Chronic health conditions have become a defining challenge for healthcare systems across Europe. With non-communicable diseases rising by 60% since 1990, the demand for healthcare services has grown significantly, especially among ageing populations. This increasing burden translates not only into greater demand for outpatient and inpatient care but also into substantial economic implications. Drawing on data from nine European countries, a recent study has explored the extent of excess healthcare utilisation linked to chronic conditions and quantified its financial impact, providing insight into both patient needs and the pressures faced by national health budgets.
Rising Utilisation of Healthcare Services
The study identifies a clear increase in healthcare service use following the diagnosis of a chronic condition. On average, individuals affected by chronic illnesses require three additional outpatient visits and one extra overnight hospital stay each year compared to those without such conditions. However, the magnitude of this increase varies between countries. Germany, Belgium and Austria report the highest excess in outpatient visits, averaging nearly four additional consultations annually. Italy and Spain also show notable increases in outpatient visits, with slightly lower figures than the top three. Switzerland and France follow closely, while Sweden and Denmark report the lowest excess in visits.
For inpatient care, Switzerland and Austria exhibit the most significant increase, with around two additional overnight hospital stays per year for those diagnosed with chronic conditions. Germany, Belgium and France show moderate increases, averaging approximately one additional stay. Spain, Italy and Sweden record less than one extra stay per year, while Denmark reports no statistically significant increase in inpatient utilisation. These figures are derived using a difference-in-differences approach across multiple time periods, ensuring comparability between individuals with and without chronic conditions. The observed rise in healthcare usage directly reflects the long-term nature and management requirements of chronic illnesses, especially in the context of an ageing population.
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Cost Variations and Financial Impact
The increased frequency of healthcare service utilisation translates into considerable costs, which differ significantly among the nine countries studied. Outpatient care, though less expensive per visit than inpatient care, still represents a meaningful financial burden when scaled to national populations. Italy experiences the highest burden for outpatient services, primarily due to its high prevalence of chronic conditions, with an estimated healthcare cost burden ranging from 2% to nearly 3% of total health expenditure. Spain follows closely, with a burden between 1.6% and 2.3%. Belgium, Germany and Austria exhibit similar levels of burden, each falling between 1.2% and 1.9%, depending on the type of facility considered. France shows a slightly lower burden, ranging from 0.9% to 1.2%, attributed to lower healthcare prices and less pronounced excess utilisation. Sweden, Switzerland and Denmark demonstrate the smallest outpatient care burdens, between 0.4% and 1%, largely due to reduced service use and lower prevalence of chronic conditions.
Inpatient care presents an even greater financial challenge due to its substantially higher unit costs. Austria and Switzerland incur the highest inpatient costs, with burdens ranging from 6.4% to 12.8% of total health expenditure, influenced by high service prices and increased healthcare usage. Belgium and Germany follow, with burdens between 4.2% and 5.9%. Italy, Spain and France show moderate burdens, primarily due to reduced prices and utilisation. Despite high healthcare prices, Sweden and Denmark report the lowest inpatient care burdens, between 1.2% and 2%, largely due to their relatively low levels of utilisation and prevalence of chronic conditions. These disparities persist even after adjusting for purchasing power parity, suggesting that service organisation and delivery models vary significantly across countries.
Strategic Considerations for Health System Sustainability
The findings underscore the need for healthcare systems to adapt in response to the growing demands of chronic disease management. Several factors contribute to the financial strain associated with chronic conditions, including rising service prices, increased demand and high prevalence. Addressing these pressures requires strategic adjustments to service delivery. Strengthening primary care is one potential solution, as many chronic conditions can be managed effectively at this level, potentially reducing reliance on more expensive inpatient services. However, expanding primary care faces challenges, particularly in Europe, where workforce shortages are a growing concern.
Another approach involves reducing unnecessary healthcare utilisation through structured referral systems or gatekeeping mechanisms. Countries such as Spain and France, which report relatively lower levels of excess service use, may benefit from such systems. These mechanisms can help control overuse while preserving access to essential care. However, careful consideration is needed when introducing cost-sharing measures, as increased out-of-pocket payments can negatively affect lower-income households and worsen health inequalities.
In addition to managing care more efficiently, it is crucial to address the root causes of chronic conditions. Prevention and rehabilitation are essential components of a comprehensive response. Preventive measures such as encouraging healthy diets and physical activity from an early age are among the most cost-effective strategies for reducing the incidence of chronic illnesses. At the same time, integrating rehabilitation services into standard care can improve quality of life and reduce complications that might otherwise lead to costly hospital admissions. Together, these approaches can help control future healthcare demand and ensure system sustainability.
Chronic conditions drive substantial excess use of healthcare services in Europe, with marked variation between countries in both frequency and financial impact. Outpatient and inpatient services are significantly more utilised following a diagnosis, and the associated costs represent a meaningful share of national health expenditures. These differences can be attributed to how healthcare systems are structured, service pricing and the population’s overall health status. To ensure long-term sustainability, healthcare systems must pursue targeted reforms focused on prevention, primary care strengthening and efficient service delivery. Such measures are essential to manage the growing burden of chronic diseases while preserving financial stability and access to care.
Source: European Journal of Public Health
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