Medicine in Europe operates within the framework of a unified health care system, which is a set of organizations providing health care services in the EU countries. It provides a high level of service, with different models and formats of work in each state, which have common features and differences. In the European Union, public health sectors and private institutions coexist successfully. The main common feature characteristic for all EU countries is the European health insurance, which allows patients to get the necessary help anywhere in the European Union.

The pan-European health care system is built on the principles of accessibility, quality and solidarity, thanks to which medical services are provided at a high level and are accessible to EU citizens, residents and their relatives. Most procedures are covered by public insurance. Non-residents can only receive emergency care. Such services are paid for by health insurance, which must be purchased before entering the EU territory.

The full range of free services is available to EU passport holders. Learn from Relocation Compass international law experts how to obtain a document that gives you free access to quality European medicine in a short period of time.

Overview of medical systems in European countries

Medicine in the EU is based on the work of the European Health System, with funding sources and method of organization varying from country to country. There are several common models by which governments organize health care facilities:

• Beveridge model – the funding of the health care system comes from taxes, so services are provided exclusively by public institutions. This format is used in Scandinavian countries and the UK.
• Bismarck model – the functioning of the system is based on compulsory health insurance, which is financed by payments from employers and employed persons, and the state performs the function of regulation and control. This format is the most common in the EU and is actively used in France, Belgium and Germany.
• Mixed models – an amalgamation of the two previous formats, in which often the state obliges citizens to have basic health insurance, but for a wider range of services citizens can independently take out an additional policy.

Public healthcare

The main goal of the public sector is to provide services at the highest possible level, with medical care available to all citizens and foreigners. Since states utilize different models of how health care systems operate, let’s look at several formats of operation in countries such as Germany, France, Spain, Italy, Slovenia, Romania, and Bulgaria:

• Germany.
  A system of compulsory health insurance is in place to cover most treatment and diagnostic costs, with citizens free to choose their own insurer. Services are partially paid for by the patient, with a minimal share of the cost covered. Citizens have the right to choose their clinic and family doctor. Medicine in Germany is considered to be of the highest quality and meets high international standards.
• France.
  Health care works according to a mixed scheme, which implies compulsory state and voluntary private insurance. Basic services in medical institutions are provided free of charge at the expense of state insurance, and additional services are provided through the policy of private companies. The state finances the services through contributions from employers and employed persons; when paying for the services, the patient covers part of the cost himself, but the policy includes visits to the doctor, purchase of medicines and hospitalization. Patients can choose their clinic and family doctor.
• Spain.
  Free medicine is realized in public institutions in Spain. Financing is carried out at the expense of taxes. The peculiarity of the Spanish health care system is its decentralized nature, in which autonomous management is independently engaged in each region of the country. Medical services on a free basis can be received by all citizens and residents of Spain, according to the social insurance card (tarjeta sanitaria). The health care system in Spain has three levels – family medicine, highly specialized treatment and hospitalization.
• Italy.
  Health care is financed by the state through taxes and employer contributions. The system is decentralized – each region manages health care independently. Medical services are provided to citizens and residents on a free basis, for which it is necessary to be registered in the health department ASL (Azienda sanitaria locale) and receive a medical card. The state system of medical services is multilevel and includes primary care by a family doctor, highly specialized treatment and hospitalization.
• Slovenia.
  The principle of solidarity, according to which all citizens have the right to receive doctor’s services free of charge, is the basis for the construction and operation of health care services. Public health care is financed by compulsory insurance, and the system is decentralized, which makes it possible to take into account the needs of the population and develop the most important areas of medical services. It is easier to get to a doctor’s appointment in Slovenia than in other EU countries.
• Romania.
  The basic package of medical services is provided in state hospitals at the expense of the country, and additional services can be obtained in private clinics. The health care system in Romania is currently in the process of modernization and active development, which began with the country’s accession to the European Union. Medical services at the basic level are covered by compulsory insurance. For treatment or diagnosis of complex diseases in the field of cardiology and oncology, many patients come to clinics in Bucharest, including from abroad.
• Bulgaria.
  The health care system is financed by the state from the contributions of the employed population. It is important to note that the quality of care differs significantly depending on the region of the country.

All systems in the listed countries have some common features:

• EHIC (European Health Insurance Card) allows you to receive care in any EU country, but only EU citizens and residents can apply for it;
• state regulation of quality standards, costs and tariffs for services;
• compulsory health insurance for the population;
• social orientation to guarantee equal access to medical services for all citizens, regardless of their income and position in society;
• multilevel structure of the system, which implies provision of primary care by a family doctor, highly specialized treatment and hospitalization.

