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Health care quality in Europe and Scandinavia: Italy, France, Germany, Sweden, Norway, Denmark, the UK and Norway

We all want access to good health care. Whether it’s preventative measures such as immunisation, the management of ongoing conditions, or critical illness and emergency treatment, everyone wants the reassurance that their mental and physical well-being is in safe hands.

Health care in Europe and Scandinavia

The region is home to some of the best and most established health care systems in the world. Public, universal provision is the norm and standards are generally very high on a global scale but there is a booming private sector catering for those who want extra comforts, choice, and shorter waiting times. As such, many employers provide health insurance for their international personnel. Different rules apply to accessing treatment and emergency services in each country, but EU citizens use their European Health Insurance Card (EHIC) to access emergency treatment within the EU, while those from outside the region will need to consider private health insurance.

Southern Europe

Italy

Centrally financed, Italy’s public health care system is managed regionally, so standards of care may vary and the best care is likely to be found in the north and centre of the country, in cities such as Milan and Rome. Health care is free for those who qualify. EU nationals can initially use EHIC, which will cover treatment in an emergency, but it doesn’t cover on-going care or repatriation, so separate private medical insurance is worth thinking about. All foreign nationals with confirmed residency can apply for a SSN card (Servizio Sanitario Nazionale), this includes a fairly comprehensive level of care from initial general practitioner (GP, also known as a family doctor) consultation to inpatient (for those requiring admission to hospital for treatment) treatment.

The private health care sector is a very popular option in Italy. For more choice, shorter waiting times, and more comfortable surroundings, many citizens choose to use private facilities but these can be expensive, so private medical insurance is worth considering — as it is for those who don’t qualify for the public system. You can find hospitals with English-speaking staff and potentially those catering for other languages, if you do a little research.

With 3.7 doctors per 1,000 inhabitants, Italy has one of the highest ratios in the world, in line with much of Europe. It spends a very healthy 9.3% of its GDP on health care and as a result ranks well for performance according to the World Health Organization.

Spain

Spain has an excellent health care system, being rated in 7th place by World Health Organization (WHO) in the World health report published in 2000, and it has a very high ratio of doctors to population (nearly 5 per 1000 people). Recent austerity measures have adversely affected nursing levels and waiting times, but public health care spending is currently at 7% of GDP, which is lower than the European average — still very well-funded compared to other areas of the world. A recent move to decentralise care into 17 regions with their own budgets means care can vary between areas.

A national health service provides treatment for free at point of access for those who are:

  • resident with access to the Convenio Especial scheme
  • holders of an EHIC, from a country with a reciprocal health agreement
  • member of the national insurance scheme

Otherwise, you will need to pay for care. 

Germany

Germany enjoys a high standard of health care. Ranked in 25th place by WHO’s league table for health care effectiveness, it’s funded by 11.3% of the country’s GDP. The country has 2,000 hospitals: half are public, the rest being profit and not-for profit private sector establishments staffed by an excellent ratio of 3.4 doctors per 1,000 inhabitants.

Purchasing medical insurance has been compulsory in the country for some time and this can be done in two ways:

  • public insurance which is processed through your employer
  • private medical insurance, which offers a higher level of care

Treatment is free at point of access but without adequate insurance, heavy bills could follow.

Scandinavia

Denmark

The public health care system has a reputation for excellent standards and is ranked as 34th in the world by the World Health Organization. Spread across a peninsula and 70 inhabited islands, the country offers free universal treatment to all its citizens. EU residents are entitled to free emergency care if they can produce their European Health Insurance Card — and once registered as Danish citizens — all foreign nationals have access to the public system.

Despite the high level of health care provision available, the private sector has seen some growth in recent years, giving patients shorter waiting times and more choice between physicians and facilities. English is taught in schools, so finding medical staff who speak the language shouldn’t be a problem. For expats who don’t have a strong grasp of English and with other languages as their native tongue, it may be worthwhile taking along someone who can translate. Denmark spends 10.8% of its GDP on its health care system, putting it in one of the highest brackets in the world and care is delivered by a high ratio of doctors (3.5 per 1,000 people).

Norway

Ranked as 11th in the world by the World Health Organization, Norway has one of the best health care systems in the world. Facilities such as the bright, intelligently designed Rikshospitalet University Hospital in Oslo demonstrate the country’s holistic and engaged approach to medicine, and English is widely spoken.

