4.8
668 reviews
4.8
668 reviews
£293 million. That is how much more UK health authorities pay to their European partners each year than they receive in return. With gross reimbursements of €319 million, the UK is the single biggest net loser in the entire EHIC (European Health Insurance Card) system. I went through the latest official European Commission report to understand how this deficit works and why it has been getting worse every year since 2021.
The EHIC (European Health Insurance Card) covers unexpected medical treatment during a temporary stay in another EU country. On paper, it is a universal right. In practice, it is a €1.5 billion market between national social security systems, with fixed winners and losers. The UK sits firmly in the loser column.
The UK's deficit is not a fluke. It comes from three structural imbalances that reinforce each other. The post-pandemic rebound in tourism turned a manageable gap into a structural drain.
British travellers pour into France, Spain, Italy and Greece — all net beneficiaries of the EHIC system. The UK, on the other hand, attracts mainly business visitors, not leisure tourists seeking treatment. The direct result: the UK funds 365,000 claims abroad but only collects on 26,000 foreign patients treated at home.
UK health authorities reimburse at the local tariff of the treating country. When a British tourist ends up in a Dutch hospital, the bill comes back at €904 per case. For Polish hospitals it reaches €1,070. At 365,000 claims a year, even a moderate per-unit cost adds up fast. The UK's average cost per claim is €1,004 — the second highest in Europe.
After Brexit, the UK negotiated continued EHIC participation through the Trade and Cooperation Agreement. The arrangement kept outgoing British claims intact but sharply reduced the number of EU visitors treated on UK soil — cutting incoming revenue while outgoing costs kept growing. It is the worst of both worlds from a balance-sheet perspective.
Three structural trends will push the bill higher by 2030. An ageing travelling population generates longer, more intensive treatment episodes (cardiology, orthopaedics). The growing community of British retirees in Spain, Portugal and France accelerates outflows. And European hospital tariffs keep rising mechanically. On this trajectory, the deficit could exceed −€370 million by 2030.
In 2017 the UK's net balance stood at around −€45 million — already negative, but manageable. By 2020 it had barely moved. Then came 2021. In a single year the deficit jumped to −€145 million. That was not a temporary blip. It was a structural break.
The 2021 turning point is not an accounting anomaly. It reflects a lasting reshaping of intra-European travel patterns, compounded by the demographic profile of British holidaymakers. These three mechanisms compound.
From 2021, British travellers flooded back into France, Spain, Greece and Italy — all net beneficiaries of the EHIC system. At the same time, post-Brexit friction reduced the flow of EU visitors seeking treatment in the UK. Outgoing claims surged; incoming revenue crept up only slowly.
After the pandemic, hospital tariffs in Austria, Spain and Italy rose steeply — driven by energy, wages and equipment replacement. Reimbursements track the local tariff, so the bill grows mechanically with the same volume. Eurostat's harmonised health price index for the euro area rose 12% between 2020 and 2023.
The age group that travels most in Europe today is the 60 to 75 bracket. These travellers also generate the most intensive medical episodes: cardiology, orthopaedics, post-operative care. Each UK claim handled abroad costs an average of €1,004 — the second highest in the system, behind Poland at €1,070.
When a UK-insured patient is admitted to hospital in France, the UK authority settles the bill through form E125 (the inter-state reimbursement form). The UK, Germany and France together account for 82% of all outgoing payments across EU-27.
Some countries treat European patients at scale and get reimbursed for it. Spain handles 454,000 foreign cases a year. Austria, with barely a third of that volume, bills nearly as much — its hospital tariffs are simply higher.
Each country's net balance is simple arithmetic: amounts collected from other states minus amounts paid out for its own insured citizens. The result reveals a stable geographic split: Mediterranean and Alpine countries collect; the large tourist-origin countries (UK, France, Germany) foot the bill.
The bilateral corridors mirror travel habits: Brits in France, Germans on Austrian ski slopes, French travellers in Spain and Belgium. The UK → France corridor is the single largest financial flow in the entire European system. That alone says a lot about the UK's position.
EHIC coverage rates vary between 1.8% and 100% across Europe. It is not a question of national wealth. It comes down to the issuance process: automatic (built into the national health card) or on explicit request, as in France.
Country to country, EHIC issuance conditions are anything but uniform. Validity periods, processing times, application channels: the differences are sometimes striking.
The UK is the single biggest net loser in the European EHIC system, with a deficit of −€293 million in 2025. That figure breaks down into two straightforward numbers.
Private clinics, medical repatriation and excess charges (the portion of costs that remain your responsibility) are not covered by the card. I have compared policies in this space: a full travel insurance policy picks up where the EHIC stops, from around £25 to £65 depending on duration and destination.
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Data
This study is based on cross-border EHIC (European Health Insurance Card) reimbursement data transmitted to HelloSafe by the Directorate-General for Employment, Social Affairs and Inclusion (DG EMPL) of the European Commission. The figures cover financial flows between European social security systems for unplanned care received during a temporary stay in another member state.
Scope
32 states: 27 EU member states + 4 EEA states (Iceland, Liechtenstein, Norway, Switzerland) + United Kingdom. Italy, Switzerland and Luxembourg are only partially covered for certain indicators due to incomplete symmetrical data.
Calculation method
• Average cost per claim: total reimbursement amount divided by the number of E125 forms (the inter-state reimbursement form) processed.
• Net balance (healthcare migration balance): amount collected from other states minus amount paid to other states.
• Historical trend 2017–2025: time series consolidated by DG EMPL through the annual EHIC questionnaires sent to member states.
Coverage and limitations
This study covers exclusively unplanned care during a temporary stay (EHIC framework, coordination regulations 883/2004 and 987/2009). Planned treatment abroad falls under Directive 2011/24/EU and is not included. The amounts reflect reimbursements between administrations, not the residual costs borne by patients (excess charges, overruns, private treatment, medical repatriation).
