Sistemul cheltuielilor publice n tarile Uniunii Europene Conceptul de cheltuieli publice este legat de ndeplinirea functiei de alocare a finantelor

publice si anume de componenta ei privind repartizarea si utilizarea resurselor financiare ale statului. Cheltuielile guvernamentale au crescut semnificativ n anul 2009, comparativ cu 2008, de la 46,9 la 50,8 % din PIB, pe fondul diminurii PIB-ului ntr-un numr mare de ri, att la nivel UE-27 ct i UE-17, diminundu-se puin n 2010 . Cele mai mici ponderi ale cheltuielilor guvernamentale generale n PIB s-au nregistrat n Bulgaria (37,7% din PIB) ntre anii 2009 i 2010, dinamica cheltuielilor guvernamentale a structurat rile din UE-27 n dou grupri, atestnd, astfel, c impactul crizei financiare a afectat n etape decalate rile europene. rile n care cheltuielile guvernamentale au sczut, au fost cele mai multe, acestea fiind afectate de criz ndeosebi n anii 20082009 (Belgia, Bulgaria, R. Ceh, Danemarca, Germania, Estonia .a.), pe cnd cele ale cror cheltuieli guvernamentale au crescut n 2010 fa de 2009, au fost mai puine, acestea fiind afectate de criz ndeosebi n anii 20092010 (Irlanda, Cipru, Polonia, Romnia). De altfel, bugetele privind protectia sociala si sanatatea reprezinta numai ele 54% din cheltuielile publice in tarile europene, urmate de cele pentru aparare, justitie, politie, diplomatice, administratie fiscala, etc. Pe anumite segmente, aceste cheltuieli pot fi delegate unor actori privati. Marea Britanie este pionier in acest sens, increditand gestionarea inchisorilor unor intreprinderi. ntr-o economie, nivelul cheltuielilor cu sntatea, ca i al celor cu educaia, reprezint un indicator fidel al nivelului de dezvoltare. rile cu economii avansate aloc resurse importante pentru finanarea sectorului de sntate, ca premiz pentru o dezvoltare sustenabil pe termen lung. Cheltuieli privind sistemul de sanatate Criza economic i constrngerile bugetare n cretere au creat presiuni suplimentare asupra sistemelor de sntate din multe ri europene. Mai multe dintre rile cel mai puternic afectate de criz au luat o serie de msuri de reducere a cheltuielilor publice pentru sntate Sistemele de sntate sunt mari consumatoare de resurse, n ultimii 30 de ani nregistrndu-se o cretere continu a nivelului resurselor necesare, cretere datorat, n principal: mbtrnirii populaiei, descoperirii de medicamente mai eficiente i de tehnologii mai avansate, dar i mai costisitoare, creterea numrului persoanelor care beneficiaz de asisten medical Din perspectiva proteciei sociale, cel mai indicat mod de mbuntire a susinerii financiare este creterea eficienei sistemului de sntate: eficientizarea se refer aici la scderea costurilor, meninnd la aceleai niveluri cantitatea i calitatea, realizat prin prevenirea supraconsumului de servicii medicale i prin alocarea de suficiente resurse destinate programelor de prevenie i celor de meninere a sntii, cu scopul reducerii unor poteniale cheltuieli viitoare. Pn n 2009, cheltuielile pentru sntate din rile europene au crescut ntr-un ritm mai rapid dect restul economiei, iar sectorul sntii a absorbit o proporie n cretere din produsul intern brut (PIB). n urma declanrii crizei economice i financiare n 2008, multe ri europene i-au redus cheltuielile pentru sntate n contextul eforturilor generale de a controla deficitele bugetare mari i creterea ponderii datoriei n PIB. Dei aceste reduceri erau probabil de neevitat, anumite msuri au impact asupra obiectivelor fundamentale ale sistemelor de sntate. Reducerile cheltuielilor publice pentru sntate s-au realizat printr-o serie de msuri, printre care micorarea

salariilor i/sau a nivelului de ocupare a forei de munc, creterea plilor directe de ctre gospodrii pentru anumite servicii i produse farmaceutice sau impunerea unor constrngeri bugetare stricte asupra sp italelor. De asemenea, s-a urmrit creterea eficienei prin fuziunea unor spitale sau accelerarea trecerii de la spitalizri la tratamentul ambulatoriu i la chirurgia ambulatorie. n 2010 cea mai mare proporie din PIB a fost alocat sntii de rile de Jos (12%), urmate de Frana i Germania (11,6% pentru ambele). n privina cheltuielilor pentru sntate pe cap de locuitor, rile de Jos (3 890 EUR), Luxemburg (3 607 EUR) i Danemarca (3 439 EUR) au nregistrat nivelurile cele mai ridicate dintre statele membre ale UE. Acestea au fost urmate de Austria, Frana i Germania, cu peste 3 000 EUR pe cap de locuitor. Bulgaria i Romnia au fost rile cu cel mai sczut nivel al cheltuielilor, i anume circa 700 EUR. Daca privim situatia din Uniunea Europeana, vom observa nu numai sisteme de sanatate destul de diferite intre ele, dar si sisteme de sanatate care combina diverse