Public provision is supported by government subsidy and the National Insurance Scheme (NIS), which everyone living and working in Norway must contribute to though their wage packet. Visits to the doctor will incur a small charge but this is annually capped for individuals. Certain services such as dentistry, specialists, and radiology also have to be funded by the patient. With these things in mind, and the fact that some Norwegians are choosing to skip the queues and use the popular private health care sector, it can be beneficial to arrange adequate private medical insurance.

Sweden

The standard of health care in Sweden is excellent, being ranked as no. 23 in the world by the World Health Organization. EU-nationals are covered for emergency treatment if they can produce an EHIC but once registered, any resident is entitled to care under the public system, regardless of their country of origin. Non-EU foreign nationals without resident status will need to consider comprehensive private medical insurance. The public scheme, subsidised by the government but managed at local level, charges a nominal fee to patients. Certain groups, such as people under 20, get free care.

In comparison with other countries, waiting time targets are very reasonable: same day consultation with a health professional and a doctor’s appointment in seven days. A specialist consultation should take place within 90 days, and no more than 90 days beyond that, for an operation or treatment. There is a private sector, but with the quality of public care available most Swedes don’t feel they need to use it. With nearly 4 doctors per 1,000 inhabitants, the country invests a very generous 11.9% of its GDP in health care, and it shows.

UK

Ranked at number 18 on WHO’s league table of the world’s best health systems of 191 countries around the world, the UK’s National Health Service (NHS) provides care at point of access, without charge. It’s not free care, however, and non-EU foreign nationals who do not qualify may find themselves being billed by the hospital after treatment. The public system is funded through the compulsory contributions of its national insurance scheme but has seen considerable strain on finances, infrastructure and staff over recent years.

The country as a whole spends only just above the global average of 9.1% of the GDP on health care (around the same as Spain and Iceland). With nearly 3 doctors per 1,000 inhabitants, it is well staffed but the system’s structure of regional trusts means that there can be wide differences in levels of care. Dental, eye care, and prescriptions are only available for free for certain groups. Add this to long waiting times for operations and elective surgery, it’s little wonder that private medical insurance for and treatment through the UK’s excellent private hospital system is such an attractive option.

France

With the highest-ranking health care system in the world (according to WHO), there are over 1,000 excellent hospitals, specialist clinics and treatment centres across the country, staffed by a good proportion of a little over 3 doctors per 1,000 inhabitants (comparable with countries like the Netherlands and Australia). The nation spends a generous 11.5% of GDP on health, and access to treatment is through private and state-administered insurance schemes. The public programme, which lacks the long waiting list culture of some other comparable countries such as the UK and Canada, is of an excellent standard and is paid for through the wage packet of nationals and reciprocal arrangements with other EU nations. The downside is that you will have to pay for many treatments up front (out-of-pocket), claiming reimbursement from the state insurance company for up to 70% of the cost. For this reason, many nationals and expats alike opt for top up private medical insurance for security and a more comprehensive level of cover.

If you’re planning to move or travel overseas and need more information on private health care insurance for a specific country, get in touch with one of our expert sales consultants today.

A world view

According to the World Health Organization, good health care provision relies on the availability of well-maintained and equipped facilities, well-trained and paid staff, infrastructure and information and, to underpin all of these things, a reliable source of adequate funding.

There are countries in the world that provide excellent universal health care for their citizens. Financed through both public and private schemes, their performance is measured in outcomes such as: life expectancy, infant mortality and the management of communicable (e.g. HIV/AIDS) and noncommunicable (e.g. diabetes) conditions.

In other areas where there are problems like a lack of public money and poor infrastructure, access to adequate health care can be difficult. Geography may pose a problem, with remote and rural areas having very little or no medical facilities.

If you’re moving overseas

For anyone considering a move to another country to live and work, it can be worthwhile doing some detailed research on the health care system.

You will need to find out:

  • Where are the best hospitals?
  • What access do foreign nationals have to universal health care?
  • What standard of facilities and personnel are available?

And what about insurance? In most cases, this will be compulsory but, in order to ensure your health and safety, what level of cover will you need? Consider whether you might need:

  • Access to a General Practitioner
  • Inpatient and outpatient care
  • Specialist treatment for on-going care and emergency health care provision
  • Evacuation or repatriation if the treatment you need isn’t available locally

Choosing the right health care insurance provider can make all the difference. Established systems, networks and relationships create the operational core of a company like Aetna International. For more information, please contact an expert sales consultant in your area.

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