Which countries offer national health services?

Health systems

We have taken the following pages from the BÄK-Intern information sheet. This information leaflet is made available to the medical associations in Germany by the German Medical Association. We believe that you too should be interested in the health systems in Europe.

The editorial office

This edition contains an introduction that explains the health policy competencies of the European Union and the Member States.

There are two basic forms of health systems in the Member States of the Community: in Great Britain, Ireland, the Scandinavian countries and Portugal the health system is mainly financed by tax revenues. Most of the medical services here are covered by state health services. The doctors usually have a contractual relationship with the respective national health service. In Sweden, doctors also have the option of offering private outpatient services outside of the health service.

There is also the principle of social insurance, which is mainly financed through the contributions of the insured. Such a system can be found in Germany, Belgium and Luxembourg. In France and the Netherlands, public health expenditure is even almost entirely covered by social security contributions. The principle of self-administration by the service providers applies.

For a long time, health policy did not fall within the remit of the European Union. Only since the EC Treaties of Maastricht (1993) and Amsterdam (1999) came into force has the EU had a common competence for public health. However, the Community is still not responsible for shaping health systems. For example, EU Health Commissioner David Byrne has had to refer to regulations for harmonizing the internal market for some time if he wants to enforce binding guidelines for his anti-tobacco campaign for the member states. The EU Commission is responsible for this.

Health policy is one of the so-called "accompanying" policy fields. This means that the EU promotes and coordinates national policies and, in particular, deals with problems that states cannot solve on their own. However, medical care and the organization of health systems are entirely up to the Member States.

The Maastricht Treaty limited EU action to prevention, research into the causes and transmission of diseases, and information on health issues. The Amsterdam Treaty expanded the EU's powers. In Article 152, for example, competences from the agricultural sector (veterinary and plant protection) have been transferred. The EU is thus turning away from economically oriented consumer protection and towards consumer protection oriented towards health policy. The aim is to take preventive action against health risks and not - as with BSE - to only react when the problem has already become acute. The Amsterdam Treaty also reaffirms the EU's health policy commitments. The Community must ensure a high level of health protection and integrate this into all areas of its policy.

The currently ongoing action programs are also legally based on Article 152 of the EC Treaty. This also means that the community may determine support measures that contribute to the protection and improvement of human health. The action programs contain the following key points:

  • Fight against cancer, mainly caused by tobacco consumption,
  • Fighting AIDS and other communicable diseases,
  • Anti-drug trafficking and awareness-raising campaigns,
  • Doping and drug abuse in sport,
  • Promoting mental health,
  • Issuing a white paper on food safety,
  • general public health measures, including the quality and safety of blood and blood components.

In July 2002 the European Parliament and the EU Commission agreed on a new joint action program for the period 2003-2008. The goals and implementation strategies have essentially remained the same. The interlinking of environmental, agricultural and health policy is emphasized more than before. The main point of contention was the budget for the action program. Only with the help of a mediation committee did the EU Commission, the European Parliament and the EU health ministers agree to provide 312 million euros for the five-year program. The new action program has not changed anything in terms of health policy competencies. The German MEPs in particular have vehemently opposed the EU Commission's request to gradually "communitize" health policy. Coordination remains the main task of the EU.

The new action program consists of three components. One element is the so-called "monitoring". An international comparison of health systems examines the question of how the existing problems can best be solved.

The second component is an administrative mechanism that can be used to react quickly to newly emerging health threats. To this end, the community is planning an EU-wide network of monitoring, reporting and early warning facilities.

Thirdly, the EU population should be made aware of a healthy lifestyle, away from alcohol and nicotine consumption, poor nutrition, lack of exercise, stress and substance abuse. This is intended to combat the causes of diseases.

It is often difficult to reach consensus on health issues in the EU. The reason for this is, among other things, the health systems of the member states, whose various forms of organization and financing sometimes lead to irreconcilable differences.

The cost development of the health systems in the EU countries has developed differently. In many countries, spending has increased steadily over the past three decades. The main reason for this is the demographic development. In Sweden and the Netherlands, on the other hand, expenditure - in relation to gross domestic product - has fallen dramatically. However, there are also considerable restrictions such as longer waiting times associated with this.

The eleven Eastern European EU accession countries have a lot of catching up to do in the development of their health systems. Some member states fear that large burdens will be passed on to neighboring states, e.g. through migration. The German Liaison Office for Health Insurance Abroad (DVKA) therefore asked the federal government last autumn to ensure that the EU aspirants' insurers are solvent during the accession negotiations. The reason is a possible health tourism relocation of the problems to the Federal Republic. The DVKA fears that the health insurances in other EU countries will not be able to pay for the treatment of their patients in Germany and that the statutory health insurance (GKV) will be left with the debts.

The EU population is generally healthier than ever before: low infant mortality and high life expectancy. However, within each EU country there is a gap in health status that can be traced back to social differences. How big this gap is varies from state to state.

However, some health problems have worsened in recent years. There is a high rate of deaths associated with lifestyle (cardiovascular diseases, cancer, accidents). In addition, the number of mental and stress-related illnesses is increasing. New health risks - such as the transmission of Creutzfeld-Jakob disease through food - threaten general health, as does the flare-up of serious infectious diseases (e.g. tuberculosis). In order to tackle these problems effectively, the Member States - despite all differences - have agreed on the joint action program.

Internet: www.europa.eu.int/index_de.htm