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European healthcare: how does your country rank?

Most healthcare systems in Europe offer a good level of care. But which countries spend the most money on healthcare? Which do well in independent ratings? And which regions have the best life expectancy?

European healthcare: how does your country rank?
Photo: Getty Images

There are significant variations between countries in terms of these factors. If you’re an international resident, knowing a little about these differences could help you better understand the health system in your adopted homeland.

In partnership with international insurance broker ASN, The Local presents a guide to some of the key differences in European healthcare that every expat needs to know.

Hey big (healthcare) spender…

For you, healthcare is all about your well-being and that of your loved ones – something nobody can put a price on. But staying healthy is a priority for everybody. Looked at on a national basis, spending on healthcare is therefore a major topic of debate wherever you live.

Comprehensive global health coverage to fit your life: find out more from ASN

Some governments spend significantly more on healthcare than others. The level of private coverage – and related spending – also varies between European countries.

So, how does your country compare with others in Europe when we look at total healthcare expenditure? France and Germany have the highest spending on healthcare relative to GDP in the EU, according to Eurostat, the statistical office of the European Union.

The figure stood at 11.3 percent in both countries in 2017, with Sweden next (11 percent). However, if we also include European Free Trade Association (EFTA) countries, Switzerland (12.4 percent) ranks as the undisputed leader.

Major countries that spend below the 9.9 percent EU average on healthcare in relation to GDP include the UK (9.6 percent), Spain (8.9 percent) and Italy (8.8 percent). Scroll over the map below to find out how much your country spends.

 
Independent country ratings

The Euro Health Consumer Index (EHCI) has been providing international comparisons for the performance of national healthcare systems since 2005. It looks at 46 indicators, including access to care, treatment outcomes, and the range and reach of services.

So, which countries come out on top? Switzerland ranks first in the latest index, followed by the Netherlands, Norway and Denmark. Countries with small populations dominate the top ten, which also includes Sweden (eighth) and Austria (ninth).

While France and Germany may have topped the European spending list, here they come in 11th and 12th positions. That still puts them ahead of other major nations in Europe such as the UK (16th), Spain (19th) and Italy (20th).

Switzerland has an “excellent, although expensive” system and it was no surprise to see it knocking the previous leader the Netherlands into second position, according to EHCI. The experts who produce the index added that “many countries have inefficient ways to fund and deliver healthcare services” – but lots of Europe’s smaller countries are setting a good example. 

Understanding public provision

The benefits of good health are huge – for you as an individual, your family and your wider community. As a recent OECD report stated: “Healthy people create healthy communities and contribute towards a well-functioning, prosperous and more productive society.”

Living abroad or frequently crossing borders can sometimes place extra strain on you – as well as leading to difficulties in understanding a foreign healthcare system. 

Many European countries have universal public healthcare systems. But this doesn’t always mean every treatment is free at the point of care or accessible immediately, so it’s worth checking your local rules and waiting list times.


Photo: Getty Images

Switzerland’s highly-rated system is based on compulsory insurance and Germany has what is known as a ‘multi-payer’ healthcare system involving a combination of public and private insurance.

Confused yet? If you’re new to a country, you may not even be fully aware of how the relevant national system works.

This is one reason why some busy expats seek out a comprehensive solution such as international health insurance. Whether you live in another country, plan to relocate, or just want private coverage for peace of mind, ASN can offer options to fit your needs. You can get worldwide coverage, ensuring you always have the same level of cover even as you travel between countries.

The many benefits can also include 27-global service, an English-speaking personal advisor, routine or annual check-ups with your preferred doctor, quick access to a second opinion, and treatment with alternative medicine. You can upgrade or downgrade your policy and add or remove benefits – meaning you stay in control of what matters most to you. All of these services are free for ASN customers.

Here’s to a long life

Increasing life expectancy should be celebrated – and it’s risen fast in many European countries this century. Across the EU, life expectancy at birth reached 81 in 2018. Women can still expect to live longer than men (83.7 years versus 78.2) – but men have closed the gap a little in recent years.

Ageing populations are one of the big trends of the 21st century – and as Eurostat itself has pointed out this adds to the pressure on people in work to support services for the elderly through their taxes.

So, where can people expect the greatest longevity? The ten EU regions with the highest life expectancy for women at birth in 2018 were all in just two countries: Spain and France. For men, four of the top five regions were in Italy, with the only exception being Madrid (which also topped the women’s list).

Find out more about what ASN provides, from 24/7 English-speaking customer service to annual checkups with your preferred doctor

 
For members

LIVING IN SWITZERLAND

UPDATE: What are Switzerland’s rules for cannabis consumption?

Switzerland has a complicated set of rules for both medical and recreational cannabis consumption. Here's what you need to know.

UPDATE: What are Switzerland's rules for cannabis consumption?

Long prohibited and seen as a gateway drug with potentially dangerous impacts, countries across the globe have begun legalising cannabis in recent years. 

While the legalisation for medical use has been widespread, there have also been successful legalisation campaigns in several countries. 

