Almost all European countries have healthcare available for all citizens. Most European countries have systems of competing private health insurance companies, along with government regulation and subsidies for citizens who cannot afford health insurance premiums. Countries with universal healthcare include Austria, Belarus, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, Moldova, North Macedonia, Norway, Portugal, Romania, Russia, Serbia, Slovenia, Spain, Sweden, Switzerland, Ukraine, and the United Kingdom.
Albania Albania operates a mixed public and private healthcare system overseen by the Ministry of Health and Social Protection. The system is not yet fully universal. Public healthcare is primarily funded through mandatory health insurance contributions and government subsidies, though a significant portion of the population remains uninsured, largely due to informal employment. Out-of-pocket payments account for a large share of total health spending, making access to care difficult for low-income households. According to the World Health Organization, about one-third of Albanians lack health insurance, 8% of households are pushed into or further into poverty by healthcare costs, and 12% experience catastrophic health spending. Reforms since 2015 have expanded access, including free annual checkups and primary care visits for uninsured individuals. However, patients continue to pay substantial co-payments for medicines and specialist care.
Armenia Armenia operates a mandatory social health insurance system. The majority of the population is enrolled in the Compulsory Health Insurance Fund, which is funded through payroll taxes and contributions from employers and employees.
Austria Healthcare in Austria is
universal for residents of Austria, as well as those from other EU countries. Austria has a
two-tier payment system in which many individuals receive basic
publicly funded care; they also have the option to purchase supplementary private
health insurance.
Belgium Belgium has a universal health care system.
Healthcare in Belgium is composed of three parts. Firstly, there is a primarily publicly funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practitioners, university/semi-private hospitals and care institutions. There are a few (commercially run
for-profit)
private hospitals. Secondly is the insurance coverage provided for patients. Finally, industry coverage covers the production and distribution of healthcare products for research and development. The primary aspect of this research is done in
universities and
hospitals.
Croatia Croatia has a
universal health care system that provides medical services and is coordinated by the
Ministry of Health. The population is covered by a basic health insurance plan provided by statute and by optional insurance. It is administered by the
Croatian Health Insurance Fund. In 2012, annual compulsory healthcare related expenditures reached 21.0 billion kunas (c. 2.8 billion euro). There are hundreds of healthcare institutions in Croatia, including 79 hospitals and clinics with 25,285 beds, caring for more than 760 thousand patients per year, 5,792 private practice offices and 79 emergency medical service units.
Czech Republic Czech Republic has a universal public health system paid largely from taxation. Private health care systems do co-exist freely alongside public ones, sometimes offering better quality or faster service. Almost all medical services are covered by health insurance and insurance companies, though certain services such as prescription drugs or vision and dental care are only covered partially.
Denmark Denmark has a universal public health system paid largely from taxation with local municipalities delivering health care services in the same way as other Scandinavian countries. Primary care is provided by a general practitioner service run by private doctors contracting with the local regions with payment on a mixed per capita and fee for service basis. Most hospitals are run by the regions (only 1% of hospital beds are in the private sector).
Estonia Estonia's health care system is based on compulsory insurance based on solidarity funding and on universal access to services provided by private service providers. About 94% of the population is covered by insurance.
