Romania ranks last in the EU for spending on prevention

Romania allocates some of the lowest resources for prevention in Europe. A recent post by the National Institute of Public Health highlights that, in 2022, preventive care expenditure amounted to only €24 per capita, compared with an EU average of €202. Eurostat data now available for 2023 point to an even more unfavourable situation: Romania fell to €12.2 per capita, the lowest level in the EU.

In a post published on its official page, Romania’s National Institute of Public Health (INSP) draws attention to the low level of funding allocated to prevention.

According to the figures presented by the institution, based on Eurostat data for 2022, Romania spent €24 per capita per year on prevention, compared with €202 across the European Union and €458 in Germany. Poland and Romania occupied the last two positions in the EU.

Latest Eurostat data: €12.2 per capita in Romania

In the meantime, Eurostat has published data for 2023, extracted in March 2026. These show that Romania spent only €12.2 per capita on prevention, the lowest level recorded in the European Union.

The EU average was €140.1 per capita. The highest amounts were reported by the Netherlands – €303.9 per capita –, Germany – €283.5 – and Austria – €245.4. Poland, with €24.5 per capita, ranked second to last.

Thus, in nominal terms, preventive care expenditure per capita in the Netherlands was approximately 25 times higher than in Romania.

Preventive care expenditure in EU countries – comparative table

Source of the table: Eurostat, 2023 data, indicators hlth_sha11_hchp and hlth_sha11_hc. Data for the EU, Malta and Finland are marked as provisional by Eurostat.

The gap remains very large even after adjusting for purchasing power

A comparison based solely on euro values is influenced by differences in prices and income between countries. Eurostat therefore also publishes values in purchasing power standards – PPS.

This adjustment, however, does not change Romania’s position. In 2023, Romania recorded only 22.3 PPS per capita for prevention, compared with 260 PPS in Germany and 250.9 PPS in the Netherlands.

After adjusting for differences in price levels between economies, Germany therefore spends around 12 times more per capita on prevention than Romania.

Why are the 2023 figures so different from those in 2022?

The figures in the INSP post are not incorrect, but they refer to 2022. Eurostat points out that the COVID-19 pandemic produced an unusual increase in expenditure classified as prevention, particularly through immunisation programmes.

At EU level, total preventive care expenditure fell by 33.6% in 2023 compared with 2022, at current prices. The share of prevention in total health expenditure declined from 5.7% in 2022 to 3.7% in 2023.

In Romania, the amount per capita fell from €24.3 in 2022 to €12.2 in 2023. At the same time, Romania moved from the bottom positions of the ranking to last place in the EU.

Only 1.3% of Romania’s health expenditure goes to prevention

The difference is not determined solely by the fact that Romania has a smaller overall health budget. The share of available resources directed towards prevention is also low.

In 2023, prevention accounted for 1.3% of Romania’s current health expenditure, compared with 3.7% at EU level. Only Malta, at 0.9%, reported a lower share.

The Netherlands allocated 5.2% of health expenditure to prevention, Germany and Croatia 4.8% each, Italy 4.7%, and Finland 4.6%.

Relative to the entire economy, Romania spent the equivalent of only 0.07% of GDP on prevention, the lowest level in the EU. Germany allocated 0.56% of GDP, the Netherlands 0.52%, Finland 0.48%, and Austria 0.47%.

Romania also has the lowest overall health expenditure in the EU

The underfunding of prevention overlaps with a generally low level of healthcare financing. According to a Eurostat analysis of healthcare expenditure, Romania spent approximately €972 per capita on health in 2023, compared with an EU average of €3,835.

Romania therefore had the lowest health expenditure per capita among EU countries. As a share of GDP, current health expenditure stood at 5.7%, compared with 10% across the European Union.

Even after adjustment for price differences, Romania remains in last place, with 1,776 PPS per capita spent on health, compared with 5,413 PPS in Germany.

OECD: prevention receives around 1% of health expenditure

The problem is also highlighted in OECD Reviews of Health Systems: Romania 2025. The organisation estimates that Romania allocated approximately 1% of health expenditure to prevention in 2023, compared with an OECD average of 3%.

The OECD also highlights the predominantly hospital-centred nature of the Romanian health system. Hospital services absorb around 44% of health expenditure, compared with an OECD average of 39%, while resources for primary care and prevention remain limited.

The organisation recommends a stronger shift of resources towards primary care, community services and prevention, including through strengthened screening and interventions addressing risk factors for chronic non-communicable diseases.

What is included in “preventive care expenditure”?

The Eurostat indicator does not include every medical service delivered before a complication develops. Countries report their data according to the international System of Health Accounts 2011 methodology, developed by the OECD, Eurostat and the World Health Organization.

The HC.6 “preventive care” category mainly includes:

• information, health education and counselling programmes;
• immunisation programmes;
• screening and early disease detection;
• health checks and monitoring;
• epidemiological surveillance and disease and risk control;
• preparedness for emergencies and disasters from a public health perspective.

The methodology mainly includes primary and secondary prevention interventions. Services intended to treat an already diagnosed disease are generally classified under other expenditure categories.

Romania also has a high level of preventable mortality

The low level of investment in prevention must also be examined in the context of health outcomes. According to the same OECD review, Romania records a preventable mortality rate of approximately 251 deaths per 100,000 population, compared with an OECD average of 145 per 100,000.

Cardiovascular diseases and cancer are the leading causes of death, while almost one third of mortality in Romania is associated with modifiable behavioural factors such as smoking, alcohol consumption, poor diet, excess weight and physical inactivity.

The OECD considers that Romania needs more consistent measures for the prevention of chronic diseases, improved health literacy and the development of population-based screening programmes.

Low expenditure does not automatically mean that every preventive service is missing

The data should nevertheless be interpreted with methodological caution. Eurostat notes that, in some countries, it can be difficult to separate preventive expenditure precisely from curative or rehabilitation expenditure. For example, a preventive check-up carried out during a family physician consultation may be recorded together with other medical services.

This may lead to some underestimation of preventive spending and may influence comparisons between countries. However, the very large differences observed in Romania remain visible regardless of whether the analysis is conducted in euros per capita, in PPS, as a percentage of health expenditure or as a percentage of GDP.

The INSP message that insufficient resources allocated to prevention later generate greater pressure on curative services should be understood as a health policy conclusion rather than as a financial formula in which every unspent euro automatically produces a fixed subsequent cost. Economic efficiency varies from one preventive intervention to another. OECD data nevertheless support the need to strengthen prevention and primary care in order to reduce avoidable disease, preventable hospital admissions and pressure on hospital services.