The situation in Switzerland is also in flux and has been complicated by a range of recent changes.

Whether referred to as cannabis, marijuana or hemp, Switzerland’s Narcotics Act qualifies it as “a psychoactive substance”, with tetrahydrocannabinol (THC) being its most intoxicating ingredient.

The law specifies that “only THC is controlled under the Narcotics Act. Other active substances like cannabidiol (CBD) are not subject to the Narcotics Act as they do not have comparable psychoactive effects”.

Here’s what you need to know. 

Switzerland has legalised medical marijuana 

As of August 1st, the use of cannabis for medical purposes will be allowed in Switzerland

Patients who are medically prescribed the drug will no longer need to seek exceptional permission from the health ministry, as was the case prior to August 1st. 

Demand for cannabis-based treatments has risen sharply, with the health ministry issuing 3,000 exceptional authorisations in 2019.

The government “intends to facilitate access to cannabis for medical use for patients” and was therefore lifting the ban on its use for that purpose, it said in a statement.

The previous procedure involved “tedious administrative procedures”, said the ministry. “Sick people must be able to access these medicines without excessive bureaucracy.”

As of August 1st, “the decision as to whether a cannabis medicinal product is to be used therapeutically will be made by the doctor together with the patient” the government wrote

The sale and consumption of cannabis for non-medical purposes will remain prohibited.

READ MORE: Switzerland to lift ban on medical use cannabis

The new regulations could benefit thousands of people suffering from severe chronic pain, it added, including those with cancer and multiple sclerosis.

READ ALSO: Why Basel is about to become Switzerland’s marijuana capital

The law change will also mean that the cultivation, processing, manufacture and trade of cannabis for medical use will be subject to the Swissmedic regulatory authority, just as with other narcotics for medical use such as cocaine, methadone and morphine.

Legality of recreational cannabis is determined by the THC

THC of at least 1 percent is generally prohibited in Switzerland and use of products with this (or higher) content may be punishable by a 100-franc fine.

Of course, if someone is determined to smoke it, 100 francs may not be much a deterrent — but that’s a subject for another article.

“By contrast, possession of up to 10g of cannabis for personal use is not considered a criminal offence”, the law states, as long as it is not used by or sold to minors.

Italy's constitutional court has blocked the latest efforts to legalise cannabis.

Photo by Miguel MEDINA / AFP.

And, as with nearly everything else in decentralised Switzerland, “there are still considerable differences between cantons regarding implementation of the fixed penalty procedure”.

However, “cannabis flowers intended for smoking with a high proportion of cannabidiol (CBD) and less than 1 percent THC can be sold and purchased legally”, according to the legislation. 

That’s because, unlike the THC, cannabidiol “does not have a psychoactive effect”.

In other words, low-content THC and CBD will not give the “high” that recreational users seek.

When will Switzerland legalise recreational cannabis?

Currently, small amounts of recreational cannabis are tolerated in Switzerland.

“The decisive factor for classification as a banned drug is how much THC is contained in a cannabis product. If the THC content exceeds one per cent, the product is prohibited. Hashish is prohibited regardless of its THC content.”

As noted by the Swiss government, “If you are caught in possession of a small amount of cannabis (no more than 10 grams) for your own consumption, you will not be fined. In addition, if you supply (but do not sell) up to 10 grams to an adult, e.g. when sharing joints, you will not be fined.”

“If you are caught using cannabis, you may be given a fixed penalty fine of 100 francs.”

In June 2020, the National Council approved a plan to start cannabis trials for recreational use.

The experiments are to be carried out in Switzerland’s larger cities. Basel, Bern, Biel, Geneva and Zurich have all expressed interest in conducting the trials. 

The study seeks to find out how the market for cannabis works – and how to combat the black market. The social effects of legalisation will also be examined. 

At this point, no decisions have been made. However, Swiss authorities have set certain conditions in case recreational use is approved.

The National Council said if cannabis were to be legalised, it must be locally grown in Switzerland – and it must be organic. 

Health Minister Alain Berset noted that legalisation should benefit Swiss farmers even though “very few producers have experience in this area”.

READ MORE: Switzerland backs recreational cannabis trials – with one condition

Can you grow your own cannabis?

In truth, a number of people cultivate marijuana plants on their balconies or in their (secluded) gardens for their own personal use.

As it turns out, the law allows it, as long as it is a variety of the plant that does not have a narcotic effect — that is, the THC content must be less than 1 percent. 

By the same token, cannabis-based products with THC content of below 1 percent can be brought into Switzerland from abroad.

However, the import rules differ depending on the type of product  it is — flowers, seeds, extracts, oils, or other goods.

How much cannabis is consumed in Switzerland each year?

Precise numbers are hard to come by, but according to an article in Le Temps, which based its information on a medical study, about 100 tonnes are consumed in the country annually.

Cannabis remains the largest market in terms of volume: it represents 85 percent of drugs consumed in Switzerland, netting between 340, 000 and 500,000 francs per year.

READ MORE: Drugs and alcohol: Just how much do the Swiss consume?

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