Healthcare expenditure statistics by function, provider and financing scheme

Data extracted in November 2024.

Planned article update: November 2025.

Highlights

In 2022, 51.3% of current healthcare expenditure in the EU was financed by compulsory schemes and savings accounts and 30.0% by government schemes. The remaining 18.7% was financed by other financing agents.

In 2022, 51.9% of current healthcare expenditure in the EU was for curative and rehabilitative care and 17.8% for medical goods. The remaining 30.3% was for other functions.

In 2022, 36.4% of current healthcare expenditure in the EU related to provision by hospitals, 25.0% by providers of ambulatory care and 16.6% by retailers and other providers of medical goods. The remaining 22.0% was supplied by other providers.

Major sources of financing of current healthcare expenditure, 2022

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This article presents detailed statistics on expenditure and financing aspects of healthcare in the European Union (EU), with analyses by financing scheme, function and provider. An overview of healthcare expenditure statistics is available in a separate article. Healthcare systems are financed and organised in different ways across the EU countries, but universal access to quality healthcare, at an affordable cost to both individuals and society at large, is widely regarded as a basic right in the EU.

Statistics on healthcare expenditure and financing can be used to evaluate how a healthcare system responds to the challenge of universal access to quality healthcare, through measuring financial resources available for the healthcare sector and the allocation of these resources between healthcare activities (for example, preventive and curative care) or groups of healthcare providers (for example, hospitals and ambulatory centres).

This article forms part of an online publication on Health in the European Union - facts and figures.

It should be noted that the latest data presented in this article are for 2022. Therefore, the data in this article show the situation after the initial impact of the COVID-19 pandemic. For this reason, particular attention should be paid when comparing 2022 data with data for 2021 and 2020 and when comparing data for 2021 and 2020 with earlier years.

Key data and overview of healthcare financing, functions and providers

Current healthcare expenditure in the EU was €1 648 billion in 2022. This was equivalent to 10.4% of gross domestic product (GDP). Relative to population size and in euro terms, current healthcare expenditure in 2022 was €3 685 per inhabitant.

Healthcare expenditure can be analysed from 3 perspectives: the sources of financing, the healthcare functions that are financed and the providers of healthcare.

Table 1 identifies the largest sources of financing, functions and providers.

In the EU, compulsory contributory health insurance schemes and compulsory medical savings accounts (which are generally part of the social security system and are hereafter referred to as compulsory schemes/accounts) had a 51.3% share of all financing in 2022. Government schemes accounted for 30.0%.
More than half (51.9%) of healthcare expenditure in the EU in 2022 was for curative and rehabilitative care, while nearly a fifth (17.8%) was for medical goods.
Hospitals were the largest providers of healthcare in expenditure terms, accounting for more than a third (36.4%) of all expenditure in the EU in 2022. Providers of ambulatory health care (25.0%) and retailers and other providers of medical goods (16.6%) were the second and third largest providers of healthcare in expenditure terms.

Table 1: Analysis of current healthcare expenditure, 2022
(%)
Source: Eurostat (hlth_sha11_hf), (hlth_sha11_hc) and (hlth_sha11_hp)

While Table 1 gives an overview of the 3 areas (sources of financing, functions and providers), the remainder of this article looks at each of these areas in more detail.

Healthcare expenditure by financing scheme

Government and compulsory schemes/accounts together financed 81.3% of healthcare expenditure in the EU in 2022

Figure 1 provides a simplified analysis of healthcare expenditure by financing scheme, distinguishing government schemes, compulsory schemes/accounts, as well as all other financing agents. The combined share of government schemes and compulsory schemes/accounts in total current healthcare expenditure was 81.3% across the EU. It was in excess of 84.0% in 8 EU countries, peaking at 86.7% in Germany. Elsewhere in the EU, this combined share was below 81.0%, with shares below 70.0% in 6 countries; Greece had the lowest share (62.0%).

In most of the EU countries, either government schemes or compulsory schemes/accounts dominated.

In 9 EU countries, government schemes accounted for more than half of all expenditure.
In 15 EU countries, compulsory schemes/accounts accounted for more than half of all expenditure.
In Bulgaria and Austria, compulsory schemes/accounts registered a larger share than government schemes or other sources, but less than half of the total.
In Greece, other sources provided a greater share of financing than either government schemes or compulsory schemes/accounts.

