Healthcare expenditure statistics - overview (2024)

Highlights

Among the EU countries, Germany (12.6%), France (11.9%) and Austria (11.2%) had the highest current healthcare expenditure relative to GDP in 2022.

Among the EU countries, the largest expansions (in percentage terms) in current healthcare expenditure per inhabitant between 2014 and 2022 were recorded in Latvia, Romania, Lithuania, Malta, Cyprus and Czechia, where expenditure more than doubled.

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This article presents key statistics on expenditure aspects of healthcare in the European Union (EU). More detailed information will be available – with analyses by functions, providers and financing schemes – in a future article. Healthcare systems are organised and financed in various 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 principle in the EU.

Statistics on healthcare expenditure and financing may 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.

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.

Healthcare expenditure

Germany, France and Austria had the highest current healthcare expenditure relative to GDP in 2022

Germany had the highest level of current healthcare expenditure among the EU countries, valued at €489billion in 2022. France recorded the second highest level of current healthcare expenditure (€314billion), followed by Italy (€176billion) and Spain (€131billion).

Current healthcare expenditure in Germany, France and Austria was equivalent to 12.6%, 11.9% and 11.2%, respectively, of gross domestic product (GDP) – see Table1. The next highest ratios were in Belgium (10.8%), Sweden (10.7%) and Portugal (10.5%). By contrast, current healthcare expenditure accounted for less than 7.0% of GDP in 5 EU countries, with Luxembourg recording the lowest ratio (5.6%).

Relative to population size and in euro terms, current healthcare expenditure in 2022 was highest among the EU countries in Luxembourg (€6590 per inhabitant). It is interesting to note that Luxembourg had the highest ratio per inhabitant despite having the lowest ratio of healthcare expenditure to GDP, reflecting the high level of GDP in Luxembourg. A significant proportion of workers in Luxembourg are cross-border workers and live outside the country and, as non-residents, the expenditure on their healthcare is not included in Luxembourg's health accounts while their economic activity does contribute to Luxembourg's GDP.

Following on from Luxembourg, ratios over €5000 per inhabitant were also observed in 2022 in Denmark, Ireland, Germany, Sweden, Austria, the Netherlands and Belgium. In turn, these were followed at some distance by Finland and France with ratios above €4600 per inhabitant. There was then a relatively large gap to Malta, Italy, Spain, Cyprus, Slovenia, Portugal and Czechia with ratios above €2200 but below €3200 per inhabitant. All of the remaining 10 EU countries recorded average expenditure below €1900 per inhabitant in 2022, 2 of these recorded an average spend on healthcare below €1000 per inhabitant: Bulgaria (€990) and Romania (€858). The ratio between the highest (Luxembourg) and lowest (Romania) levels of expenditure per inhabitant was 7.7:1.

The disparities in current healthcare expenditure per inhabitant are less apparent when expenditure is expressed in purchasing power standards (PPS). This measure adjusts for differences in price levels between the EU countries. Germany (5317 PPS per inhabitant), Austria (4751 PPS per inhabitant) and the Netherlands (4531 PPS per inhabitant) recorded the highest ratios of healthcare expenditure per inhabitant in PPS terms. Romania (1627 PPS per inhabitant) had the lowest ratio. As such, by taking account of price level differences, the ratio between the highest (Germany) and lowest (Romania) levels of healthcare expenditure per inhabitant was considerably smaller than the equivalent ratio in euro terms mentioned above, as it was 3.3:1.

Developments over time

Table2 and Figures2 and 3 highlight developments in the level of healthcare expenditure and the level of healthcare expenditure relative to GDP in recent years, focusing on a comparison between 2014 and 2022. Note that the analyses in Table2 and Figure2 are presented in current price terms and so reflect price changes (inflation and deflation) as well as changes in real expenditure.

Based on the data shown in Table2, all EU countries recorded higher healthcare expenditure in 2022 than in 2014. The largest overall increases were observed in Latvia, Romania, Lithuania, Malta, Cyprus and Czechia, where expenditure in 2022 was more than double that in 2014. The highest increase, in Latvia, was 126.7%, equivalent to a compound annual average increase of 10.8%. The smallest increases between 2014 and 2022 were observed in Italy (up 21.8% overall) and Sweden (23.0%).

As well as being affected by price changes, comparisons of healthcare expenditure over time can also be influenced by demographic changes. Figure2 shows the average healthcare expenditure per inhabitant in 2014 and 2022. All EU countries recorded a higher level of expenditure per inhabitant in 2022 than in 2014. As with the rate of change based on overall expenditure, Latvia, Romania and Lithuania recorded the largest increases, with average expenditure per inhabitant increasing by 140.5%, 125.6% and 123.1%, respectively; in Bulgaria and Czechia, this ratio also at least doubled. The smallest increase was observed in Sweden, up 13.8%.

Figure3 provides another analysis of the change in overall healthcare expenditure between 2014 and 2022, focusing on the ratio between this expenditure and GDP. Healthcare expenditure and GDP are both influenced by price changes and so, when combining the 2 indicators in a ratio, the impact of inflation may cancel out to some degree: this depends on the extent to which the price changes related to healthcare expenditure are similar to those experienced in the economy as a whole.

There were 7 EU countries that reported a lower ratio of healthcare expenditure to GDP in 2022 than in 2014. Ireland recorded the largest decrease, down 3.4 percentage points, its share falling from 9.5% in 2014 to 6.1% in 2022, in part reflecting a large increase in Irish GDP between these years. The 6 other decreases were smaller than 1.0 points. In the EU countries where the ratio was higher in 2022 than it had been in 2014, the increase was smaller than 2.0 percentage points in most cases. A larger increase was observed in Latvia, up 2.2 points.

Source data for tables and graphs

Data sources

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

Tables in this article use the following notation

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

Current healthcare expenditure

Current healthcare expenditure quantifies the economic resources dedicated to health functions, excluding capital investment. Current healthcare 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.

System of health accounts – methodology

Eurostat, the Organisation for Economic Co-operation 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 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 details 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 – legal basis

Commission Regulation (EU) 2021/1901 of 29October 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. Commission Regulation (EU) 2015/359 of 4March 2015 implementing Regulation (EC) No1338/2008 as regards statistics on healthcare expenditure and financing applied 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 providing new health services and a 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 specifically recommends following developments on:

• expenditure on healthcare as a percentage of GDP
• expenditures on healthcare in purchasing power standards (PPS).

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