This presentation is compiled from several sources and summarizes the health care system in Europe. Some of the information could be outdated and readers are encouraged to follow recent updates as well.

1. Prabesh Ghimire
European Model of Health Care
System
A classroom presentation on:

2. This presentation will cover
 Introduction
 Social context of Europe
 Health status in Europe
 Building blocks of European Health System
 Health Service Delivery
 Health Financing
 Human Resource
 Governance
 Health system characteristics of selected European
countries
 Summary
2

3. Introduction
3
 Second largest continent
 50 countries with 6 dependent states.
 10% of world population
 Very high-high HDI. 8 of the 10 countries
with highest HDI are from Europe (Human
Development Report 2016)

4. Social context
 Almost every fourth person in the Europe (EU) still
experiences at least one of the three forms
of poverty or social exclusion (eurostat).
 Financial poverty- 17.3 % of EU residents (2015)
 50 % of all single parents- at risk of poverty or social
inclusion
 Noticeable disparities across regions
 Per capita expenditure on social protection (20 times
difference between highest and lowest mark)
 Five distinguishing social welfare systems across
Europe
4

5. Social context
5
Regions Nordic Anglo-
Saxon
Continental/
Bismarck
Mediterrane
an/
Southern
Central/
Eastern
European
Countries Norway,
Sweden,
Finland,
Denmark
UK
Ireland
Austria
France
Germany
Belgium
Italy
Spain
Greece
Portugal
Baltic states
Bulgaria
Romania
Slovakia
Social
security
High High High High Low-High
Source of
financing
Gov. and
local
authorities;
Taxation
Gov for
unemployed
,
Social
insurance
for
employed
Social
insurance
Local
authorities,
family
support, self
support
Gov,
taxation,
family and
self support
Employmen
t
High High High Low Low

6. 6Figure source: Wikipedia

7. Health Status in Europe
7
 Average SDR
 for premature mortality from four major NCDsa (CVD,
cancer, diabetes, chronic respiratory diseases= 404 per
100,000 population (in 2012)
 IMRb:
 1.6/1000 live births in Slovenia (Lowest)
 5.1/1000 live births in Slovak Republic (Highest)
a. European health report 2015,
b. OECD.Stat (2016 data)

8. Health Status in Europe
8
 1 in 5 premature deaths (30-44 yrs)
 1 in 3 premature deaths (45-49 yrs)
 Overweight – 44.9% to 66.9% (51 countries)
 Obesity – 13.6% to 29.5%
Tobacco use
Data source: European health report 2015

9. 9
Building
Blocks
of
European
Health System

10. Health Financing
10
 Major Financing sources
 General Taxation
 Contributions to health insurance funds
 Predominant systems of health care financing
system
 Beveridge Model: Public finance by general taxation
 Bismarck Model:Public finance based on compulsory
social insurance
 Private Finance: Voluntary insurance

11. Health Financing
11
Predominant System of
Finance
Countries
Public: Taxation Denmark, Finland, Greece,
Italy, Sweden, Spain, UK
Public: Compulsory social
insurance
Austria, Belgium, France,
Germany
Mixed: Compulsory social
insurance and private voluntary
insurance
Netherlands

12. Health Financing
Source: OECD.Stat
(2016 data)
 Health Care Expenditure (% of GDP) – 6.3%-11.3
Country All schemes Gov /
compulsory
schemes
Voluntary/
household OOP
France 11% 8.7% 2.3%
Germany 11.3% 9.5% 1.7%
Luxembourg 6.3% 5.3% 1.1%
Denmark 10.4% 8.7% 1.6%
Austria 10.4% 7.8% 2.5%
UK 9.7% 7.7% 2%
Italy 8.9% 6.7% 2.2%

13. Health Service Delivery
13
 Two modes of delivery of Primary Health Care
services
 Public setting
 Private setting
 Delivery through public health centers
 E.g. Finland, Spain, Italy, Sweden
 Delivery through private setting:
 All Countries with social health insurance and
 Some countries with National Health System
 Eg. Germany, Netherlands, Denmark, UK, Austria,
Belgium

