High out-of-pocket pharmaceutical costs in Malta, according to EU-wide report

In Malta, patients cover 41% of the total spending on pharmaceuticals – whether prescribed or purchased over the counter – outside of hospital care. This is significantly higher than the EU average, where out-of-pocket payments account for 29%, according to the OECD’s State of Health report on EU health systems.

The report, released at the end of 2024, showed that in the EU, most retail and pharmaceutical spending is paid for by the government or mandatory insurance schemes. However, in Malta, only 55% of total expenditure on medicines is funded by the government, voluntary insurance schemes cover 4%, and a significant 41% is funded directly by patients.

Public coverage is particularly high in Cyprus, where 90% of all pharmaceutical retail spending is financed from the public purse, followed by Germany, France, and Ireland, with coverage rates exceeding 80%. However, public coverage falls below 60% in 15 countries, including Malta, and is below 40% in Bulgaria and Poland.

Slovenia is the only country where voluntary health insurance covers more than one-fifth of the costs.

Malta also records the second-highest pharmaceutical spending per capita (€639), after Germany (€721), while Denmark (€266) reports the lowest expenditure. However, in Denmark, a comparatively high proportion of medicines is dispensed as part of inpatient or outpatient treatments, bypassing traditional retail channels. The report noted that pharmaceutical expenditure in Malta and Switzerland is 30% to 35% above the EU average. In contrast, per capita pharmaceutical spending in Poland, the Netherlands, and Estonia is at least one-third below the EU average.

The report reveals that prescription medicines account for three out of every four euros spent on retail pharmaceuticals in the EU. Over-the-counter medicines (i.e., medicines that do not require a prescription from a physician) and other medical non-durables make up the remainder.

Across EU countries, out-of-pocket payments accounted for 15% of all health spending on average in 2022. However, in Malta, this percentage increased to 30%. In addition, households in Lithuania, Latvia, Bulgaria, and Greece had to pay more than 30% of their total health spending out of pocket.

Malta also reported the sixth-highest proportion of health expenditure funded directly by the state (67%). This is largely due to the lack of compulsory health insurance schemes, which cover 52% of spending across the EU. This helps explain the high level of private spending on medicines in Malta.

As defined in the report, pharmaceutical expenditure covers prescription medicines and self-medication spending. Retail pharmaceuticals are those provided outside hospital care, dispensed by a retail pharmacy, or bought from a non-specialist retailer such as a supermarket.

Moreover, there are challenges in comparing how pharmaceuticals are managed and dispensed for hospital outpatients. In some countries, these costs are classified under curative care, while in others, they are considered part of pharmaceutical expenditure.