Finland In Finland, public medical services at clinics and hospitals are run by the municipalities (local government) and are funded 76% by taxation, 20% by patients through access charges, and 4% by others. Private provision is mainly in the primary care sector. There are a few private hospitals. The main hospitals are either municipally owned (funded from local taxes) or run by the medical teaching universities (funded jointly by the municipalities and the national government). According to a survey published by the European Commission in 2000, Finland's is in the top 4 of EU countries in terms of satisfaction with their hospital care system: 88% of Finnish respondents were satisfied compared with the EU average of 41.3%. Finnish health care expenditures are below the European average. The private medical sector accounts for about 14 percent of total health care spending. Only 8% of doctors choose to work in private practice, and some of these also choose to do some work in the public sector. Taxation funding is partly local and partly nationally based. The national social insurance institution
KELA reimburses part of patients prescription costs and makes a contribution towards private medical costs (including
dentistry) if they choose to be treated in the private sector rather than the public sector. Patient access charges are subject to annual caps. For example,
GP visits cost €11 per visit with annual €33 cap; hospital outpatient treatment €22 per visit; a hospital stay, including food, medical care, and medicine €26 per 24 hours, or €12 if in a psychiatric hospital. After a patient has spent €683 per year on public medical services, all further treatment in that year is covered (although the required initial deductible is reviewed annually, so it may vary). There is a separate reimbursement system for prescribed medicine: after paying €578 per year, the remaining bought medicine will have a maximum price of €2.50 per purchase. Finland has a highly decentralized three-level public system of health care and alongside this, a much smaller private health care system. Overall, the municipalities (funded by taxation, local and national) meet about two thirds of all medical care costs, with the remaining one third paid by the national insurance system (nationally funded), and by private finance (either employer-funded or met by patients themselves). is above the
OECD average and similar to the levels seen in Germany (77%) and France (80%) but below the level seen in the UK (87%). The quality of service in Finnish health care, as measured by patient satisfaction, is excellent. According to a survey published by the European Commission in 2000, Finland has one of the highest ratings of patient satisfaction with their hospital care system in the EU: 88% of Finnish respondents were satisfied compared with the EU average of 41.3%. There are caps on total medical expenses that are met out-of-pocket for drugs and hospital treatments. The National Insurance system pays all necessary costs over these caps. Public spending on health care in 2006 was 13.6 billion euros (equivalent to US$338 per person per month). The increase over 2005 at 8.2 per cent was below the OECD average of 9 percent. Household budgets directly met 18.7 per cent of all health care costs.
France France has a system of health care largely financed by government through a system of
national health insurance. Nonetheless, not all medical care is paid for by the state, with only 70% of initial GP care covered and anywhere between 35% and 100% of prescription medication covered. It is consistently ranked as one of the best in the world.
Georgia In 2013,
Georgia adopted a universal health care system. Healthcare in Georgia is provided by a universal health care system under which the state funds medical treatment in a mainly privatized system of medical facilities. In 2013, the enactment of a universal health care program triggered universal coverage of government-sponsored medical care of the population and improving access to health care services. Responsibility for purchasing publicly financed health services lies with the Social Service Agency (SSA). However, according to the UN, due to the high out-of-pocket costs that patients incur, Georgia has not yet achieved universal healthcare.
Germany (Hospital) in
Berlin Germany has the world's oldest national
social health insurance system, with origins dating back to
Otto von Bismarck's Sickness Insurance Law of 1883. The system is decentralized with private practice physicians providing ambulatory care, and independent, mostly non-profit hospitals providing the majority of inpatient care. Employers pay for half of their employees' health insurance contributions, while self-employed workers pay the entire contribution themselves. Approximately 90% of the population is covered by a statutory health insurance plan, which provides a standardized level of coverage through any one of approximately 90 public sickness funds. Purchasing basic health insurance is mandatory for all persons residing in Germany if not employed. Historically, the level of provider reimbursement for specific services is determined through negotiations between regional physician's associations and sickness funds. Since 1976 the government has convened an annual commission, composed of representatives of business, labor, physicians, hospitals, and insurance and pharmaceutical industries. The commission takes into account government policies and makes recommendations to regional associations with respect to overall expenditure targets. In 1986 expenditure caps were implemented and were tied to the age of the local population as well as the overall wage increases. Although reimbursement of providers is on a fee-for-service basis, the amount to be reimbursed for each service is determined retrospectively to ensure that spending targets are not exceeded. Capitated care, such as that provided by U.S. health maintenance organizations, has been considered as a cost containment mechanism but would require consent of regional medical associations, and has not materialized. Copayments were introduced in the 1980s in an attempt to prevent
overutilization and control costs. The average length of hospital stay in Germany has decreased significantly in recent decades, falling from 14 days to approximately 7.2 days by 2024, though it remains longer than average stays in the U.S. (approx. 5 to 6 days). This difference is partly attributed to the historical reimbursement structure, although Germany has since transitioned to a system based on diagnosis-related groups (DRGs). Despite ongoing cost-containment efforts, overall health care expenditures have continued to rise. In 2024, total health expenditure in Germany reached €538.2 billion, representing 12.4% of the gross domestic product (GDP). The financing is primarily provided by the statutory health insurance (GKV) with €300.8 billion, followed by social long-term care insurance (€64.7 billion), private households (€65.0 billion), and private health insurance (€44.8 billion). This expenditure remains comparable to other high-income Western European nations, but is still lower than the percentage of GDP spent in the United States.
