Health insurance in Europe

European countries are united by many things, from common values to currency. It may seem that the medical system in the European Union is also the same. To the surprise of many foreigners looking to buy EU insurance, this is not the case. Each country is responsible for the health of its citizens independently.

In this article, we will talk about how health insurance works in Europe, and how this issue is regulated in individual countries.

How European Insurance Works

Each country has its own way of organizing the insurance system and medical care. They are united only by the desire to ensure that everyone has access to basic services.

In most European countries, compulsory health care is based on one of the following models:

• The Bismarck model was developed in Germany. It is financed by contributions from employees and employers. This scheme is common in Germany, Austria, Switzerland and the Czech Republic.
• Beveridge’s model was created in the UK. Healthcare is financed from the state budget at the expense of taxes from enterprises and the population. In addition to the United Kingdom, this model works in Italy, Spain, Portugal, Denmark, Sweden, Norway, etc.
• A hybrid option that combines elements of the two above.

The main element of the Bismarckian system is insurance payments, which are tied to wages. The amount of contributions paid by both the employer and the employee is 13-15% of the salary. But the proportion differs from country to country. In Germany, it is 50-50, in the Czech Republic, two-thirds is paid by the employer, a third by the employee, and in France, the employer transfers almost 96% of the insurance premium.

Medical care is paid for by funds, to which contributions are received. They can be privately or publicly operated. All residents, including the poor, the elderly and the disabled, are provided with the same set of services. In the Czech Republic, the state pays contributions for the unemployed, pensioners, children, students (up to 26 years old) and a number of other categories of citizens. In France, the SMS system covers almost 100% of the population.

In the Beveridge model, medicine is financed not by insurance premiums, but by taxation. It makes it possible to provide subsidies to low-wage earners, the unemployed and pensioners. However, in this model, there is less opportunity to choose a medical institution, which can lead to queues for certain types of medical services.

In addition, in this model, there are both insurance principles and co-payments of the population. For example, in the UK, 80% of costs are covered by taxation, 12% by public insurance, and 8% by patient co-payments.

Despite adherence to one or another model of organization of health care for the population, at present almost no country applies the chosen system in its pure form. More often than not, European states borrow working elements of another health care system to improve their own.

In which European countries is free medicine?

First of all, let’s figure out what is meant by this. Almost all citizens of EU countries have health insurance from birth, which means that medical services received free of charge are paid for at the expense of insurance funds. Thus, by free medicine we can consider those services for which the European does not pay directly at the time of their provision.

A foreigner can also receive medical services free of charge in Europe if he is here legally. In this case, he has insurance contributions, which means that medical care will be provided at the expense of these funds.

It is no coincidence that when obtaining a visa (tourist, student, employment, etc.), you need to provide insurance, the same when applying for a residence permit. That is, any legal status of staying in a European country provides for a certain amount of guaranteed medical care. Of course, it is different for a tourist and a resident.

For example, insurance requirements for traveling to Europe, in particular to Schengen countriesFollowing:

• the minimum amount of insurance coverage is 30 thousand euros;
• valid throughout the territory of the Schengen countries;
• the policy must be without a deductible;
• Valid for the entire period of stay in the country + 15 days.

This insurance includes:

• necessary inpatient and outpatient treatment according to the doctor’s indications;
• ambulance services in case of emergency;
• the cost of medicines and dressings;
• a visit from a relative, if the period of hospitalization is 10 days or more;
• possible medical repatriation.

Health insurance for a residence permit must generally be valid for a year. The cost of the policy depends on the reason for moving (for example, student insurance is cheaper), as well as the country of destination.

Where is the best insurance in the EU

According to World Population Review, for the first quarter of 2023, the top 5 European countries with the best healthcare system are as follows:

• Denmark
• Austria
• France
• Spain
• Belgium

Also in the top 10 are the United Kingdom and Germany.

