7
(EU: 1.6%) (Table 1).
14
Since the 1990s, it has increased as a share of GDP in all EU Member
States except for Luxembourg. Countries with high total pharmaceutical expenditure as a
percentage of GDP (e.g. those above 2% of GDP) include Bulgaria, Greece, Lithuania,
Hungary, Portugal and Slovakia. Those with low pharmaceutical expenditure in terms of
GDP, as well as a percentage of total health expenditures, include Denmark, the Netherlands,
Luxembourg, Sweden and the UK. In the EU, between 7.7 and 35.3% of total spending on
health is accounted for by outpatient pharmaceutical spending. There is no overall trend, as to
what percentage of total health care spending is devoted to pharmaceuticals.
Public spending on outpatient pharmaceuticals varied from 0.3 to 1.7% of GDP in 2010 (EU:
1.1%). Since the 1990s, it has increased as a share of GDP for all countries in the EU except
the Czech Republic, Denmark, Luxembourg, Italy, Poland and
Sweden. Some countries, such as Germany, Greece, Spain, France and Slovakia, have
relatively high public spending on pharmaceuticals and a relatively low share of private co-
payment. Bulgaria, Denmark, Cyprus, Latvia, Luxembourg, Romania spend relatively little
public money on pharmaceuticals in terms of GDP. Except for Luxembourg, this is because
the private share in total pharmaceutical spending is relatively high.
Whilst health care in EU Member States is to a large extent publicly funded, this is less the
case for pharmaceutical spending, where private co-payment can be extensive. Still, public
spending is considerable. In the EU, around 60% of total pharmaceutical spending is public
spending. It is predominantly private in Bulgaria, Estonia, Italy, Cyprus, Latvia, Lithuania,
Poland and Romania (Table 2). For Member States with available long-term data, it appears
that the public share in total spending went up for some (e.g. Germany, Netherlands, Finland,
UK) and down for others (Czech Republic, Slovakia), with no apparent overall trend for the
EU.
The variation in spending as a share of GDP conceals a much more considerable variation in
total and per capita spending. As expected, given the size of the population, in 2010, Germany
was the biggest pharmaceutical market in the EU (Euro 42,383 million), followed by France
(€ 36,006 million), Italy (€ 24,872 million), Spain (€ 18, 500 million), and UK (€ 18,154
million) (Table 1). These five countries account for over 70% of pharmaceutical turnover in
the EU. In per capita terms, between 152 Euro PPS (Romania) and 492 Euro PPS (Germany)
are spent annually (EU: 409 Euro PPS). Public per capita expenditure varies between 46 in
Bulgaria and 403 Euro PPS in Ireland (EU: 283). Both total and public per capita expenditure
have increased considerably over the last decades.
14
Differences in spending on outpatient pharmaceuticals may results partly from differences in accounting
standards, such that some expensive pharmaceuticals may be accounted for in some countries in hospitals and in
other countries in pharmacies.