Greece The
Greek healthcare system provides high quality medical services to
insured citizens and is coordinated by the
Ministry for Health and Social Solidarity. Public health services are provided by the National Healthcare Service, or ESY (). In 2010 there were 35,000 hospital beds and 131 hospitals in the country. The Greek healthcare system has received high rankings by the
World Health Organization, ranked 14th in the overall assessment and 11th in quality of service in a 2000 report by the WHO. The data listed above is from 2000.
Iceland Iceland has a universal public health system paid largely from taxation with local municipalities delivering health care services in the same way as the Scandinavian countries. Iceland's entire population has equal access to health care services.
Ireland The public
health care system in Ireland is governed by the Health Act 2004, which established a new body to be responsible for providing health and personal social services to everyone living in Ireland – the
Health Service Executive. The new national health service came into being officially on January 1, 2005; however, the new structures are currently in the process of being established as the reform program continues. In addition to the public-sector, there is a large private health care market. In Ireland, 28% of the population hold a medical card that gives the holder access to free GP (doctor) care and caps prescription drugs at €1.50. A separate 10% of the population holds a GP visit-card which provides free GP care. For those who do not have a medical card or a GP visit-card, the average price for an appointment with a GP is €50 to €90.The standard charge for Irish and
EU citizens who attend the A&E in hospitals is €100 but the fee is waived if referred by a GP. Ireland is currently in the process of establishing a universal healthcare system known as Sláintecare.
Italy Italy has a public health care service for all the residents called "Servizio Sanitario Nazionale" or SSN (National Health Service). It is publicly run and funded mostly by taxation. Some services require variable co-pays, while other services (such as emergency medicine and a general doctor) are free. Medication is mostly covered. There is also a small parallel private health care system, especially in the field of
dentistry and
optometry. It is consistently ranked as one of the best in the world, especially in the Northern regions.
Latvia Healthcare in Latvia is
universal for citizens of Latvia. The healthcare system in Latvia operates as a universal program that is primarily funded through government taxation. It bears similarities to the National Health Service (NHS) in UK and employs a purchaser-provider split (PPS). Following several reforms, a National Health Service (NHS) type system, known as Nacionālais veselības dienests (NVD) in Latvian, was established in 2011. The NVD controls the implementation of healthcare policies while the Ministry of Health develops policies and oversees the system. Healthcare services are available for free for citizens of Latvia. The country's Ministry of Health manages its healthcare system through a combination of social insurance institutional body, legislative healthcare provision financed by taxes and numerous public and private providers. Despite near-universal population coverage provided by the NVD established in 2011, there are challenges to equitable access with issues around geographical distribution of health professionals, user charges and long waiting lists. The publicly funded health benefits package is limited in scope and only covers a predetermined set of services.
Lithuania The public healthcare system in Lithuania ensures free healthcare for almost all its citizens. This state-funded healthcare is available to long-term residents and expats too.
Luxembourg Luxembourg provides universal health care coverage to all residents (Luxembourgers and foreigners) by the National Health Insurance (CNS -
Caisse nationale de santé (French) or
National Gesondheetskeess (Luxembourgish)). It is funded by mandatory contributions of employers and the workforce, and by government subsidies for insuring jobseekers, the poor, and for financing medical infrastructure. The nation also has mandatory public long-term care insurance.
Netherlands The Netherlands has a dual-level system. All primary and
curative care (family doctors, hospitals, and clinics) is financed from private
compulsory insurance. Long-term care for the elderly, the dying, the long-term mentally ill etc. is covered by
social insurance funded by public spending. According to the WHO, the health care system in the Netherlands was 62% government-funded and 38% privately funded as of 2004. Norway regularly comes top or close to the top of worldwide healthcare rankings.
