Healthcare is delivered by a wide variety of providers ranging from hospitals and medical practices to ambulatory facilities and retailers, which impacts expenditure patterns for various healthcare goods and services. Analysing health spending by provider can be particularly useful when considered alongside the functional breakdown of health expenditure, giving a fuller picture of the organisation of health systems.
The way healthcare delivery is organised differs substantially across EU countries, resulting in a wide variation in the distribution of health spending across providers. Hospitals are the healthcare provider that consumes the largest part of the total health budget in the EU. In 2022, they accounted for around 37% of all health spending. This proportion was much higher in Cyprus, Croatia, Czechia and Spain, which allocated over 45% of all health expenditure to hospitals. On the other hand, this share was less than one‑third in Lithuania, Luxembourg and Germany (Figure 5.11).
With roughly one‑fourth of total health spending, the ambulatory sector constituted the second largest group of health providers in the EU in 2022. As in the case of hospitals, the proportion of spending going to ambulatory providers in overall health spending varied significantly between EU countries, ranging from 30% or more in Germany, Luxembourg and Finland to only around 15% in Bulgaria, Greece, Croatia and Romania.
The remaining key health provider categories are retailers (primarily pharmacies) and long-term care facilities (predominantly providing inpatient care to dependent people), which accounted for 17% and 9% of the EU’s total health budget in 2022, respectively.
Across EU countries, there is a wide variation in the range of activities that may be performed by the same category of provider, reflecting differences in the structure and organisation of health systems. These differences are particularly pronounced in hospitals (Figure 5.12). While hospitals are primarily focused on providing inpatient curative and rehabilitative care, they can also provide outpatient care through emergency departments or specialists. In some countries, such as Bulgaria, Germany and Greece, hospitals are rather mono-functional and primarily geared towards the delivery of inpatient services, accounting for around 90% of total hospital spending. In Finland, Croatia and Portugal, on the other hand, the share of inpatient spending is much lower (around 40%). In these countries – but also in Denmark, Sweden and Estonia – a substantial share of hospital budgets is allocated to outpatient care services. Finally, in some EU countries, a significant amount of the total financial resources going to hospitals are spent on day care activity, such as same‑day elective surgeries or dialysis. In Belgium, Cyprus and Croatia, almost a quarter of all hospital spending were allocated to this mode of provision.
The hospital spending trajectory has been influenced to some extent by the COVID‑19 pandemic. Across the EU, the financial resources allocated to hospitals grew by more than 8% (in real terms) in 2020 and by more than 6% in 2021. These increases can be partly explained by the additional resources to build up capacity and treat COVID‑19 patients, as well as subsidies going to these facilities (mainly in 2020) and the mobilisation of additional funding to address the backlog of patients (in 2021 in some countries). In 2022, hospital spending dropped by around 2% in the EU as exceptional COVID‑19 funding dried up. Yet, the share of hospital spending in overall health spending in 2022 is above the one seen in 2019.
