally managed by the government, either directly through tax revenues (as in the UK) or semi-directly through mandated, government-run and subsidized social health insurance (as in Germany). Across Europe, public and social health insurance provides a health care network for almost all citizens, as shown by data from the OECD Health System Survey (Figure 1, blue bars). Although the form of insurance varies between countries and additional private insurance (orange bars) is common in some (Belgium, Netherlands, Slovenia) but not in others (France, Norway), the most important implication for service provision is , that where they exist, private providers in most countries are paid either by national health insurance systems or by highly regulated social health insurance schemes that coordinate purchasing (4–6). Out-of-pocket payments for healthcare are consistently low in all European countries studied, amounting to <0.5% of preventive care spending and <20% of total healthcare spending in 2018 (9, 10). The lesson for other countries is that government purchases and regulation are neither a guarantee nor a barrier to a large private market for health care provision.

Figure 1. Public and private insurance coverage. The blue bars show the population covered by social security. The orange bars show the population with private insurance*. *Private insurance is a supplement to public insurance in all countries except the US, where private coverage is often a substitute for public insurance. Countries showing zero private insurance coverage did not report any to the OECD in 2018 (Source:

Directorate For Employment, Labour And Social Affairs

We limited our analysis to European countries that are members of the OECD. We excluded non-OECD EU members and non-European OECD countries. Turkey is an OECD country and partially on the European continent, but 97% of its landmass is in Asia, and we decided to exclude it from this analysis for this reason. In this article, for simplicity, we refer to the selected countries as “Europe”.

We reviewed all publications on the health systems of the participating countries from the OECD and WHO European websites. For each country, we searched English-language journal publications through PubMed and Google Scholar, and when data were conflicting or missing, we conducted subject-specific Google Scholar country searches (eg, “dentist Luxembourg”) for additional white paper sources. When all these sources failed, we contacted experts within WHO and personal connections within academic institutions in countries with information gaps for additional sources in other languages.

When calculating the scale of the role of the private sector in each country, we relied heavily on the Health Systems in Transition (HSiT) national reports from the European Observatory on Health Systems and Policies. They range in production dates from 2003 (Iceland) to 2019 (Latvia) (11, 12). If country-specific reports use data before 2008, regardless of when they were published, we set them aside and instead use data from the 2008/9 OECD Health Systems Survey (8). Where journal publications or national reports had reliable national data that were more recent than the 2008/9 Survey or the national HSiT report, we used this source. The year of data used for each country is shown in supplementary material.

Comparing Health Insurance Systems In Europe: A Comprehensive Overview

We applied the categories of health services used by the OECD to consider hospital services, specialist services, primary care and pharmacies separately (8, 13). We use hospitals as a proxy for hospital services, which reflects the majority of providers and care provided in hospitals in all countries studied (14). Outpatient specialized services and dentistry are treated together. Primary care can be either general practitioners (UK) or primary care centers (Sweden). And pharmacies here refer only to public pharmacies and thus exclude hospital pharmacies.

International Health Insurance Plans

This study uses publicly available data to examine the behavior of healthcare systems. No patients were included and no direct data collection was undertaken that would have involved public participation.

We evaluated each state on hospital ownership data and then checked for consistency with other aspects of care delivery. From this, we grouped health systems in Europe into four types (Figure 2), based on how dependent the overall system is on private provision. This grouping was informed by analyzes of the interaction between regulatory agencies and government purchasing agencies and private providers of care in health service domains (15–17). Health systems are highly path-dependent (18, 19), and the four types, or groups, reflect the continuing influence of the funding and ownership patterns that created the current structures. In Germany, the influence of the Bismarckian model of social security and privately contracted provision remains evident (20). In the United Kingdom, the influence of Beveridge’s vision of the National Health System continues to resonate today (21). Nevertheless, as Kucin argued persuasively as early as a decade ago, the differences between European health systems are becoming less important as funding models align, driven by an aging population and rising expectations of care, so that government funding increasingly fills and more gaps in traditional social health insurance, while competition is increasingly common in national health insurance systems to manage costs (22–24).

Hospitals are in transition across Europe as outpatient services move out of medical facilities and most countries push for increased efficiency as measured by shorter average length of stay and higher bed utilization rates (14, 15). Our findings from countries with more recent data show little change from the ownership status summarized in a 2008/2009 survey of OECD countries (8). Across all European countries, the role and importance of private hospitals in the larger health system fall into four distinct categories (Figure 2).

The behavior of private hospitals differs between the four groups, as can be seen in how private hospitals contribute to available hospital beds in each group (Figure 3). In some countries, private hospitals provide inpatient beds and services in proportion to their importance within the overall system; in other countries, private hospitals have very few beds, focusing instead on outpatient care only. In Group 1, private hospital beds roughly match the number of private hospitals: this is where most hospital care of all kinds is provided. Where public and private hospitals coexist, as in Germany, the differences in services

Greece Healthcare System 2023: Public And Private Sectors Guide

Healthcare systems in europe, health insurance in europe, health insurance companies in europe, comparing international health care systems, comprehensive health systems, comparing health care systems around the world, health care systems in europe, comprehensive health care systems, comparing health systems, health systems in europe, train systems in europe, comparing health care systems

About andikak kakak