North Macedonia The country inherited a large health infrastructure after independence in 1991 with good well-distributed public health services. Private hospitals were opened and primary care was privatised. Subsequently, both public and private providers have been integrated into one social insurance-funded model managed by the
Health Insurance Fund of North Macedonia. The public hospital sector is seen as inefficient and is unpopular with both patients and professional staff. 90% of the population is within 30 minutes of a health service. Expenditure on healthcare was $851 per head in 2014, 6.5% of GDP. According to the
Euro health consumer index, the Macedonian health system made the most remarkable advance of any country in the history of their Index, from 27th to 16th place in 2014, because by implementing a real-time
e-Booking system they reduced waiting lists so significantly. From July 2013, any GP can make a booking at any specialist or heavy diagnostic equipment in the country in real-time while the patient is present. They rated North Macedonia 16th in Europe in 2015. The
Doctor's Chamber of Macedonia complains that there is a discrepancy between the available funds and the quality of service expected, that facilities are not used efficiently, equipment is outdated and staff are not used effectively.
Poland Healthcare in Poland is insurance based, delivered through a publicly-funded health care system, called the
National Health Fund, which is free for all the citizens of
Poland, provided they fall into the "insured" category (usually meaning that they have health insurance paid for by their employer, or are the spouse or child of an insured person).
Portugal Portugal's National Healthcare Service, known nationally as Serviço Nacional de Saúde (SNS), is a universal and free healthcare service provided nationwide since 1979 and available to both Portuguese and foreign residents. In 2014, Portugal SNS ranked 13th best healthcare service in Europe. The National Medical Emergency Institute (INEM) is the main emergency medical service and can be activated by calling 112.
Romania According to Article 34 of the
constitution of Romania, the state is obligated "to guarantee the protection of healthcare". Romania has a fully universal healthcare system, which covers medical check-ups, surgical interventions, and any postoperative medical care, as well as free or subsidized medicine for a range of diseases. The state is also obliged to fund public hospitals and clinics. Dental care is not funded by the state, although there are public dental clinics in some hospitals, which treat patients free of charge.
Russia In the former
Soviet Union, the preferred term was "socialist medicine"; the Russian language has no term to distinguish between "socialist" and "socialized" (other than "public", Rus:
obshchestvenniy/общественный, sometimes "collectivized" or "nationalized", Rus:
obobshchestvlenniy/обобществленный). Russia in Soviet times (between 1917 and 1991) had a totally socialist model of health care with a centralized, integrated, hierarchically organised government providing free health care to all citizens. Quality of care and access to medications was not equal however and was dependent on the
social status of
patient. The best care was provided for
nomenklatura and their family members, who had been segregated from the rest of population facilities, such as
Kremlin hospital. Initially successful at combating infectious diseases, the effectiveness of the socialized model declined with underinvestment. Despite a doubling in the number of hospital beds and doctors per capita between 1950 and 1980, the quality of care began to decline by the early 1980s and medical care and health outcomes were below western standards. The new
mixed economy Russia has switched to a mixed model of health care with private financing and provision running alongside state financing and provision. The OECD reported that unfortunately, none of this has worked out as planned and the reforms have in many respects made the system worse. The population's health has deteriorated on virtually every measure. The resulting system is overly complex and very inefficient. It has little in common with the model envisaged by the reformers. Although there are more than 300 private insurers and numerous public ones in the market, real competition for patients is rare leaving most patients with little or no effective choice of insurer, and in many places, no choice of health care provider either. The insurance companies have failed to develop as active, informed purchasers of health care services. Most are passive intermediaries, making money by simply channelling funds from regional OMS funds to healthcare providers. Article 41 of the Constitution of the Russian Federation confirms a citizen's right to state healthcare and medical assistance free of charge. This is achieved through state compulsory medical insurance (OMS), which is funded by an obligatory medical insurance payroll tax and government subsidies. It is worth mentioning that Russian citizens never pay taxes for themselves and often don't even know how much taxes they pay, because tax payment process is maintained by companies they are working on. Introduction in 1993 reform of new free market providers in addition to the state-run institutions intended to promote both efficiency and patient choice. A purchaser-provider split helps facilitate the restructuring of care, as resources would migrate to where there was greatest demand, reduce the excess capacity in the hospital sector and stimulate the development of primary care. Russian Prime Minister
Vladimir Putin announced a new large-scale health care reform in 2011 and pledged to allocate more than 300 billion rubles ($10 billion) in the next few years to improve health care in the country. As of 2020 the health insurance tax (called deposition to an OMS fund) is 5.1%.