Health insurance in EU countries

Country	Financing	Users	Registration (documents)	Features
Austria	The health care system is financed from the budget, which is replenished by insurance contributions. Very little at the expense of private funds. There are no polyclinics, there are offices of practicing doctors. All of them are registered in the state register.	Austrian citizens, foreigners with residence permits, permanent residence and even tourists are entitled to free medical care.	Registration takes place automatically when applying for a job. Self-employed people are insured when obtaining a business license. The insured receive an electronic card.	The social insurance of working citizens includes dental services, surgeries, etc.
Germany	It is financed by employer and employee contributions. Just like in Austria, there are separate doctors’ offices, in fact, these are family doctors who issue referrals to other specialists.	German citizens, foreigners legally residing in the country.	In order to be entitled to health care, you must register with your local authority (Einwohnermeldeamt) and obtain a social security number. The insurance company issues a Krankenversichertenkarte card, which must be taken with you when visiting doctors.	Payment comes from the health insurance funds, which are formed by contributions. Massage therapists and physiotherapists are charged separately. They are free for children.
Poland	It is financed by the employee’s contributions + part from the state budget. There are polyclinics to which you can be attached at your place of residence.	Citizens, foreigners with a residence permit, permanent residence and other legal statuses.	Identity card, PESEL, extract from ZUS ZUA (made by an accountant at the company), application (can be obtained at the clinic).	A working family member can include all dependents who live with him in his insurance and payments for them will be withheld from his salary. Contributions for the unemployed are paid by the Employment Centre.
Italy	It is financed from income tax + additional transfers from the state budget.	Citizens and foreigners with legal status.	Identity document; a valid residence permit in Italy (Permesso di soggiorno); tax number (Codice fiscale); Certificate of registration (Certificato di residenza).	The insurance includes general medical consultations, pediatrics, gynecology, dentistry, medicines.
France	The state covers 75% of the costs of health care + insurance system.	The services are available to all citizens of the country and foreigners with a residence permit, permanent residence.	The employer registers the employees with the Social Insurance Fund, after which they register themselves in the health care system. The self-employed apply to the Regime Social des Indépendants, RSI. Documents: passport, residence permit/permanent residence, proof of residential address, certificate of income, information about marital status and children. Upon registration, a health insurance carte vitale is issued.	In international institutions, first aid is free of charge. The fee for a public hospital is no more than 10%.
United Kingdom	95% of medical institutions are owned by the state. There are clinics in your community where you can register.	The services are available to citizens of the country and foreigners with a residence permit, permanent residence.	Fill out an application at the clinic at your place of residence. Documents: passport, proof of address and legal status in the country. A card with an NHS number will be sent to the mail.	Medical services are free of charge, without an ophthalmologist and dentist (except for women during pregnancy and a few months after childbirth). Calling an ambulance is free of charge. Emergency treatment is subject to a fee.

EHIC Card

The EHIC (European Health Insurance Card) is a document that is obtained in addition to an existing insurance policy in Europe. If the owner, while abroad, needs urgent assistance, the services will be provided free of charge and at the same level as for citizens of this country.

The map has many limitations. For example, the owner doesn’t choose which services are covered—they can only be used for emergency care. For example, if a person travels to another country to receive treatment, the EHIC cannot be used.

The EHIC card is in no way a substitute for travel or health insurance in Europe! It does not cover private medical care. And be careful: services that are received free of charge under the EHIC in one country may turn out to be paid in another.

The EHIC card is issued by the national health insurance company. You can get it if a person is a full-fledged resident of the country or has local (not travel) insurance. This also applies to migrants. EHIC is issued for free – don’t believe the sites that charge money for it.

Health insurance in the EU for migrants

As we have already mentioned, medical care for migrants in any EU country is essentially the same as for citizens, provided that the foreigner is there legally.

Refugees, the unemployed and other categories of the population also receive medical care, but this is usually done through special funds, special status or through the Employment Service.

Nevertheless, assistance can also be provided to illegal immigrants. First of all, this applies to children and pregnant women. Foreigners can also take advantage of free vaccination and treatment of infectious diseases.

European Children’s Insurance

In most EU countries, children’s health care is considered a priority, and the state strives to ensure that these services are accessible to all children without exception. Therefore, even if only one parent works, their insurance often covers the child as well. In some countries, even this is not mandatory, and children are automatically included in the public health system.

Terms and conditions of children’s insurance in the EU

Country	Insurance for children of migrant workers
Austria	Together with parents, at no extra charges.
Cyprus	Children under the age of 26 are enrolled in the general health care system (GESY).
Czechia	Private medical for foreigners with limited coverage, similar to tourist.
Estonia	Up to 19 years of age with a parent at no extra charge.
Finland	Included in the state program without additional payments.
France	Up to the age of 18 are insured together with their parents.
Germany	Insured together with parents.
Ireland	Up to 6 years old — free of charge. After the age of 6 – together with parents.
Italy	Together with parents at SNN, young children, patients with chronic diseases are served free of charge.
Latvia	Registered in the state system, without additional payments.
Lithuania	Children under the age of 18 are free of charge from the state.
Poland	Together with parents, free of charge.
Portugal	Together with parents, free of charge.
Slovakia	Up to the age of 15 is free of charge in the public health system, up to the age of 26 is free if studying.
Spain	Together with parents, free of charge.
Sweden	Up to the age of 18 are served free of charge by the state.

In conclusion, it should be noted that taking care of the health of citizens is one of the priority areas of activity for European countries. And for the most part, they succeed in showing it at a fairly good level.

Of course, for foreigners, understanding and learning how to properly use the medical services provided may be unusual and uncomfortable at first. But adaptation should be more relaxed if we accept the existing conditions as a given and adapt to them as necessary. We hope that our article will help with this at least partially.