Healthcare in Europe – How Does It Work and How Much It Costs

Is Healthcare in Europe Free?

The first thing to note about this topic is that although the European Union often makes decisions as one coherent “block”, its nations still maintain much of their individuality when it comes to managing their infrastructure and laws. Each different European country will have its own healthcare system, with its different set of rules and characteristics.

The second thing to consider is that even “free” healthcare is never actually free as, although it is usually provided by the local government, it also is, at the end of the day, funded by citizens, often through the payment of taxes.

Yet, in some European countries, there is no extra bill connected to many types of medical assistance and you can just walk out of the hospital or health center straight into treatment and recovery. That is what fundamentally happens in Greece, Germany, Italy, Spain and Portugal. Even when extra fees are applied, and sometimes they are, those co-payments are extremely affordable. That means that in those countries, it is possible to access medical care at minimum-to-free costs, depending on what your needs are and where you seek treatment.

One thing to always keep in mind is that, in Europe, even private medical care is a very inexpensive option, with monthly fees starting at 30€ on average. Therefore, it is not uncommon for citizens to turn to both private and public care depending on their needs and time constraints.

Difference Between Universal Healthcare and Free Healthcare

When getting to know about how healthcare works in Europe, it is important to know the difference between Universal Healthcare and Free Healthcare. Those two terms can interwind, but that is not always the case.

• Free Healthcare: in this system, all citizens receive health care without having to pay for medical assistance.
• Universal Healthcare: in this system, healthcare is provided to a very high percentage of citizens, even if sometimes patients must pay for added fees or for compulsory insurance plans.

How Does the Universal Healthcare System Work in Europe?

A free healthcare system is almost certainly universal, but a universal system is not necessarily free. That is why, from now on, we will use Universal Healthcare System when referring to any system that is highly supported or established by the government. That is because that affordability makes it highly accessible for the majority of citizens, which is what happens in many European countries.

There are a few types of frameworks used by nations and they mainly differ in the way they are funded and whether the infrastructure is government or privately owned and operated. Here is a brief comparison of different European Healthcare Systems based on their models.

The Single-Payer or the National Health Insurance Model

In this case, healthcare is mainly provided through private facilities, but it is the government who pays the medical bills and not the citizens. In Europe, some countries that use this method are Norway, Sweden, Denmark, and Finland.

The Beveridge or Government Owned and Run Model

In this model, the government owns and runs public healthcare facilities that provide services for the citizens as well as employing all the doctors, nurses, and other administrative workers. In general, to have access to the system, residents must have a social security number and have deductions made to their monthly earnings. That is the model used, in some form or another, by the United Kingdom, Spain and Portugal, for example.

The Bismarck or Privatized, but Regulated Model

In this case, citizens are required to buy health insurance, which is usually paid for through payroll deductions or taxes, but that insurance is highly regulated by the government. Some subsidies may be granted to low-income individuals and families, in order to keep the system accessible, but many services still require extra co-payments. This is the model in which is based the German, French and Dutch healthcare Systems.

To give an idea on costs, in Belgium, for example, 7.35% of your gross salary is deducted to health insurance purposes, with 3.55% being paid by you and 3.8% by your employer. That means that if you make the average Belgium salary of 3,500€, you will only pay 124,25€ on health deductions. A co-payment of 6€ is necessary for consultations with general practitioners and consultations with specialist physicians require a co-payment of 12€. If you are self-employed then you should be the one fully paying the 7.35% of your income. Still, very affordable for what it offers.

The Out-of-Pocket Model

Just for clarification, there is one other healthcare model that is not universal as it is not free or subsidized. That is the out-of-pocket model, in which the patient must pay directly to private providers to get medical care, with no heavy regulation from the government on pricing or even acceptance rules. Although the USA uses a combination of each model, with some citizens being covered by the main characteristics of one framework or another, there are a considerable number of people who do not have access to any type of medical care that is not fully paid by the patient.

Is It Possible to Get Private Medical Care in Europe?

Yes, not only is it possible to get private medical care, even in countries with Universal Healthcare Systems based on the government-owned and run Model, but in many, private health insurance costs are also extremely affordable. Take Portugal, for example: a private plan can start at 30€ per month for an average 30-year-old person. Co-payments are usually required but they are also often inexpensive. The fair cost of healthcare in Europe is, at the end of the day, an important source of quality of life and peace of mind.

As the waiting time to get treatment in public hospitals and clinics can be long, also counting on a private provider gives extra peace of mind as well as access to more comfortable installations and privacy if admission is necessary.

Does Europe Have Good Medical Care?

Yes, Europe is known for its advanced and established healthcare systems, with high-quality medical services and cutting-edge technology being found in hospitals and clinics. 