Serbia The
constitution of Serbia states that it is the right of every citizen to seek medical assistance, free of charge. This is achieved by mutual contribution to the Compulsory Social Healthcare Fund of RZZO (Republički Zavod za Zdravstveno Osiguranje or National Health Insurance Institution). The amount of contribution depends on the amount of money the person is making.
Spain Spain provides a public
universal health care system for all citizens and, under certain conditions, also non-citizens. Healthcare is free except for co-payments for some products and services; it is mostly paid from the
Social Security budget. Adult dental care is not covered but for basic extractions or problems that could result in serious
stomatological conditions. Irrespective of the nationality and insurance situation of the patient, the public system always treats medical emergencies until achieving the best possible outcome. If not covered by the Spanish Social Security (i.e., a visiting foreigner), the provider later negotiates payment with the patient or the patient's insurer. If actually unable to pay, it is covered by Social Security on humanitarian grounds unless the patient purposely traveled to Spain to get free healthcare. Obvious unexpected emergencies such as accidental injuries or sudden illness are customarily covered, but those that could be reasonably expected (e.g., arising from a chronic condition or from avoidable risk-taking) are studied on a case-per-case basis. According to the World Economic Forum and to Bloomberg, Spain has the most efficient health system in Europe, and also ranks at the top worldwide along with Hong Kong, Japan and Singapore. Private health insurance is available for those who prefer it, and recommended for visitors not covered by the Spanish Social Security or a foreign public or private insurer with overseas coverage. The health system is organized territorially, with health services decentralized, allowing the 16 autonomous regions of Spain to operate their own health systems. Notwithstanding decentralization, in recent years the central government has begun to enforce national regulations that may be perceived as an effort to centralize the country's health system.
Sweden Sweden has a universal public health care system paid for through taxation. The Swedish public and private health care systems are funded through taxes levied by the
county councils. Government-paid dental care is accessible to those under 23 years old. Sweden also has a smaller private health care sector, mainly in larger cities or as centers for preventive health care financed by employers. In recent years the health care system of Sweden has been heavily criticized for not providing the same quality of health care to all Swedish citizens. The disparity of health care quality in Sweden is growing. Swedish citizens of other ethnicities than Swedish, and citizens who are of a lower socio-economic class, receive a significantly lower quality of health care than the rest of the population. This was especially brought to light during the
COVID-19 pandemic, as Swedish media and public health researchers pointed out that Swedish citizens of other ethnicities than Swedish, and people living in working class areas, were dying from COVID-19 at a significantly higher rate than the rest of the population, due to the fact that they were not provided with the same quality of health care.
Switzerland Purchasing basic health insurance is mandatory for all persons residing in Switzerland (within three months of taking up residence or being born in the country). Healthcare in Switzerland is universally available and is regulated by the Federal Health Insurance Act of 1994. Supplemental insurance plans are optional. Insurers are required to offer insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans.
United Kingdom Each of the
countries of the United Kingdom has a
National Health Service that provides public healthcare to all UK permanent residents that was originally designed to be free at the point of need and paid for from general taxation; but changes included introducing charging for prescription medicines and dentistry (those below 16 and those on certain benefits may still get free treatment). However, since health is now a
devolved matter, considerable differences are developing between the systems in each of the countries for example Northern Ireland, Scotland and Wales abolished prescription charges. Private healthcare companies are free to operate alongside the public system.
