In addition to the share of the population entitled to core health services, the extent of healthcare coverage is defined by the range of services included in a publicly defined benefit package and the proportion of costs covered. Figure 7.5 assesses the extent of coverage for key health services by calculating the share of expenditure covered under government schemes or compulsory health insurance. Differences in the extent of coverage across countries can be the result of specific services being included or excluded in the publicly defined benefit package (such as a particular drug or medical treatment), different cost-sharing arrangements, or some services only being covered for specific population groups in a country (such as dental treatment).
On average across EU countries, four‑fifths of all healthcare costs were covered by government or compulsory health insurance schemes in 2022 (see the indicator “Financing of health expenditure” in Chapter 5). However, financial protection is not uniform across all types of health services, and there is considerable variation across countries. In nearly all EU countries, inpatient services in hospitals are more comprehensively covered than any other type of care, with free access or very limited cost-sharing in many countries. As a result, 90% of all inpatient costs were borne by government or compulsory insurance schemes in 2022. Coverage rates were near 100% in Sweden, Estonia, Romania, Germany and Italy. In Greece, on the other hand, financial coverage for the cost of inpatient care was only around two‑thirds of the total costs. Copayments for care delivered in private hospitals contracted by the public single purchaser, and direct payments for non-covered services, explain the low public coverage in Greece (OECD/European Observatory on Health Systems and Policies, 2023[1]).
More than three‑quarters (77%) of spending on outpatient medical care across the EU was covered by government and compulsory insurance schemes in 2022. Coverage varied from less than 60% in Malta, Portugal, Italy and Latvia to over 90% in the Slovak Republic, Denmark, Czechia and Sweden. Many EU countries (for example Croatia, France, Belgium, Ireland, Spain) use safety nets to protect vulnerable patients from user charges for outpatient care, including exemptions or caps on co-payment charges based on income. Generally, public coverage for outpatient medical care is less comprehensive than for inpatient care. In Belgium, for example, there is relatively little regulation on the supplement fees that practitioners are allowed to charge on top of official tariffs for outpatient care visits, compared with supplements charged for hospital stays.
Coverage for dental care costs is far more limited across EU countries. Many countries restrict benefits to specific treatments or age groups, and many services require either substantial cost-sharing or are fully paid out-of-pocket by patients. As a result, only one‑third of total costs are borne by government schemes or compulsory insurance across the EU. More than 60% of dental spending is covered in only three EU countries: Croatia, Germany and France. In Romania and Spain, the level of public coverage is very low. Voluntary health insurance is common for dental care, including in Germany, France, the Netherlands and Portugal, providing either full coverage of some services or coverage of cost-sharing obligations.
Coverage for pharmaceuticals is also typically less comprehensive than for inpatient and outpatient care. Across the EU, 59% of all pharmaceutical retail spending are financed by government or compulsory insurance schemes. The most generous coverage can be found in Cyprus, Germany, France and Ireland where over 80% of the pharmaceutical costs are covered. Conversely, this share is less than 40% in Bulgaria and Poland.
Finally, the extent of coverage for therapeutic appliances, such as glasses and other eye products, hearing aids, and other medical devices, is low across European countries. Government and compulsory insurance schemes cover more than 50% of these expenses in only three EU countries.