According to the 2023 Health Index Report, which measures the extent to which people are healthy and have access to the necessary services to maintain good health, Europe has 13 nations among the top 20. Norway is the highest-ranked European country, in 7th position, followed subsequently by Iceland, Sweden, Switzerland, The Netherlands, Luxembourg, and Germany. Italy, Malta and France are some of the other European countries in the top 20 of the Health Index Score. Portugal and Greece made it to the top 40, both with a score of 77,4, scoring only 3,1 points below France, the last country within the top 20, and home to one of best healthcare systems in Europe. 

These results come as no surprise when considering that it is not unusual for European countries to allocate a considerable portion of their GDP to healthcare.

Doctors and nurses are also highly skilled and knowledgeable, as they undergo many years of training in some of the top universities in the world. In its latest published statistics on physicians in Europe, Eurostat stated that there were an estimated 1.82 million practicing physicians across the continent in 2021.

Among the EU Member States, Greece had the highest number of physicians relative to population size (629.2 per 100.000 inhabitants), followed by Portugal (562.0 per 100.000 inhabitants) and Austria (540.9 per 100.000 inhabitants). This ratio of the number of physicians per 100.000 inhabitants increased in nearly all of the EU Member States between 2016 and 2021, which shows that despite being very well established, the multiple European Healthcare Systems are constantly growing, in an attempt to best serve the need of the population living in the continent.

In countries like Portugal, the healthcare users are ideally assigned a primary care physician, the equivalent of a General Practitioner, commonly referred as a family doctor. As the name implies, those physicians are responsible for the care of all members of the same family unit, giving general assistance, consultation and treatment prescriptions. However, even patients who do not have a PCP or GP assigned for some reason, can turn to any public hospital for assistance and they will get medical care, nonetheless.

How Does the European Healthcare System Work for Foreigners?

As many European Healthcare Systems are universal, they tend to also somehow extend to foreigners benefits similar to the ones enjoyed by local citizens. This, of course, will vary from country to country.

In Portugal, all legal residents are entitled to the same healthcare benefits as Portuguese citizens, as long as they have a social security number, and deductions are made from their wages. Then, they must simply register with their local health center to obtain a Serviço Nacional de Saúde (National Health Service) user number to access a wide range of medical services.

The same happens in France, with the difference that you must reside in the country for at least six months per year to be able to access the public healthcare system. In Greece, expats who work in the country pay regular contributions to social security and may be able to enjoy full or subsidized health care benefits. Therefore, those are some of the countries with the best healthcare for expats in Europe.

Malta, for example, takes another direction as, although citizens born in the country can get public medical assistance for free, foreigners must buy health insurance before acquire residency. The same goes for Germany.

There are also some reciprocal agreements between nations, including non-European countries, allowing citizens from both parties to get free assistance when visiting one another. This is something that needs to be investigated before your arrival in Europe.

It is also important to know that if you are visiting the Schengen area as an out-of-EU tourist, it might be compulsory to purchase private travel insurance to cover possible medical costs for the whole duration of your stay.

The European Health Insurance Card

If you are already a resident of the European Union, or if you become one, you can apply to get a European Health Insurance Card. This free card gives access to state-provided healthcare, when medically necessary, during a temporary stay in any of the 27 EU countries, as well as Iceland, Liechtenstein, Norway, Switzerland and the United Kingdom.

Those cards are issued by the national health provider of your country of residency and are intended to be used in unforeseen events and will not cover the costs of those traveling for the express purpose of obtaining medical treatment.

The European Health Insurance Card does not guarantee free services, but it does enable you to use the national healthcare system under the same conditions and at the same cost as people insured in the country you are visiting.

Healthcare in Europe vs. in the USA

As we commented on earlier, the healthcare system in the USA is a mixed system, with a combination of characteristics of all the models. Medicare and Medicaid, for instance, are insurances publicly financed by the government. However, only a small percentage of the population is covered by those programs. Some people have private health insurance coverage through their employer while many others have the out-of-pocket model as the only option to get medical care. That means that the USA does not provide a Universal Healthcare System.

In Europe, either through the application of one model or the other, the majority of countries offer Universal Healthcare. It might not always be free, but it will be affordable, according to your means. Another important difference in European healthcare, when compared to the USA, is that even the private sector offers very inexpensive insurance plans.

It is no wonder that so many Americans turn to Europe for a life change or for retirement, as being able to have medical care with no major worries on how this will affect your present and future finances poses as a major boost in quality of life. Especially when you know that the healthcare service and staff that you will find are world renowned for their quality.

Residency in Europe: a Great Investment in Health and Quality of Life

With all main European countries having established and very well-prepared universal healthcare systems, as well as affordable private insurance, is no wonder why so many Americans and people from all over the world are keen to move to Europe.

Setting up residency in Europe means enjoying a higher quality of life while also ensuring that your family’s health will be well taken care of without any major financial constraints.

If you are interested in making that move, the Investment Visa team is ready to assist and help you find out what is the best and fastest way to make your investment take you to your life goals. Reach out to us and let us guide you through this process smoothly and seamlessly.