Health insurance is necessary for foreigners who plan to stay in the EU for a long period of time. As a rule, the policy should cover medical expenses from 30 000 EUR.

Private medicine

Private medicine in European countries is a very important sector, complementing and expanding the capabilities of public hospitals and clinics. The main features of the functioning of the system of private clinics are:

• standards of care are higher, from quick appointments to the provision of a wide range of specialized care;
• financing is provided directly through patient payments and supplementary insurance policies;
• private clinics have a much broader range of options, including exclusive modern technologies and individualized patient care;
• access to services is available only to those who have private insurance or can pay for services.

Private medicine is very well developed in Germany, France and Spain. The population of these countries prefers specialized clinics, as the level of service and medical equipment used is much higher than in state clinics. Residents of Italy use the services of private clinics, as a rule, in order not to wait in queues and to get to a doctor’s appointment faster. In Romania, Slovenia and Bulgaria, the private sector is still developing, while the public system remains the main one, showing success in diagnosing and treating complex diseases, including neurology and neurosurgical procedures.

Health insurance

European medicine is considered to be one of the best in the world due to the great attention from the governments and the well-functioning system of compulsory insurance of the population. Foreigners who work in the EU on a contractual basis or who are studying in one of its member states must have a European Health Insurance Card (EHIC). This card is issued free of charge by the insurance company together with the policy (printed on the back of the insurance) and entitles you to receive public health services in public institutions under the same conditions as insured citizens of the EU country you are in.

The EHIC covers the costs of health care services to be provided to non-residents in order to extend their stay in the EU and the Schengen area until their planned departure. For example, a tourist who comes on vacation for a week and breaks his arm can expect to have surgery. A student who has to stay in the country for 6 months according to a residence permit, in a similar case, will have an operation and all necessary procedures, including physiotherapy.

The EHIC has some peculiarities, for example, it is not a substitute for travel insurance. It does not cover expenses if you are traveling for medical treatment and is issued only for the period of validity of your residence permit (or indefinitely for EU passport holders). For comparison, let’s look at the conditions of public and private policies in different EU countries:

• Germany.
  There are two types of health insurance in the country – state GKV (Gesetzliche Krankenversicherung) and private PKV (Private Krankenversicherung). According to the state program, the financing of policies is made from the contributions of employers and insured citizens. The cost of consultations, medication, hospitalization and some dental services are covered. Private insurance is quite expensive, but may include accommodation in an individual ward, extensive diagnostic facilities and priority in specialist care. Foreigners often come to the oncology, cardiology and neurology departments of the Charité Clinic – Universitätsmedizin in Berlin for treatment, due to the institution’s good reputation.
• France.
  French citizens are required to have a public health insurance policy Assurance Maladie, but may also have additional Mutuelle insurance from a private company. The basic policy covers most services such as doctor visits, medicines and hospitalization. The private insurance may include dentistry, opticians and some types of medicines. The principle of co-financing is used to calculate the payment for services – the patient pays part of the bill himself (ticket moderateur), and the insurance covers the other part of the payment. Hôpital Européen Georges-Pompidou (Paris) is considered one of the best clinics in the country. It specializes in treatment of cardiological and oncological diseases, as well as neurosurgery.
• Spain.
  Private health insurance in Spain is quite popular among the population, as such a policy allows you to get to the appointment with the necessary specialist much faster. Also, citizens take out additional insurance to get access to a wider range of medical services, the cost of which is not covered by the state, such as dentistry, optics and cosmetology. For surgical procedures and transplants, foreigners often come to Hospital Clinic de Barcelona.
• Italy.
  Public insurance allows you to get first aid from a family doctor and referral to a specialist, and covers hospitalization costs in case of need. Citizens can also purchase a health insurance policy from a private company at their own discretion. The disadvantage of such a policy is its high cost. One of the best clinics in the country in terms of treatment of heart problems, transplants and neurosurgery is Ospedale San Raffaele, located in Milan.
• Slovenia.
  Health insurance in Slovenia is compulsory for everyone, with pensioners and other vulnerable categories of the population receiving the necessary assistance through monthly contributions from pension payments. Insurance payments are made by the employed and employers. The state policy traditionally covers only basic services, but most people in the country take out supplementary insurance to get a more comprehensive reimbursement. Bežigrad Medical Centre, a popular clinic among patients, is located in Ljubljana, specializing in various types of diagnostics, dentistry and plastic surgery.
• Romania.
  Health insurance in Romania is compulsory for employed citizens, but it only covers basic care needs. It is possible to take out additional insurance and receive services in private clinics. Clinics of cardiology and neurosurgery – Clinica de Cardiologie “Prof. Dr. C. C.” are considered the best in Romania. C. Iliescu and Spitalul Universitar de Urgență București, located in Bucharest.
• Bulgaria.
  Public insurance covers check-ups and diagnostics by a family doctor, appointments with a specialist and hospitalization. A private policy allows you to receive more services in laboratories and hospitals, to undergo any kind of diagnostics on modern equipment. Such insurance is quite expensive, but it significantly reduces the waiting time for visits to doctors. Without additional insurance, medical care is quite expensive, especially in private clinics. Foreigners often come to the Bulgarian Institute of Oncology, located in Sofia, for cancer diagnosis and treatment.

