chart 3
Comparison between the variation in the total current health expenditure and
out-of-pocket payments on health: Years 2000–2015
500
Slovakia
(240%; 481%)
450
400
Estonia
(309%; 325%)
350
300 Czech Republic
250 United Kingdom
Slovenia
200
Germany
150
100
50
0
50
-50
Austria
Portugal
Italy
Greece
France
Denmark
Finland
Luxemborg
Ireland
Netherlands
Spain
Hunary
R 2 = 0.70683
Latvia
Sweden
Poland
Switzerland
Belgium
100
150
200
250
Total health Current health expenditure on health, PPP$ per capita: Variation 2000-2015
compulsory private insurance and compulsory
medical savings account. Private current health
expenditure includes voluntary health care
payment schemes and household out-of-pocket
payments. The first component includes, in
turn, all domestic pre-paid health care financing
schemes under which the access to health
services is at the discretion of private actors.
The second component corresponds to direct
payments for health care goods and services from
the household primary income or savings: the
payment is made by the user at the time of the
purchase of goods or use of service. 2
In 2016, the percentage of public sector
health expenditure to the total current health
expenditure was higher than 70% in most
countries, except for Latvia (56%), Greece (58%),
Portugal (66%), Hungary (68%) and Poland (69%)
and outside the EU, in Switzerland (64%) (Chart 1).
Between 2000 and 2016, the public health
expenditure in PPP$ per capita more than
doubled in all the EU countries except in Greece
(+49%), Portugal (+63%), Italy (+71%), France (+84%)
and Austria (+84%). However, from 2008 to 2016,
the variation was less significant than from 2000
to 2008.
Chart 2 shows the last 14-year trend
concerning the share of government expenditure
in health. It presents the aggregated data
concerning the EU, EU 15 and EU 13, and
the figures of the three countries having the
highest and the lowest values in the year 2014,
Switzerland included.
In 2014, the percentages of government
expenditure devoted to health differed by 4
percentage points (p.p.) between EU 15 (16.2%)
and EU 13 (11.9%); Switzerland shows 22.7%,
higher but also growing faster than the EU
member states.
The trends illustrated in Chart 2 are generally
positive between 2000 and 2006 with an average
increase of percentage of government outlays
devoted to health by 0.2 p.p. per year. Yet, from
2006 onwards, this way of development slackened
off in many countries. The reasons can be the
In the last
years, public
sector health
expenditure
accounted on
average for 74%
of total health
expenditure and
15% of the total
government
expenditure
14
HHE 2018 | hospitalhealthcare.com
beginning of economic difficulties or in the
shift of interest and priorities to other sectors.
Out-of-pocket payments show the direct
burden of medical costs that households bear at
the time of service use. Out-of-pocket payments
play an important role in every health care
system. In lower-income countries, out-of-pocket
expenditure is often the main form of health care
financing. 3
In 2015, the private contribution to healthcare
spending was around 20.0 % in the EU. It was
higher than 25% in Portugal (27.7%), Switzerland
(28.8%), Hungary (29.0%), Greece (35.5%) and Latvia
(41.6%); it was lower than 10% only in France
(6.8%).
Between 2000 and 2015, the percentage of
out-of-pocket payments to total health
expenditure steadily declined. In EU 15, reductions
were registered in Finland (-3.3 p.p.), Luxembourg
(-3.6 p.p.), Italy (-3.6 p.p.) and Belgium (-8.7 p.p.)
while increases were observed in Portugal
(+2.7 p.p.), Netherlands (+2.8 p.p.), Ireland (+3.0
p.p.) and the United Kingdom (+3.3 p.p.). In EU 13,
according to available data, the abovementioned
percentage increased in Hungary (+1.7 p.p.), Estonia
(+2.4 p.p.), Czech Republic (+4.6 p.p.) and Slovakia
(+7.6 p.p.) and decreased in Slovenia (-2.6 p.p.),
Latvia (-6.0 p.p.) and Poland (-7.9 p.p.). The total
out-of-pocket payments in PPP$ per capita
continued to increase, because the total health
expenditure did.
Chart 3 illustrates the trend 2000–2015 of
both the total current health expenditure per
capita and the private households’ out-of-pocket
payments on health. These values present
a correlation (R² = 0.7068) showing that there
is dependence between the two indicators. The
chart highlights the fast growth of both expenses
in the countries located in the upper part of the
graph. In the ones in the lowest-left part of the
graph, the out-of-pocket payments grew more
slowly compared with the total current health
expenditure.
More than a third of current health expenditure
(excluding investments and capital outlays)