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1st June 2023
The health status in Germany has improved over the last two decades, and life expectancy remains above the EU average despite the temporary reduction registered in 2020 that was caused by the Covid-19 pandemic.
Infection and death rates from Covid-19 in 2020 were lower in Germany than in most other EU countries. When measured as a share of GDP, health spending in Germany is the highest in Europe. The health system offers a generous benefits package, high levels of service provision and universal access to relatively high-quality and effective care. The Covid-19 pandemic revealed the challenges faced by federal systems in coordinating and managing such outbreaks.
In 2020, Germany registered a life expectancy of 81.1 years – six months above the EU average but still somewhat lower than in EU countries with the highest levels. The Covid-19 pandemic had less of an impact on life expectancy in Germany than in the EU as a whole, having fallen by 2.5 months in 2020 compared to an average of just over eight months across the EU. The leading causes of death in Germany in 2019 were ischaemic heart disease, stroke and lung cancer.
Around one in five adults smokes on a daily basis in Germany. While smoking rates have been declining, the growing popularity of e-cigarettes, particularly among young people, is a cause for concern. Adult and adolescent obesity rates are growing, and alcohol consumption among adults and 15-year-olds is considerably higher than the EU average.
In 2019, Germany spent €4,505 per capita on health – the highest among EU countries, and 28% more than the average (€3,523). Germany also spends a greater proportion of its GDP on health (11.7%) than any other EU country. The majority of health spending comes from public sources; out-of-pocket payments amount to only 12.7%, which is well below most other EU countries.
Mortality from preventable causes is lower in Germany than in the EU as a whole, reflecting the country’s effective public health and primary care system. Germany also has lower rates of death from treatable causes, owing to good access to effective treatments.
Access to care is generally good in Germany. Historically low rates for unmet needs rose during the Covid-19 pandemic when many non-urgent services were cancelled or postponed. One in seven people reported that they had to forgo needed care in 2020. However, the use of teleconsultations increased during the pandemic.
Despite well prepared health infrastructure and resources, Germany scaled up testing and laboratory capacities, intensive care unit beds and the health workforce. By the end of August 2021, around 60% of the population had received two Covid-19 vaccine doses.
OECD/European Observatory on Health Systems and Policies (2021), Germany: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
28th April 2023
Life expectancy in Belgium remains slightly above the EU average, but it temporarily fell sharply in 2020 because of deaths due to Covid-19.
While the Belgian health system provides good access to high-quality care, the Covid-19 pandemic highlighted important challenges with prevention and public health, the health workforce and quality of care in long-term care facilities for older people. The pandemic stimulated many innovative practices in Belgium that could be expanded to build a more resilient healthcare system.
Life expectancy in Belgium increased more than the EU average between 2010 and 2019, but fell by more than a year in 2020 because of deaths due to Covid-19. About 60% of the Covid-19 deaths in 2020 were among residents in long-term care facilities. As in many other countries, the mental health of many young people and adults in Belgium deteriorated greatly during the pandemic, with reports of anxiety and depression reaching much higher levels than in previous years.
Risk factors for health are major drivers of ill health and mortality in Belgium. While tobacco consumption has substantially decreased over the past two decades, 15% of adults were daily smokers in 2018. Nearly 30% of adults reported regular heavy alcohol consumption in 2018, a rate well above the EU average. About 16% of adults were obese in 2018, close to the EU average, but up from 12% in 2001. Overweight and obesity among 15-year-old adolescents have also increased to 17% in 2018, up from 11% in 2002.
Health spending per capita increased slowly between 2008 and 2019 and remains higher than the EU average. In 2019, health spending accounted for 10.7% of GDP, up from 9.6% in 2008, and also a higher share than the current EU average (9.9%). Public spending accounted for 77% of overall health spending – slightly less than the EU average of 80%.
Avoidable mortality was slightly lower than the EU average before the pandemic, but higher than in many other western EU countries. This suggests that more could be done to save the lives of people through health promotion and a reduction of risk factors and through better healthcare.
Although access to healthcare in Belgium is generally good, the Covid-19 pandemic significantly affected access to care in 2020: 22% reported forgone care during the first 12 months of the pandemic, which is close to the EU average of 21%. Growing use of teleconsultations helped maintain access to care during the pandemic.
Belgium was among the EU countries hardest hit by the Covid-19 pandemic in numbers of cases and deaths relative to its population size, particularly during the first wave. Belgium accelerated its vaccination campaign in the first half of 2021. By the end of August 2021, 70% of the population had received two doses (or equivalent) of a Covid-19 vaccine.
OECD/European Observatory on Health Systems and Policies (2021), Belgium: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
Life expectancy in Austria is higher than the EU average, but fell sharply in 2020 due to Covid-19 deaths.
While the Austrian health system generally provides good access to high-quality care, the Covid-19 pandemic underscored some structural issues, including the need to pursue reforms to overcome fragmentation and strengthen primary care.
A strong digital infrastructure offers Austria the potential to build a more integrated and resilient health system.
Although life expectancy in Austria in 2020 was more than half a year higher than the EU average, it fell by 0.7 year compared with 2019 because of the Covid-19 pandemic. Even before the pandemic, gains in life expectancy in Austria had slowed considerably between 2010 and 2019.
About 40% of all deaths in Austria in 2019 can be attributed to behavioural risk factors. Tobacco consumption among adults has fallen but remains slightly higher than the EU average. Alcohol consumption among adults in Austria is the second highest in the EU. Heavy alcohol consumption among adolescents is also higher than the EU average.
Spending on health per capita in Austria was the third highest in the EU in 2019. Austria spends substantially more than most countries on hospital inpatient care, while spending on prevention is lower than average. It also has relatively high numbers of physicians and hospital beds. While three quarters of all health expenditure is publicly funded, direct out-of-pocket spending by households is higher than the EU average.
Mortality from preventable and treatable causes in 2018 was lower in Austria than the EU average. Nevertheless, Austria lagged behind many other EU countries on preventable mortality, suggesting that more could be done to scale up prevention and reduce risk factors for cancer and other leading causes of death.
Access to healthcare is good in Austria, although Covid-19 created barriers to access. One in eight Austrians reported that they had forgone care during the first 12 months of the pandemic. Digital services helped to maintain access to care during the Covid-19 crisis: 35% of Austrians reported that they used teleconsultation services during the first year of the pandemic, which was slightly lower than the EU average.
Between March 2020 and August 2021, confirmed Covid-19 case numbers in Austria were similar to the EU average, although the death rate was lower. By the end August 2021, more than 60% of the population had received at least one dose of a Covid-19 vaccine, and 57% had received two doses or the equivalent. These proportions were close to the EU average.
OECD/European Observatory on Health Systems and Policies (2021), Austria: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.