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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

 

HEALTH

UPDATE: How to access mental health services in France

On World Mental Health Day, we take a look at how to access mental health services in France - and what changes will come into place in 2022.

A man sits depressed during a mental health consultation. The Covid-19 pandemic has put us all under mental strain.
Accessing mental health services in France can be difficult. Read our guide on how to navigate this system and changes on the horizon. (Credit: Nik Shuliahin/Unsplash)

The Covid-19 pandemic has taken a mental toll on people around the world. France is no exception. 

According to a study conducted by French health authorities in September: 15 percent of French people are depressed (up 5 percent from pre-pandemic levels); 23 percent are anxious (up 10 percent); and 10 percent have had suicidal thoughts over the course of the year (up 5 percent). 

Accessing partially reimbursed or fully reimbursed mental healthcare in France can be difficult. Soaring demand coupled with a lack of staffing (close to a third of positions in public mental health hospitals are unfilled) means that waiting lists can be long. But there are ways to get help.

Accessing mental health services

The easiest way to book an appointment with a psychiatrist is through the Doctolib website. It is possible to filter your search for English-speaking clinicians. 

READ ALSO: How to get a carte vitale in France and why you need one

If you have a carte vitale it is possible to have partial or full reimbursement for psychiatric treatment in France. If booking an appointment online, be sure to check whether the doctor is conventionné secteur 1 to get the highest level of reimbursement possible.

You can read an approximate guide to current reimbursement levels HERE.

Psychologists (who are unable to prescribe drugs) are not considered doctors in France and therefore consultations with this kind of practitioner are rarely reimbursed. However, you may be able to access both psychological and psychiatric treatment if you can get an appointment in a Medical Psychology Center (centre medico psychologique – CMP). These services are free but often require a referral letter from a GP.

Counselling is another option. Generally less qualified than psychologists or psychiatrists, counsellors can provide a simple form of listening therapy. Anne Poulton, a retired professional counsellor with an NHS Community Mental Health team, set up the Counselling in France website after moving to France with her husband in 2000. It serves as a directory for English-speaking counsellors who may be able to help you. These services are not covered by social security.

READ ALSO: Health insurance in France – what you need to know about a mutuelle

Private mental healthcare will only be reimbursed if you have a private insurance (mutuelle) which specifically covers this kind of healthcare. It is however, easier to get an appointment quickly if you go down this route. 

Upcoming changes

In September, President Macron made a number of announcements that should significantly improve access to mental health services from an unspecified date in 2022. 

Psychological consultations will finally be at least partially reimbursed by the state – although you will need to have a recommendation letter from a GP to benefit from this.

For everyone with a carte vitale, the state has promised to cover ten psychological consultations at the price of €40 each. These ten consultations can be renewed once. After that, patients will continue to receive reimbursement, to the tune of €30 per session. 

READ ALSO: What your French health insurance card entitles you to

The French government intends to spend €50 million to cover these costs in 2022 and a further €100 million in 2023. 

CMPs are to employ a further 800 staff, which will help to absorb some of the demand for free mental healthcare. 

The government has also promised to invest €80 million in neuroscience research in a bid to find better treatments to the country’s mental health crisis. 

Helplines

SOS Helpline offers a telephone listening service in English – 01 46 21 46 46

The UK-based Samaritans can be accessed from France – 0044 8457 909090

If you are experiencing domestic violence you can call (English-speakers may not always be available) or report online HERE.

The British Consulate is able to advise you on various treatment options available but cannot give clinical advice on individual mental problems – 01 44 51 31 00

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