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European healthcare: how does your country rank?

Most healthcare systems in Europe offer a good level of care. But which countries spend the most money on healthcare? Which do well in independent ratings? And which regions have the best life expectancy?

European healthcare: how does your country rank?
Photo: Getty Images

There are significant variations between countries in terms of these factors. If you’re an international resident, knowing a little about these differences could help you better understand the health system in your adopted homeland.

In partnership with international insurance broker ASN, The Local presents a guide to some of the key differences in European healthcare that every expat needs to know.

Hey big (healthcare) spender…

For you, healthcare is all about your well-being and that of your loved ones – something nobody can put a price on. But staying healthy is a priority for everybody. Looked at on a national basis, spending on healthcare is therefore a major topic of debate wherever you live.

Comprehensive global health coverage to fit your life: find out more from ASN

Some governments spend significantly more on healthcare than others. The level of private coverage – and related spending – also varies between European countries.

So, how does your country compare with others in Europe when we look at total healthcare expenditure? France and Germany have the highest spending on healthcare relative to GDP in the EU, according to Eurostat, the statistical office of the European Union.

The figure stood at 11.3 percent in both countries in 2017, with Sweden next (11 percent). However, if we also include European Free Trade Association (EFTA) countries, Switzerland (12.4 percent) ranks as the undisputed leader.

Major countries that spend below the 9.9 percent EU average on healthcare in relation to GDP include the UK (9.6 percent), Spain (8.9 percent) and Italy (8.8 percent). Scroll over the map below to find out how much your country spends.

 
Independent country ratings

The Euro Health Consumer Index (EHCI) has been providing international comparisons for the performance of national healthcare systems since 2005. It looks at 46 indicators, including access to care, treatment outcomes, and the range and reach of services.

So, which countries come out on top? Switzerland ranks first in the latest index, followed by the Netherlands, Norway and Denmark. Countries with small populations dominate the top ten, which also includes Sweden (eighth) and Austria (ninth).

While France and Germany may have topped the European spending list, here they come in 11th and 12th positions. That still puts them ahead of other major nations in Europe such as the UK (16th), Spain (19th) and Italy (20th).

Switzerland has an “excellent, although expensive” system and it was no surprise to see it knocking the previous leader the Netherlands into second position, according to EHCI. The experts who produce the index added that “many countries have inefficient ways to fund and deliver healthcare services” – but lots of Europe’s smaller countries are setting a good example. 

Understanding public provision

The benefits of good health are huge – for you as an individual, your family and your wider community. As a recent OECD report stated: “Healthy people create healthy communities and contribute towards a well-functioning, prosperous and more productive society.”

Living abroad or frequently crossing borders can sometimes place extra strain on you – as well as leading to difficulties in understanding a foreign healthcare system. 

Many European countries have universal public healthcare systems. But this doesn’t always mean every treatment is free at the point of care or accessible immediately, so it’s worth checking your local rules and waiting list times.


Photo: Getty Images

Switzerland’s highly-rated system is based on compulsory insurance and Germany has what is known as a ‘multi-payer’ healthcare system involving a combination of public and private insurance.

Confused yet? If you’re new to a country, you may not even be fully aware of how the relevant national system works.

This is one reason why some busy expats seek out a comprehensive solution such as international health insurance. Whether you live in another country, plan to relocate, or just want private coverage for peace of mind, ASN can offer options to fit your needs. You can get worldwide coverage, ensuring you always have the same level of cover even as you travel between countries.

The many benefits can also include 27-global service, an English-speaking personal advisor, routine or annual check-ups with your preferred doctor, quick access to a second opinion, and treatment with alternative medicine. You can upgrade or downgrade your policy and add or remove benefits – meaning you stay in control of what matters most to you. All of these services are free for ASN customers.

Here’s to a long life

Increasing life expectancy should be celebrated – and it’s risen fast in many European countries this century. Across the EU, life expectancy at birth reached 81 in 2018. Women can still expect to live longer than men (83.7 years versus 78.2) – but men have closed the gap a little in recent years.

Ageing populations are one of the big trends of the 21st century – and as Eurostat itself has pointed out this adds to the pressure on people in work to support services for the elderly through their taxes.

So, where can people expect the greatest longevity? The ten EU regions with the highest life expectancy for women at birth in 2018 were all in just two countries: Spain and France. For men, four of the top five regions were in Italy, with the only exception being Madrid (which also topped the women’s list).

Find out more about what ASN provides, from 24/7 English-speaking customer service to annual checkups with your preferred doctor

 
For members

HEALTH INSURANCE

Everything foreigners need to know about the Austrian healthcare system

The alpine country has a few peculiarities in its health system - starting with the fact that it is mandatory to be insured. Here's an overview.

Everything foreigners need to know about the Austrian healthcare system

When it comes to Austria’s health system, a few things always surprise foreigners. For example, unlike some other countries, like the United States, Brazil, or India, residents in Austria are obliged to have public health insurance.