Cost of medical services in Europe

Prices for medical treatment in Europe depend on many factors, including, for example, the need for emergency care or a doctor’s home visit. A doctor’s visit outside of normal working hours is also charged at a higher rate, and all EU countries have a system of payment for kilometers when a doctor has to travel far to your home. Also, sometimes the service may cost more due to additional fees, for example, for more time spent at the doctor’s consultation.

Prices at private clinics are discussed below. Getting a consultation at a doctor’s office costs on average 13 EUR in Germany to 48 EUR in Spain, and for a visit to the patient’s home you have to pay from 25 to 56 EUR (additional fees for transportation costs may apply). Emergency care is cheapest in France – 25 EUR, most expensive in Romania – 160 EUR.

Vaccination with most drugs is also usually covered by health insurance, vaccination in a private clinic costs from 5 to 10 EUR on average. If it is necessary to have an MRI scan, for example of the knee joint, you have to pay from 85 to 280 EUR. Outpatient surgery in the majority of EU countries is quite expensive, thus hernia surgery will cost 1 500-3 000 EUR, the price depends on the complexity of the situation and the method of the procedure.

Citizens of the EU countries significantly save on medical care thanks to the unified health insurance. This policy allows you to get the necessary assistance in any EU state, the monthly cost of insurance starts from 51 EUR and can be higher depending on the age and presence of chronic diseases. Also, the price of the policy may increase significantly due to the inclusion of additional services, such as nursing care or dental care.

For residents of non-EU countries, health insurance is usually compulsory to enter the territory of the association. Usually, insurance companies provide tariff packages for trips of 30 to 90 days or a pay-per-day format for stays in the European Union or Schengen area. The tariff for 30 days is about 20 EUR, the daily fee varies between 1.19-1.70 EUR. Dental services are covered by insurance within 500 EUR.

How to get medical care in Europe

Both EU citizens and non-residents can receive medical care in Europe, and the system of care is slightly different. Passport holders of the countries and residents of the association have the European Health Insurance Card, which entitles them to cover the costs of care in medical institutions included in the unified European system.

Citizens of countries not included in the EU are entitled to receive medical services by insurance or at their own expense. Foreigners can receive treatment in public and private clinics, but before visiting a doctor it is important to check whether your policy can be used to cover the costs. The procedure for non-residents to apply to a medical institution or a particular doctor is as follows:

1. Making an appointment at the clinic reception, by phone or online.
2. Arrival at the doctor’s office (you need to show your health insurance policy and ID card).
3. Consultation with a general practitioner who, if necessary, will write a prescription for medication or issue a referral to a subspecialist.

If you are planning a trip to one of the European countries to receive medical services, it is important to take care in advance of choosing a clinic and a specialist with whom to make a treatment plan. This way, you will have information about the length of stay abroad and the cost of the course. Some clinics may request a deposit, after which they will issue you an invitation for a visit, which will allow you to issue a medical visa.

Peculiarities of medical care for foreigners

During their stay on the territory of the EU, foreigners must have a health insurance policy, which should be issued before traveling. In case of need for emergency assistance, you should contact the single telephone line 112. It should be remembered that calling an ambulance in Europe is possible only in cases of critical condition, such as severe bleeding, loss of consciousness, acute pain or heart attack. The work of the first aid team as well as medication in such cases is covered by insurance up to the amount of the policy.

Quality of medical care in Europe

According to the World Health Organization, the highest level of medicine from year to year remains in Switzerland, Germany, France, Holland, Norway, Austria and Sweden. For an objective assessment during the formation of the rating, such indicators as equal access to medicine for all segments of the population, quality of services, waiting time for treatment, life expectancy of the population, as well as the cost of providing health care as a percentage of GDP are taken into account.