abordari: finantarea din bugetul de stat, asigurari de sanatate publice sau private, coplata sau plata directa a unor servicii de catre pacienti. Finantarea prin taxarea generala (de la bugetul de stat) se face in Marea Britanie, Irlanda, Danemarca, Suedia, Finlanda, Spania si Portugalia. In Grecia si Italia finantarea este asigurata in acelasi timp prin taxe generale si prin asigurari de sanatate. In Germania, Belgia, Luxemburg si Austria sistemul de sanatate este finantat predominant prin asigurari sociale. In Franta si Olanda cheltuielile publice pentru sanatate sunt aproape exclusiv acoperite prin asigurari sociale de sanatate. Sectorul public este principala surs de finanare a sntii n toate rile europene cu excepia Ciprului. n 2010, n statele membre ale UE au fost finanate public n medie aproape trei sferturi (73%) din totalul cheltuielilor pentru sntate. Finanarea public a reprezentat peste 80% n rile de Jos, rile nordice (cu excepia Finlandei), Luxemburg, Republica Ceh, Regatul Unit i Romnia. Cele mai mici proporii s-au nregistrat n Cipru (43%) i n Bulgaria, Grecia i Letonia (55-60%). n unele ri criza economic a afectat raportul dintre finanarea public i cea privat a sntii. Cheltuielile publice pentru anumite produse i servicii au fost reduse, fiind frecvent nsoite de creteri ale nivelului plilor directe de ctre gospodrii. n Irlanda, proporia finanrii publice a cheltuielilor pentru sntate a sczut cu aproape 6 puncte procentuale ntre 2008 i 2010, ea fiind n prezent de 70%, n timp ce proporia plilor directe de ctre gospodrii a crescut. De asemenea, au existat reduceri importante n Bulgaria i n Republica Slovac. Dup finanarea public, n majoritatea rilor principala surs de finanare a cheltuielilor pentru sntate este reprezentat de plile directe. Finanarea din asigurrile private de sntate are un rol semnificativ doar n cteva ri. n 2010, proporia plilor directe a fost cea mai ridicat n Cipru (49%), Bulgaria (43%) i Grecia (38%). Ea a fost cea mai sczut n rile de Jos (6%), Frana (7%) i Regatul Unit (9%). Aceast proporie a crescut n ultimul deceniu n aproximativ o jumtate dintre statele membre ale UE i mai ales n Bulgaria, Cipru, Malta i Republica Slovac rile cu economii avansate aloc resurse importante pentru finanarea sectorului de sntate, ca premiz pentru o dezvoltare sustenabil pe termen lung. Starea bun de sntate duce, n timp, la creterea participrii forei de munc i a productivitii, prin urmare, fiind unul dintre principalele motoare ale creterii economice. Norvegia Sistemul de sntate n Norvegia este finanat n cea mai mare parte prin intermediul taxelor colectate direct din salarii i nu exist nici un fond special pentru contribuiile de sntate. Administraia Naional a Asigurrilor, numit Trygdeetaten este responsabil pentru Schema naional de asigurare NIS, un program de asigurri de stat care garanteaz tuturor acelai nivel de susinere

La polul opus se afl state cum ar fi Frana, Elveia, Germania, Olanda i Danemarca, care investesc sume considerabile n sistemul de sntate, ntre 11,1% i 11,6% Cheltuielile publice pentru nvatamnt n 2008, procentul cheltuielilor publice totale cu educaia a fost de peste 5% din PIB n multe dintre rile europene. Danemarca, Cipru i Islanda au avut cele mai ridicate rate, de 7%, n timp ce alte ri nordice, precum i Belgia i Malta s-au situat la peste 6%. Spre deosebire de acestea, n Slovacia i Liechtenstein, cheltuielile publice cu educaia au reprezentat mai puin de 4% din PIB. Cheltuielile publice pe nivel de educaie difer de la o ar la alta parial fiindc acestea sunt influenate de diferenele structurale dintre sistemele de nvmnt, incluznd durata fiecrui nivel de educaie; durata total a nvmntului obligatoriu i ratele de participare la nvmntul post-obligatoriu .Printre ali factori de impact se numr i schimbrile demografice, care afecteaz pe rnd fiecare nivel de educaie ncepnd cu cel precolar pe msur deoarece schimbrile privesc populaia colar. n aproape toate rile europene, cheltuielile publice totale alocate nvmntului secundar reprezint o proporie mai mare din PIB dect cheltuielile de la alte niveluri educaionale, dar procentul maxim pentru toate rile este de 3,2% (n Cipru i Malta). n Spania, Polonia, Slovacia, Liechtenstein i Croaia, acesta este sub 2% din PIB. Cheltuielile publice totale cu nvmntul primar se situeaz n general la mai puin de 2% din PIB, exceptnd Cipru i Islanda, unde se ridic la 2,5%. La nivel european (UE-27), procentul din PIB reprezentat de cheltuielile cu nvmntul primar i nvmntul superior este aproximativ acelai (1,1%, respectiv 1,2%). Totui, costul unitar pe elev/student este mult mai ridicat la nivel teriar dect la nivel de nvmnt primar. Procentul