Compulsory schemes/accounts accounted for close to or in excess of three-quarters of overall spending on healthcare in France (80.4%), Luxembourg (78.7%), Germany (75.0%), the Netherlands (74.7%) and Croatia (74.5%) in 2022, but less than 5.0% in Spain, Portugal, Ireland, Italy and Malta. It should be noted that compulsory schemes/accounts do not exist in Denmark, Latvia and Sweden. By contrast, Sweden (86.0%) and Denmark (84.6%) reported that government schemes accounted for more than four-fifths of their expenditure on healthcare, while shares around 75.0% were registered in Ireland and Italy.

Figure 1: Major sources of financing of current healthcare expenditure, 2022
(% of current healthcare expenditure)
Source: Eurostat (hlth_sha11_hf)

Table 2 provides a similar analysis of healthcare expenditure by financing scheme, but with more detail concerning other financing schemes.

The third largest source of healthcare funding in the EU was household out-of-pocket payments, with a 14.3% share in 2022. This was generally the second or third highest share in most EU countries, accounting for a third or more of total healthcare expenditure in Bulgaria (35.1%) and Greece (33.5%). Luxembourg, France and Croatia were the only EU countries where household out-of-pocket payments accounted for less than a tenth of healthcare expenditure, with shares ranging from 8.7% to 9.2%.

Table 2: Current healthcare expenditure, analysed by source of financing, 2022
(% of current healthcare expenditure)
Source: Eurostat (hlth_sha11_hf)

Voluntary health insurance schemes generally represented a small share of healthcare financing in the EU in 2022. Their share peaked at 12.6% in Slovenia, followed by 10.6% in Ireland; the next highest share was 7.0% in Portugal. There were 5 EU countries where voluntary health insurance schemes provided less than 1.0% of the finance for healthcare expenditure in 2022, with the lowest share recorded in Czechia (0.1%).

The final analysis concerning financing (see Figure 2), shows the same sources of financing as in Table 2, but presented as values per inhabitant in purchasing power standards (PPS) rather than as a share of all healthcare expenditure. When expenditure is expressed in PPS, the expenditure data account for differences in price levels between countries. This analysis shows how much is spent on average per inhabitant from each of the different sources. The total for all sources (the overall height of each stacked column) shows the average expenditure per inhabitant. To put this in perspective, the EU countries and the EFTA countries have been ranked based on their overall level of current healthcare expenditure relative to GDP.

Figure 2: Current healthcare expenditure per inhabitant, analysed by source of financing, 2022
(PPS per inhabitant)
Source: Eurostat (hlth_sha11_hf)

Healthcare expenditure by function

Curative and rehabilitative care services accounted for more than half of current healthcare expenditure in all but 3 of the EU countries in 2022

The functional patterns of healthcare expenditure presented in Figure 3 and Table 3 show that curative and rehabilitative care services accounted for more than 50.0% of current healthcare expenditure in 2022 in the vast majority of EU countries. The exceptions were Germany, the Netherlands and Malta, with shares between 45.9% and 49.7%. The average for the EU was 51.9%. By contrast, at the upper end of the range, more than two-thirds of current healthcare expenditure in 2022 was for curative and rehabilitative care services in Cyprus (68.6%), while Poland and Portugal also recorded shares that were above 60.0%.

Figure 3: Major functions of healthcare expenditure, 2022
(% of current healthcare expenditure)
Source: Eurostat (hlth_sha11_hc)

Medical goods accounted for just under a fifth of healthcare expenditure in 2022

Medical goods (non-specified by function) were the second largest function in the EU in 2022, with a 17.8% share of current healthcare expenditure. There was a substantial variation between the EU countries in terms of the share of expenditure for these medical goods. The lowest shares were recorded for Denmark (10.4%), the Netherlands (10.7%) and Ireland (11.3%). By contrast, the highest share – where medical goods accounted for close to a third of current healthcare expenditure – was recorded for Bulgaria (33.0%).

Table 3: Healthcare expenditure, analysed by function, 2022
(% of current healthcare expenditure)
Source: Eurostat (hlth_sha11_hc)

The proportion of healthcare expenditure spent on long-term healthcare was 16.2% in the EU in 2022: more information about this function is given below.

