Background: Both rising healthcare costs and the global financial crisis have fueled a search for
policy tools in order to avoid unsustainable future financing of essential health benefits. The scope of
essential health benefits (the range of services covered) and depth of coverage (the proportion of costs
of the covered benefits that is covered publicly) are corresponding variables in determining the benefits
package. We hypothesized that a more comprehensive health benefit package may increase user costsharing charges.
Methods:We conducted a desktop research study to assess the interrelationship between the scope
of covered health benefits and the height of statutory spending in a sample of 8 European countries:
Belgium, England, France, Germany, the Netherlands, Scotland, Sweden, and Switzerland. We conducted
a targeted literature search to identify characteristics of the healthcare systems in our sample of countries.
We analyzed similarities and differences based on the dimensions of publicly financed healthcare as
published by the European Observatory on Health Care Systems.
Results:We found that the scope of services is comparable and comprehensive across our sample, with
only marginal differences. Cost-sharing arrangements show the most variation. In general, we found
no direct interrelationship in this sample between the ranges of services covered in the health benefits
package and the height of public spending on healthcare. With regard to specific services (dental care,
physical therapy), we found indications of an association between coverage of services and cost-sharing
arrangements. Strong variations in the volume and price of healthcare services between the 8 countries
were found for services with large practice variations.
Conclusion:Although reducing the scope of the benefit package as well as increasing user charges may
contribute to the financial sustainability of healthcare, variations in the volume and price of care seem
to have a much larger impact on financial sustainability. Policy-makers should focus on a variety of
measures within an integrated approach. There is no silver bullet for addressing the sustainability of
healthcare