| Abstract [eng] |
Ensuring the long-term sustainability of public health systems requires not only institutional reforms but also robust, equitable financing. This has become particularly urgent amid accelerating demographic aging, rising costs of healthcare delivery, and recurrent global crises such as the COVID-19 pandemic. The war in Ukraine has further highlighted the vulnerability of public health systems. This study analyses financial and institutional trajectories across 11 European countries (Switzerland, the Netherlands, Malta, Italy, Spain, Norway, France, Sweden, Portugal, Luxembourg, and Ukraine) from 2000 to 2024 to identify how financing patterns shape sustainable public health systems. Using a set of financial indicators (CHE per capita; CHE as % of GDP; government share of CHE; out-of-pocket and private shares; GGHE-D per capita; GDP per capita PPP) alongside institutional, workforce, and outcome metrics, we document large and persistent cross-country disparities. We found wide disparities in financing patterns, with wealthy countries consistently spending more and relying on stronger public contributions, while lower-resource settings such as Ukraine showed rapid but uneven growth, often accompanied by high private and household burdens. Trends reveal both convergence toward stronger public financing in some states and growing privatization or household burden in others (e.g., rising OOPE in Ukraine and Malta; increasing private share in the Netherlands). These financing patterns correlate closely with equity and outcome gaps: constrained public financing and high OOPE coincide with poorer health-outcome indicators. We conclude that financial reforms - expanding public fiscal space for health, reducing out-of-pocket exposure, stabilizing government health investments, and targeting incremental increases in GGHE-D per capita for low-resource settings - are essential to strengthen sustainability and equity. Strengthened financial data systems and coordinated, equity-oriented policy strategies are recommended to support sustainable and inclusive public health systems across Europe. |
