A joint initiative led by the European Observatory on Health Systems and Policies and the Organisation for Economic Co-operation and Development in cooperation with the European Commission released the fifth edition of the Country Health Profiles, offering a concise, policy-relevant assessment of health system performance across the European Union (EU), Iceland, and Norway.

Designed to support evidence-based policymaking and mutual learning, the profiles present a concise overview of health systems across Europe. They draw on comparable data covering population health status; behavioural and environmental risk factors; health system organisation and spending; and system effectiveness, accessibility, and resilience. Each country profile also includes a dedicated section on the pharmaceutical sector and national medicine policy.

Taken together, these profiles allow countries to be compared with EU averages across health outcomes, risk factors, health system performance, accessibility, resilience, and pharmaceutical use through an interactive dashboard.

Europe-Wide Trends

At the European level, a Synthesis Report 2025 published with the country’s health profiles highlights the major policy trends shaping health system reform.

Noncommunicable diseases remain the leading cause of preventable illnesses and deaths in the EU.

In 2022, an estimated 2.4 million years of productive life were lost, and more than 725,000 deaths could have been avoided. Reducing mortality from noncommunicable diseases could offset 12% of the projected decline in the EU workforce linked to population aging between 2022 and 2040.

Member states are responding with policies targeting the consumption of tobacco, nicotine, alcohol, obesity, and physical inactivity, particularly among younger populations. Ongoing policy adaptation is necessary to address emerging challenges, such as vaping and childhood obesity.

Primary Care Pressures

Primary care systems across the EU are in increasing demand because of an aging population, long-standing underinvestment, and workforce shortages.

Only 1 in 5 physicians in the EU are general practitioners. Simultaneously, more than one third of adults reported having a long-term illness in 2024, increasing to 60% among those aged 65 years or older.

In response, member states are implementing reforms to attract and retain primary care professionals and expand integrated care models aimed at improving access, patient-centred care, and system efficiency.

Pharmaceutical expenditure represents another growing pressure. In 2023, medicines accounted for approximately 60% of the total pharmaceutical spending and 13% of the overall health expenditure in the EU.

Against the backdrop of rising prices and demand, countries have introduced major pharmaceutical policy reforms between 2020 and 2025 to improve access and affordability, supported by updated EU pharmaceutical legislation and health technology assessment regulations.

Digital Health Expansion

Digital transformation of health systems has accelerated across the EU in the context of the COVID pandemic, the European Health Data Space, and the Artificial Intelligence Act.

Investment in health-related information and communication technologies has increased by approximately 30% since 2021, driven by the rising demand for care, workforce shortages, and policy efforts to promote innovation and highly skilled employment in health technology.

By the end of 2024, all EU member states had implemented electronic health record services. In 85% of countries, at least 80% of the population has the technical capacity to access electronic health records.

Spain in Focus

Within the European context, the health profile in Spain reports strong health outcomes and persistent structural challenges.

In 2024, Spain recorded its third highest life expectancy in the EU at 84 years. Life expectancy declined sharply between 2019 and 2020 because of COVID-related deaths before recovery. The gender gap in life expectancy, favouring women, was 5.3 years. In 2023, cardiovascular disease and cancer accounted for more than one quarter of all deaths.

Daily smoking among adults remained higher than that in most EU countries in 2020, although the rates have declined steadily since 2000.

Alcohol consumption increased after 2010, reaching 11.1 litres per adult in 2023, about 10% above the EU average. Adult obesity rates rose only slightly after 2017 and were in line with the EU average in 2022.

Health expenditure per capita in Spain reached €3137 in 2023, approximately one fifth below the EU average. Public spending remained the main source of financing, while out-of-pocket payments accounted for 21% of the total health expenditure compared with an EU average of 16%.

In 2022, Spain reported one of the lowest rates of preventable and treatable mortality in the EU, reflecting policies targeting behavioural risk factors and the impact of screening programs. The low hospital admission rates for congestive heart failure and diabetes suggest effective primary and integrated care delivery, although regional disparities remain.

Access to healthcare is generally good in Spain; however, workforce shortages may affect its availability in some regions. Spain has implemented strategic digital health initiatives and has increased funding in this area. A large proportion of the population schedules appointments and accesses their medical records online. Health remains a priority in the country’s political agenda, and public spending on healthcare has increased over time.

Despite these strengths, one of the key challenges remains per capita spending on retail pharmaceuticals in Spain. This was below the EU average in 2023, accounting for 15% of total health expenditure. Although spending on retail medicines has declined over time, expenditures on medicines dispensed in hospitals have increased rapidly, partly because of the introduction of new and expensive medicines that are administered exclusively in hospitals.

The report also highlights workforce imbalances, with a relatively high number of physicians and a comparatively low number of nurses. In 2023, Spain had 4.4 physicians per 1000 population, slightly above the EU average of 4.3. Family physicians accounted for 22% of doctors, exceeding the EU average of 19%.

However, Spain faces significant challenges in its health workforce, including an aging workforce, uneven geographic distribution of health professionals, and a projected shortage of family physicians and other specialties, notably geriatrics, psychiatry, and radiology. Of concern is that, although the number of nurses has increased gradually in recent years, reaching 5.9 per 1000 population in 2023, this figure remains well below the EU average of 8.5 per 1000.

This story was translated from El Medico Interactivo, part of the Medscape Professional Network.