The fourth largest function was expenditure for preventive care, which averaged 5.5% of current healthcare expenditure in 2022 in the EU. Among the EU countries, this share ranged from 1.2% in Malta to 7.9% in Germany. The next largest function was ancillary services (such as laboratory testing or the transportation of patients), which accounted for 4.9% of healthcare expenditure in the EU in 2022. The share of these services exceeded 10.0% in Latvia, Estonia and Croatia. Expenditure related to governance and health system and financing administration averaged 3.5% in the EU in 2022 and ranged from 0.8% in Finland to 5.0% in France; Slovakia was an exception, as its share of expenditure related to governance and health system and financing administration was 7.1%.

Long-term healthcare expenditure accounted for more than a quarter of current healthcare expenditure in the Netherlands and Sweden in 2022

As noted above, services related to long-term healthcare accounted for 16.2% of current healthcare expenditure in the EU in 2022. This share was below 10.0% in 12 of the EU countries (see Figure 4). Relatively low shares could be due to the main burden of long-term healthcare residing with family members, with no payment being made for providing these services. On the other hand, more than a fifth of healthcare expenditure was attributed to long-term healthcare in Denmark, Ireland and Belgium, with this share exceeding a quarter in Sweden and the Netherlands (26.0% and 28.5%, respectively). It should be noted that it can be difficult to separate the medical/health and social components of expenditure for long-term care, leading to an inevitable impact on cross-country comparisons.

Figure 4: Long-term healthcare as a share of current healthcare expenditure, 2022
(%)
Source: Eurostat (hlth_sha11_hc)

Healthcare expenditure by provider

In expenditure terms, hospitals were the main providers of healthcare in most EU countries in 2022

An analysis of current healthcare expenditure by provider is shown in Figure 5 and Table 4. It should be borne in mind that healthcare providers classified under the same group do not necessarily perform the same set of activities. For example, hospitals may offer day care, out-patient, ancillary or other types of services, in addition to in-patient services.

Hospitals accounted for the highest proportion (36.4%) of healthcare expenditure in 2022 in the EU. Among the EU countries, the share of current healthcare expenditure related to hospitals ranged from 26.9% of the total in Germany to 50.1% in Croatia and 50.3% in Cyprus. Only Germany reported that hospitals did not have the highest share of healthcare expenditure, as ambulatory health care providers accounted for a greater share of total healthcare expenditure.

Figure 5: Healthcare expenditure on major providers, 2022
(% of current healthcare expenditure)
Source: Eurostat (hlth_sha11_hp)

The second largest healthcare provider (in expenditure terms) was generally that of ambulatory health care providers. Their share of current healthcare expenditure in 2022 averaged 25.0% in the EU and ranged from 15.0% in Bulgaria to 30.8% in Germany.

The share of current healthcare expenditure accounted for by retailers and other providers of medical goods averaged 16.6% in the EU in 2022. However, their share varied greatly between the EU countries, from 10.1% in the Netherlands and 10.4% in Denmark to 29.1% in Slovakia, 30.3% in Greece and 32.7% in Bulgaria.

Table 4 gives information on the relative size of the providers shown in Figure 5 as well as more detailed information on the shares of other providers. By far the largest of the other providers was residential long-term care facilities. Among the EU countries, the share of residential long-term care facilities within current healthcare expenditure varied from 0.4% in Bulgaria and 0.5% in Croatia to 17.9% in Sweden, with the share in the Netherlands above this range at 28.2%.

Table 4: Healthcare expenditure, analysed by provider, 2022
(% of current healthcare expenditure)
Source: Eurostat (hlth_sha11_hp)

Source data for tables and graphs

Healthcare expenditure statistics by function, provider and financing scheme: tables and figures

Data sources

The 2022 data for the EU, Poland, Finland, Norway and Serbia are provisional as are the 2022 financing data for Spain.

Tables in this article use the following notation

a colon ' : ' is used to show where data are not available

Key concepts

Current healthcare expenditure quantifies the economic resources allocated to health functions, excluding capital investment. Healthcare current expenditure is primarily concerned with healthcare goods and services that are consumed by resident units, irrespective of where that consumption takes place (it may be in the rest of the world) or who is paying for it. As such, exports of healthcare goods and services (to non-resident units) are excluded, whereas imports of healthcare goods and services for final use are included.

Medical goods are split into i) pharmaceuticals and other medical non-durable goods and ii) therapeutic appliances and other medical durables. This category aims to include all consumption of medical goods where the function and mode of provision is not specified. It includes medical goods acquired by the beneficiary either as a result of prescription following a health system contact or as a result of self-prescription. It excludes medical goods consumed or delivered during a health care contact that are prescribed by a healthcare professional.

