Household Out-of-Pocket Health Payments Across the EU

Key Takeaways

• Households across the EU pay an average of 14.9% of total health costs out of pocket, but this figure conceals a gap from 8.8% in Luxembourg to 35.5% in Bulgaria.
• Bulgaria, Latvia, and Greece record the highest household burden in the EU. Households in these three countries directly cover more than a third of all health costs.
• France and Luxembourg sit below 9%. Both run compulsory health insurance systems that cover a broad range of services, including medicines and primary care.
• High absolute spending does not equal a high household share. Belgian households pay 983 PPS per person, among the highest in the EU, yet cover only 21.5% of total health costs.
• Countries with the highest household shares tend to have limited public coverage for outpatient medicines, dental care, and diagnostics. Households fill those gaps directly.
• The divide tracks closely with the strength of compulsory public coverage. Eighteen of 27 EU member states sit at least 3 percentage points above or below the EU average.

EU Countries by Household Out-of-Pocket Health Costs

Stay tuned!

Learn something new about Germany every week and make informed decisions with confidence.

Stay tuned!

Learn something new about Germany every week and make informed decisions with confidence.

In most EU countries, healthcare is not entirely free. Even within systems that have public coverage, patients often pay part of the bill themselves. These direct payments are called out-of-pocket costs. They include things like co-payments at the doctor’s office, medicines not covered by insurance, dental visits, and diagnostic tests.

Across the EU, households cover 14.9% of total health costs this way. Public health systems and other financing schemes pay the remaining 85%. But that 14.9% does not apply evenly. In Bulgaria, households pay 35.5% of total health costs directly. In Luxembourg, they pay 8.8%. The difference is how much each system absorbs.

Households Bear More Than a Third of All Health Costs In Bulgaria, Latvia, and Greece,

Three countries rank above 34% of total health expenditure paid out of pocket. All three have public health systems that cover a smaller share of total health costs than the EU average.

• In Bulgaria, household out-of-pocket payments account for 35.5% of total health expenditure.
• Latvia ranks second at 35.1%.
• Greece sits at 34.3%.

The reasons trace to structural gaps. After the fall of communism, Central and Eastern European countries moved away from state-financed healthcare. Coverage gaps opened for outpatient medicines, dental care, and diagnostic tests. Households began filling them directly. Those gaps have not fully closed. A similar dynamic applies to Greece. Coverage for several categories of care remains limited compared to Western European systems.

Household out-of-pocket payments per person do not tell the same story. Bulgarian households pay 736 PPS per person. German households pay 598 PPS. But those 736 PPS represent 35.5% of Bulgaria’s total health expenditure. Germany’s 598 PPS represent just 11.1%. The burden is not the amount households pay. It is the share of total health costs that the public system fails to absorb.

France and Luxembourg Record the Lowest Household Out-of-Pocket Shares in the EU

France sits at 9.3%. Luxembourg sits at 8.8%. Both run compulsory health insurance systems. These cover a broad range of services, including hospital care, primary care, and prescribed medicines.

In Luxembourg, the majority of total health expenditure comes from compulsory insurance and the state. User charges exist for most services. Comprehensive benefit packages keep direct household costs low.

System-Level Divide in Out-of-Pocket Payments for Healthcare Costs

The EU average of household out-of-pocket health costs does not describe any single country’s experience. The divide maps closely onto the strength of compulsory public coverage.

Four countries cluster well below the EU average: France, Luxembourg, Germany, and the Netherlands. In all four, government and insurance schemes absorb a large share of health costs. Countries with thinner public benefit packages sit well above it.

For households in Bulgaria or Latvia, the practical effect is direct. A larger share of the bill for medicines, specialist visits, dental work, and diagnostics lands on the household. The public system covers less of it.