There is another indicative rating of Numbeo resource, the positions in which are distributed in accordance with the analysis of qualification of medical personnel, technological equipment, the scale of public funding, as well as the development of the infrastructure of the health care system. According to the rating, the top 10 European countries with the best medicine include:

• Netherlands;
• Spain;
• Austria;
• Belgium;
• Finland;
• Portugal;
• United Kingdom;
• Norway;
• France;
• Germany. 

The innovation and rapid development of European medicine has been made possible by several organizations. The Innovation Health Initiative is a public-private association that funds medical research and the introduction of new protocols in the treatment process. Funds are mainly distributed between the fields of pharmaceuticals, medical industry and biotechnology.

A separate role in the distribution and licensing of medical products is played by the European Medicines Agency, which closely cooperates with the European Commission. The main task of the organization is to support innovations in the field of drug development and related technologies.

The European Union itself has created the main program for financing research and implementation of the latest technologies called Horizon Europe, the budget for which is 95.5 billion EUR for 2021-2027. Within the framework of the health cluster of the program drug development, reduction of health risks and increase of economic efficiency of building and development of public health care are carried out.

The basis of high-quality medicine and innovation is the training of specialists, therefore there are several programs dedicated to doctoral education and further specialized training, e.g., Marie Skłodowska-Curie Action (MSCA).

Access to specialized services and subspecialists in Europe is often complicated by long waiting times for an appointment. Therefore, many Europeans prefer to receive care in private clinics with additional insurance or by paying the bills themselves. The biggest gap in the quality and speed of medical care is still between large cities and small towns. The main problems in small towns and villages are:

• shortage of health workers, most of whom are interested in better-paid positions in large public or private clinics;
• shrinking and aging populations in rural areas, as younger populations increasingly choose to live in urban areas;
• limitations in access to subspecialists due to their concentration in urban medical centers;
• the cost of services in rural areas is an order of magnitude higher than in urban areas because the population is more dispersed.

Foreigners most often come to European countries to receive medical services for diagnosis of complex diseases and surgical interventions, treatment of cancer, as well as cosmetic procedures and prosthetics. Having a passport of a citizen of the European Union, all these services will be provided at a high level, and you will have access to all medical facilities located on the territory of the association. It is also important to remember that European health insurance will help you get the necessary help much cheaper, and sometimes free of charge.

Drug supply and pharmacies

Circulation of medicines on the territory of Europe is controlled by national regulatory bodies based on the recommendations of the European Medical Agency and the European Commission. The basis of the regulatory system is to ensure the safety and efficacy of medicines, which is why in Europe you can buy potent medicines only with a prescription, in general, this is the majority of pharmaceutical products. Some painkillers, antipyretics and cold medicines are available in pharmacies without a prescription.

The dispensing of medicines in pharmacies is also influenced by the legislation of each individual country and European directives that set minimum required quality standards for pharmaceutical products. At the moment, many European countries are introducing a system of electronic prescriptions, which allow to simplify and speed up the process of treatment, as well as facilitate access to the necessary medicines for patients.

Online pharmacies are becoming increasingly popular in Europe, which not only sell and deliver the necessary goods, but also provide advice on the use of medicines. The activities of online pharmacies are strictly regulated by licensing, quality control and safety of delivery methods (especially temperature control), as well as mandatory protection of customer privacy.

Advantages and disadvantages of medical care in Europe

Like any other aspect of life in Europe, medical care has a number of pros and cons. Among the main advantages that contribute to the influx of foreigners to undergo treatment and rehabilitation in European facilities are:

• high level of service;
• modern methods of treatment and introduction of innovative technologies;
• access to medical assistance of highly qualified specialists.

At the same time, European medicine has some disadvantages and imperfections in the system. The main and most popular disadvantages of service in medical institutions in Europe are:

• long queues for appointments with family doctors and subspecialists;
• high cost of services outside of insurance conditions.

You can get access to all the advantages and opportunities of European medicine much faster and easier by obtaining a passport of one of the EU countries. As a citizen of the association, you will be able to receive medical treatment anywhere in the association, in public and private institutions, while using a European insurance policy. You can acquire EU citizenship thanks to simplified migration programs, which allow you to obtain the status in a short period of time. You can learn more about the available legalization options during a free consultation with the Relocation Compass company’s specialists.