Long-term healthcare consists of a range of medical and personal care services that are consumed with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency. The aim of long-term social care is to provide services and support, by formal and informal care givers, to individuals who, for reasons of disability, illness or other dependency, need help to live as normal a life as possible. Social care covers a wide range of services, including professional advice and support, accommodation, various types of assistance in carrying out daily tasks, home visits, home help services, provision of meals, special equipment, house adaptation for disabled people, as well as assessment and care management services. There may be a mixed economy of health and social care provision and this mix of services can make it difficult to separate expenditure between health and social components. For the purpose of this article, the analysis of long-term healthcare (as shown in Figure 4) is composed solely of the health component.

System of health accounts – methodology

Eurostat, the Organisation for Economic Cooperation and Development (OECD) and the World Health Organization (WHO) established a common framework for a joint healthcare data collection exercise. The data collected relates to healthcare expenditure following the methodology of the system of health accounts (SHA).

The SHA shares the goals of the system of national accounts (SNA): to constitute an integrated system of comprehensive, internally consistent and internationally comparable accounts, which should as far as possible be compatible with other aggregated economic and social statistical systems. Health accounts provide a description of the monetary flows related to the final consumption expenditure on healthcare goods and services. Health accounts are used in 2 main ways: internationally, where the emphasis is on a selection of comparable expenditure data; nationally, with more detailed analyses of healthcare spending and a greater emphasis on comparisons over time.

For more detail on health accounts, see A system of health accounts, 2011 – revised edition. The core set of SHA tables addresses 3 basic questions i) what kinds of healthcare goods and services are consumed ii) which healthcare providers deliver them and iii) which financing schemes are used to finance the expenditure?

Healthcare expenditure is recorded in relation to the international classification for health accounts (ICHA), defining:

healthcare expenditure by financing schemes (ICHA-HF) – classifies the types of financing arrangements through which people obtain health services; healthcare financing schemes include direct payments by households for services and goods and third-party financing arrangements
healthcare expenditure by function (ICHA-HC) – details the split in healthcare expenditure following the purpose of healthcare activities – such as, curative care, rehabilitative care, long-term care (health), or preventive care
healthcare expenditure by provider (ICHA-HP) – classifies units contributing to the provision of healthcare goods and services – such as hospitals, residential facilities, ambulatory health care services, ancillary services or retailers of medical goods.

Healthcare expenditure – legal basis

Commission Regulation (EU) 2021/1901 of 29 October 2021 as regards statistics on health care expenditure and financing is the legal basis for data collection according to SHA 2011 methodology for healthcare expenditure. The regulation applies to data from reference year 2021.

Commission Regulation (EU) 2015/359 of 4 March 2015 implementing Regulation (EC) No 1338/2008 as regards statistics on healthcare expenditure and financing applies to data from reference year 2014 to 2020.

Statistics on healthcare expenditure are documented in a background article which provides more information on the scope of the data, the legal framework, the methodology employed, as well as related concepts and definitions.

Context

Health systems across the globe are developing in response to a multitude of factors, including new medical technology and improvements in knowledge; new health services and greater access to them; changes in health policies to address specific diseases and demographic developments; new organisational structures and more complex financing mechanisms. However, access to healthcare and greater patient choice is increasingly being considered against a background of financial sustainability.

The European Commission adopted a Strategic Plan for the period 2020–24. In order to improve the quality and effectiveness of public expenditure and contribute to prosperity and social cohesion, the European Commission seeks to provide expertise on health systems and support actions that help prevent and reduce the impact of ill-health on individuals and economies, while encouraging and supporting innovation and the uptake of modern technologies for better care delivery and cost-effectiveness.

The Directorate-General for Health and Food Safety has constituted a list of 88 European core health indicators (ECHIs) for monitoring progress in relation to health policy and broader objectives. Among these, it recommends specifically following developments for:

Explore further

Database

Health (hlth), see

Health care (hlth_care)

Health care expenditure (SHA 2011) (hlth_sha11)

Thematic section

Health

Methodology

A system of health accounts 2011 – revised edition
Healthcare expenditure (SHA 2011) (ESMS metadata file – hlth_sha11_esms)

External links

Legislation

Implementing legislation

Commission Regulation (EU) 2015/359 of 4 March 2015 as regards statistics on healthcare expenditure and financing (up to and including the 2020 reference year)
Commission Regulation (EU) 2021/1901 of 29 October 2021 as regards statistics on healthcare expenditure and financing (first reference year starting from 2021)