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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

HEALTHCARE

Who can register for national healthcare in Italy?

Who is entitled to free registration with Italy's national service health service, and what are the options for people who aren't? Here's a guide to the basics.

Who can register for national healthcare in Italy?
Registering for public healthcare in Italy will allow you to get medication at a subsidised rate. Photo: Andreas Solaro/AFP

The Italian National Health Service (SSN – Servizio Sanitario Nazionale) is open to anyone living in Italy, and registering with it guarantees foreign residents all the same care available to Italian nationals at the same cost.

But that process is more straightforward – and cheaper – for some than for others.

Here’s what you need to know about registering with Italy’s public healthcare system.

Who can register for free?

Certain people are entitled to iscrizione obbligatoria, ‘mandatory registration’ or ‘registration by right’, in the national health service.

That means you can register with the SSN for free.

Iscrizione obbligatoria applies to the following categories:

  • Immediate family members of an Italian citizen living in Italy
  • People with a valid work contract from an employer in Italy
  • Self-employed people with a partita IVA (VAT number)
  • People who previously worked in Italy but are currently unemployed and registered on the unemployment lists (liste di collocamento)
  • People who have a residence permit expressly for the purpose of applying for citizenship, fostering or adopting children, or because they are pregnant or have given birth in the past six months
  • Asylum seekers, refugees and others under international protection

People in these categories are also allowed to register their spouse, children or other dependents under the same conditions, with the exception of elderly parents.

READ ALSO: Tessera sanitaria: How do you apply for or renew your Italian health card?


Photo: Filippo Monteforte/AFP

Who else can register?

If you don’t fall into any of these categories, you can also opt in to the Italian health service (iscrizione volontaria or ‘voluntary registration’).

It involves paying an annual registration fee in order to access public healthcare.

Once registered, you’ll pay the exact same for the care you receive as people who enrolled for free.

ITALIAN BUREAUCRACY EXPLAINED: 

Voluntary registration is open to anyone legally resident in Italy who doesn’t qualify for free registration, notably non-working elective residents, students, diplomats, volunteers, people aged 65 or over who have moved Italy to be with their children, or anyone else who doesn’t pay social security contributions.

The only condition is that you must be staying in Italy for more than three months – unless you are a student or an au pair, in which case you are still allowed to register for healthcare during a short stay at a reduced fee.

You can also extend voluntary registration to your dependent family members.

How much does it cost?

The fee for voluntary registration is calculated by your local health authority (ASL – Azienda Sanitaria Locale) according to your means. It therefore varies depending on where you live in Italy and your financial circumstances.

The minimum annual fee is €387.34, rising to a maximum of €2,788.86. One fee also covers any dependents you’re registering at the same time.

Students and au pairs can benefit from fixed fees of around €150 and €220 respectively, though this will not allow you to register any dependents (you can do so by opting to pay the full fee instead).

NB: the fee is fixed for the calendar year, so you’ll pay the same amount whether you register in January or November. If it’s late in the year, it might work out better value to wait and if necessary use private healthcare for a month or two before registering.

How do you register?

You register directly with your nearest ASL. Find a list here

You will need:

  • Your passport
  • Your certificate of residence (for EU citizens and Brits) or permesso di soggiorno (for non-EU citizens), or an official receipt to show you have applied for it
  • Your codice fiscale, or tax code
  • For iscrizione obbligatoria: a work contract, payslip, declaration from an employer, VAT registration, UK S1 form, or any other document that shows your entitlement to free registration.
  • For iscrizione volontaria: evidence of your previous year’s income, such as a tax return.
  • If registering dependents: birth or marriage certificates that document your relationship, as well as evidence of family members’ income.
  • If registering as a student or au pair: proof of enrolment in a study programme or a contract with a family.

Ask your ASL exactly which documents you require for your particular circumstances.

If you’re registering voluntarily, you’ll also need to have your ASL calculate your annual fee, which you have to go to the nearest Post Office to pay by postal order (bollettino postale). You’ll then return to the ASL office to show receipt of payment and complete your registration.

Either way, be prepared for multiple consultations – in person – before the process is complete.

And since registration is annual, you can expect to repeat it all over again the following year.

READ ALSO: How do you renew your Italian health card?

The following video explains the process for British nationals and may be applicable to others too:

What are you entitled to once you register?

The benefits of registering are that you’ll be able to access the Italian public healthcare system for free or at a subsidised rate.

Once registered, you’ll receive a tessera sanitaria or health card that shows you’re entitled to public healthcare. You can also register with a GP (medico di base) and register your children with a paediatrician, whom you can consult without charge.

Other forms of care may require you to pay part of the cost (a co-pay known in Italian as the ticket), but the amount will be subsidised by the national health service.

READ ALSO: 

Registering can also help you secure residency in Italy: proving you have healthcare is a condition of being granted a residency permit, in many cases, so if you’ve registered with the SSN (or can at least show you’re in the process of doing so), that will meet the requirement.

However, since residency is a condition of registering it can be a Catch-22 situation. You may be able to persuade officials to accept provisional documents, but there are no guarantees.

You might find it more expedient to take out private health insurance in the short term to allow you to secure the residency permit you need to register with the SSN; or if you prefer, you can opt to skip the public health system altogether and pay for private care throughout your time in Italy.

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