14. Health Service Delivery
14
 Gate-Keeping system
 More prevalent in countries with National Health Systems
except Sweden
 Also existent in Netherlands
Registration with primary
care provider
Countries
No obligation Austria, Greece, Sweden
Financially encourage Belgium, France, Germany,
Hungary, Switzerland, UK
Compulsory Denmark, Italy, Netherlands,
Portugal, Spain, Ireland

15. Health Service Delivery
15
 Gate-Keeping system
Referral to access
secondary care
Countries
No obligation Austria, Greece, Sweden
Financially encouraged Belgium, France, Germany,
Switzerland, Ireland
Compulsory UK, Hungary, Denmark,
Italy, Netherlands, Portugal,
Spain

16. Human Resource
16
 Regulation of physician’s location of practice
 No restriction on location of practice: Belgium, Greece,
Netherlands, UK
 Regulation of practice for contracted or publicly funded
providers: Austria, Germany, Denmark, Spain, Sweden
 Pay for performance
 Existent in only few European health system
 Third party payers offer financial incentives to providers
for achievement of agreed quality of care
 E.g. Belgium, Hungary, Italy, Spain, Portugal, UK

17. Human Resource
17
 Policy to address HRH mal-distribution
 No: Italy, Luxembourg, Portugal, Spain, Sweden
 Yes: Austria, Belgium, Denmark, Germany, Greece,
Netherlands, Portugal, UK
 Policy to address HRH shortages
 No: Austria, Denmark, Germany, Greece,
 Yes: Belgium, Italy, Netherlands, Norway, Spain,
Sweden, UK

18. Governance of Health System
18
 Five forms of governance for health system
management
Governance Features Countries
Decentralized • Regulation, operation
and also co-funding are
delegated to regional authorities
or States
Italy,
Spain,
Austria,
Denmark
Partially
Decentralized
• Local and regional governments
are responsible for several
planning and implementation
functions, besides co-funding
• Local regional authorities own
and manage health care
facilities
Bulgaria,
Poland

19. Governance of Health System
19
Governance Features Countries
Operatively
Decentralized
• Local and regional authorities
have operational functions
• Co-funding from sub-national
budget is limited
UK,
Netherlands
Centralized
but structured
at territorial
level
• Most of the responsibilities lie
with the central government
even if implementation is at
territorial level
• Local and regional authorities
may manage health facilities
France,
Greece
Centralized • All of the responsibilities lie
with the central government
Cyprus,
Finland

20. 20
Health System
Characteristics of
Some European Countries

21. UK Health System
21
 Coverage to ‘ordinarily residents’ in England, largely
free at the point of service.
 Mainly public financing of health care- out of general
taxation and national insurance contributions.
 Primary and secondary care is very much separated
by gate-keeping system.
 Mostly public service provision

22. Dutch Health System (Netherlands)
22
 Market-based, with an important role played locally
by the municipal health services (GGDs)
 Nearly universal (99%) coverage through
compulsory health insurance
 Mainly funded through compulsory income-related
contributions and premiums paid to insurers
 Service provision is private, on the basis of a
regulated competitive market.

23. Germany Health System
23
 Decentralized, with several competences delegated
to state level and an important role played by civil
society organizations
 Providing universal coverage through statutory and
private health insurance
 Health expenditure is mostly funded through public
funds– out of social insurance contributions and
taxation, and complemented by private payments.
 Mixed service provision – public and private

24. Denmark Health System
24
 Decentralized, with a significant role played by
regional and local (municipal) authorities, the latter
also in financial terms.
 Providing universal coverage free of charge at the
point of service
 Mainly public financing of health care – out of
national and local taxation
 Mostly public service provision

25. Conclusion
25
 Health care system is Europe varies on a country
basis
 Two predominant financing systems: Taxation and
social health insurance.

26. Open Discussion………
26

27. References
27
 Health Care System in the EU: A comparative study.
Public Health and Customer Protection Series;
European Parliament.
 The management of health systems in the EU
Member States- The role of local and regional
authorities. European Union; 2012.
 Health Systems Institutional Characteristics.
Organization for Economic Co-operation and
Development; 2010.
 European Health Report, 2015
 OECD.Stat