Enrolment is generally automatic and linked to employment. A vast majority of workers are insured by ÖGK through their employer. Still, many, such as self-employed people, will have their insurance with SVS or BVAEB, in the case of public servants.  

Insurance is also guaranteed to co-insured persons, such as spouses and dependents, pensioners, students, disabled people, and those receiving unemployment benefits.

“People are surprised about the amount of different health insurance providers, all of which are part of the public system”, says Miglena Hofer, senior legal counsel at Austria For Beginners

The Local spoke to her and Severina Ditzov, also a senior legal counsel with the company focusing on easing the integration process of expats and their families, to understand a few of the things that can be most surprising about the health care system for those coming into Austria. 

Different insurers, different systems

Austrian health care is universal, and contributions are mandatory – with few exceptions. However, one thing that will surprise many people is that your insurance fund can differ depending on your occupation.

READ ALSO: What is Austria’s e-card? Everything you need to know

For example, most people in the country are insured by the Österreichische Gesundheitskasse (ÖGK), with about 7.4 million insured people in Austria (some 82 per cent of the population). 

However, civil or public servants, miners, and persons employed with the federal railways are insured by BVAEB. According to the company, more than 1.1 million people in Austria are insured with it. 

Additionally, the self-employed, freelancers and farmers will be insured by SVS

There is also the General Accident Insurance Fund (AUVA) for accident insurance and the pension fund Pension Insurance Fund (PVA), to which all residents contribute. 

“People are, of course, surprised to find out that each provider offers different coverage”, highlights Miglena. This means that not every doctor will work with all ÖGK, SVS, and BVAEB, for example. Therefore, it’s essential to check whether the doctors you are going to work with your insurer.

Even more, the insurers might cover different things or pay in different ways. “Some of the public insurances, like SVS and BVA, have self participation. The fund will cover 90 per cent of the treatment, and the rest will be paid by the patient”, Severina explains.

READ ALSO: EXPLAINED: How freelancers in Austria can pay four times less in social insurance

This can be particularly surprising for people changing insurers, for example, those who went from being formally employed by a company with ÖGK to being a self-employed person insured with SVS.

On top of that, people can have private insurance

Austria works with a two-tier system, so besides the mandatory public insurance, residents can also have their own private policies. 

So, additionally, from the public contribution to the state funds, they can pay private companies to provide health care policies too. Doctors can also choose to work with public or only private patients – or both.

“Public doctors may also have private practices, and they are not obligated to have them in two different places”, says Severina.

“It is very common that the doctor works as a public doctor on Mondays and Wednesdays and private doctor on Tuesday and Friday, or private before noon and the public after 12pm, for example”. 

READ ALSO: Reader question: Am I liable for ambulance costs in Austria?

A receptionist would need to tell the patient beforehand if the examination will be private or not, and the information should also be available online, but sometimes they forget to inform, or the person doesn’t correctly check and gets thoroughly surprised when receiving a bill at the end of the consultation.

There is also a difference between Wahlarzt and a Privatarzt. “While both are private doctors, you only get partially reimbursed by the public insurance if you go to a Wahlarzt”, Miglena clarifies. 

A different style of medicine

The style of the consultations can also be shocking to foreigners. 

“Austrian doctors, especially those working with public insurance, are not very empathic or chatty”, Miglena says. “During your appointment, you hardly speak to the doctor as they jump from one room to another”, she adds.  

It is not rare for consultations to last just a few minutes, a drastic change for people from South America, for example, where doctors sometimes spend 30 to 60 minutes talking to patients. 

Another substantial difference is that Austrian medicine is very much focused on prevention and natural remedies, with many doctors prescribing teas and exercise to patients used to getting prescriptions for anxiety and sleeping pills in the United States, for example. 

Pollyanna, a Brazilian who has been living in Vienna for four years, tells how she had difficulties finding a prescription to take the medicine she was used to and that helped her sleep: “The doctor didn’t even want me to take melatonin, let alone my usual prescription medicine”.

Her husband, who is an American, went through a similar situation and felt the difference between doctors in the United States and in Austria.

This style of medicine, one that focuses on prevention and self-recovery, makes it common for people with the flu to be sent home with the recommendation to rest and also creates one of the most unusual things for many expats in Austria: the fact that the public healthcare system will cover a weeks-long stay at a spa.

The expert advice

If any of these quirks, especially the quick consultations with long waiting times, bothers you, you might want to invest in additional private insurance, according to the expert lawyers.

“Sadly, one gets treated way better if they have private insurance”, Miglena says. “Suddenly, every doctor speaks English and is friendly to you, looks you in the eyes, and doesn’t mind answering your questions in detail”. 

“With public insurance, one has to wait for approximately four to eight weeks for examination with a specialist; private insurance can get you faster appointments,” Severina adds.

If you are looking for a doctor – private or not- Austria’s DocFinder.at is a good tool with filters to help you find a doctor based on your insurer or which languages they speak.

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