England , a
National Health Service hospital. The
National Health Service (NHS), created by the
National Health Service Act 1946, has provided the majority of healthcare in England since its launch on July 5, 1948. The
NHS Constitution for England documents, at a high level, the objectives of the NHS, the legal rights and responsibilities of the various parties (patients, staff, NHS trust boards), and the guiding principles that govern the service. The NHS constitution makes it clear that it provides a comprehensive service, available to all irrespective of age, gender, disability, race, sexual orientation, religion, or belief; that access to NHS services is based on clinical need and not an individual's ability to pay; and that care is never refused on unreasonable grounds. Patient choice in terms of doctor, care, treatments, and place of treatment is an important aspect of the NHS's ambition, and in some cases patients can elect for treatment in other European countries at the NHS's expense. Waiting times are low, with most people able to see their primary care doctor on the same day or the following day. Only 36.1% of hospital admissions are from a waiting list, with the remainder being either emergencies admitted immediately or else pre-booked admissions or the like (e.g., child birth). One of the main goals of care management is to ensure that patients do not experience a delay of more than 18 weeks from initial hospital referral to final treatment, inclusive of time for all associated investigative tests and consultations. In 2009, two-thirds of patients were treated in under 12 weeks. Though centrally funded, the NHS is not managed by a large central bureaucracy. Responsibility is divided among geographical areas through
strategic health authorities. Management is distributed even more locally through
primary care trusts,
hospital trusts—and increasingly to
NHS foundation trusts that provide even more decentralized services within the NHS framework, with more decisions left to local people, patients, and staff. The central government office—the Department of Health—is not involved in day-to-day decision making in either the Strategic Health Authorities or the individual local trusts (primarily health, hospital, or ambulance) or the national specialist trusts such as
NHS Blood and Transplant. It does lay down general guidelines they must follow. Local trusts are accountable to their local populations, whilst government ministers are accountable to Parliament for the service overall. The NHS provides, among other things,
primary care,
in-patient care,
long-term healthcare,
psychiatric care and treatments,
ophthalmology, and
dentistry. All treatment is taxpayer-funded with the exception of certain charges for prescriptions, dentistry and ophthalmology (which themselves are free to children, certain students in full-time education, the elderly, the unemployed and those on low incomes). Around 89 percent of NHS prescriptions are obtained free of charge, mostly for children, pensioners, and pregnant women. Others pay a flat rate of £9.90, and others may cap their annual charges by purchasing an NHS Prescription Prepayment Certificate. Private health care has continued parallel to the NHS, paid for largely by private insurance. Private insurance accounts for only 4 percent of health expenditure and covers little more than a tenth of the population. Private insurers in the UK only cover acute care from specialists. They do not cover generalist consultations, pre-existing conditions, medical emergencies, organ transplants, chronic conditions such as diabetes, or conditions such as pregnancy or HIV. Most NHS general practitioners are private doctors who contract to provide NHS services, but most hospitals are publicly owned and run through
NHS trusts. A few NHS medical services (such as
"surgicentres") are sub-contracted to private providers as are some non-medical services (such as catering). Some capital projects such as new hospitals have been funded through the
Private Finance Initiative, enabling investment without (in the short term) increasing the
public sector borrowing requirement, because long-term contractually obligated PFI spending commitments are not counted as government liabilities.
Northern Ireland Health and Social Care in Northern Ireland is the designation of the national public health service in
Northern Ireland.
Scotland is a specialist
children's hospital within
NHS Scotland.
NHS Scotland, created by the
National Health Service (Scotland) Act 1947, was also launched on July 5, 1948, although it has always been a separate organization. Since devolution, NHS Scotland has followed the policies and priorities of the
Scottish Government, including the phasing out of all prescription charges by 2011. Prescriptions are now free in Scotland for all citizens.
Wales NHS Wales was originally formed as part of the same NHS structure created by the
National Health Service Act 1946 but powers over the NHS in Wales came under the Secretary of State for Wales in 1969, in turn being transferred under devolution to what is now the
Welsh Government.
Crown dependencies Isle of Man The
Isle of Man, a UK Crown dependency, provides universal public health coverage to its residents.
Channel Islands The medical care system in the Channel Islands is very similar to that of the UK in that many of the doctors and nurses have been trained from the UK health perspective. There is universal health care for residents of Jersey. Healthcare in Guernsey and Alderney is charged for with all primary care provided for on a private basis. There is no universal healthcare for residents of Sark. == North America ==