din PIB acordat nvmntului superior variaz foarte mult de la ar la ar, situndu-se ntre 0,8% i 2,2%. Doar Danemarca i Norvegia depesc 2%. Bulgaria se afl pe ultimul loc ntre statele UE privind alocarea din PIB pentru educaie n 2011, conform datelor fcute publice de Eurostat. Practic, Bulgaria a cheltuit doar 3,6% din PIB n 2011, din care 1,8% s-au alocat pentru nvmntul secundar. n 2011, la nivelul UE-27 cheltuielile totale au reprezentat 49,1% din PIB, iar din acestea 5,3%, reprezentnd 347 de miliarde de euro, au fost alocate educaiei. Ca proporie din PIB, cele mai mari alocri pentru educaie au fost cele din Islanda, 7,9% din PIB, Danemarca (7,8%) i Cipru (7,2%). a. Sistemul naional de sntate. Acest model este cunoscut i sub denumirea de Beveridge model i este folosit n Marea Britanie, Italia, Grecia, Finlanda, Spania, Norvegia, Suedia. Principalele caracteristici legate de aspectul financiar al acestui model sunt: Populaia are acces liber la serviciile de sntate bazate pe taxele obligatorii din venituri, deci exist un grad ridicat de echitate social. Resursele financiare provin din colectarea de taxe pe venituri, iar sistemul este gestionat de ctre stat. Cei care ofer servicii medicale n ambulatoriu sunt angajai ai statului. Plile ctre prestatori sunt fcute prin salarii i n funcie de numrul pacienilor. Prestatorii de servicii medicale secundare au la dispoziie un buget general. b. Sistemul de asigurri de sntate (Bismark model) este un sistem inspirat de legislaia german. Este folosit n multe ri membre ale UE, cum ar fi Frana, Germania, Austria, Belgia, Olanda i Romnia. Caracteristicile acestui model sunt: Resursele financiare sunt, n principal, reprezentate de contribuiile obligatorii pltite de angajai i angajatori.

 De asemenea, exist resurse care provin din subvenii de la bugetul de stat (local sau naional) sau alte tipuri de subvenii. Instituiile care administreaz fondurile de asigurri sunt nonprofit. Gestionarea i folosirea fondurilor de asigurri sunt fcute la nivel naional i prin direcii locale. FRANA 181 mld. reprezint cheltuielile din sistemul de sntate franceez din 2011. n Frana exist n jur de 2.700 de instituii medicale (pentru diagnostic, supraveghere i tratament), dintre care o treime sunt de stat i dou treimi private; Orice persoan care muncete i locuiete n Frana trebuie s fie nscris n sistemul public de asigurare social (scurit sociale, care include i asigurarea de sntate - l'assurance maladie); Asigurarea de sntate public este gestionat de CNAM - Casa Naional de Asigurri de Sntate; CNAM nu acoper toate cheltuielile medicale. n medie, asigurarea de stat acoper 75% din cheltuielile unui pacient; vizitele la medicul generalist (de familie) sunt acoperite n proporie de 100%, n timp ce alte investigaii sunt acoperite n diverse proporii. Pentru a acoperi i costurile neasigurate de CNAM, exist asigurri facultative. Acestea sunt de dou tipuri: asigurri la firme private sau, mult mai frecvent, mutuale. 85% din francezi au i asigurare facultativ la o "mutuelle" (societate nonprofit, cotizaiile membrilor fiind n totalitate reinvestite, care, spre deosebire de asigurtorii comerciali, nu poate selecta pacienii n funcie de riscuri); Medicina de urgen este organizat n jurul a trei piloni: unitile de urgen, SAMU (serviciu care direcioneaz pacienii sau ambulanele disponibile ctre pacieni) i SMUR (serviciu mobil de urgen i reanimare). GERMANIA 260 mld. reprezint sum cheltuit cu sntatea n Germania. Spitalele sunt n mare parte administrate de organizaii nonprofit, aflate n proces de privatizare; statul particip ca prestator de servicii doar n plan secundar sub forma unor direcii de sntate public, spitale locale sau clinici universitare; Din ianuarie 2011, contribuia a fost fixat prin lege la 15,5%, iar suplimentar, fondurile de asigurri de sntate (publice) pot solicita o sum n plus (premium) dac nu i acoper cheltuielile din banii primii din contribuii; Este obligatorie ncheierea asigurrilor de sntate; majoritatea populaiei are asigurare de stat. Aproximativ 10,5% din populaie are asigurare de sntate privat; 2,3% din populaie (de exemplu militarii, voluntarii, beneficiarii de ajutor social) au asigurri cu regim special. Doar 0,1% din germani nu posed asigurare medical. Primele, cu unele mici excepii, sunt suportate n egal msur de angajator i angajat. Cea mai ieftin asigurare privat pentru o persoan de 18 ani este de aproximativ 150 de euro; Medicina de urgen este reglementat de legislaia landurilor: fie autoritile locale pun la dispoziie personal i dotare pentru serviciile de salvare, fie dein companii proprii pentru serviciile de urgen, fie confer aceste atribuii personalului angajat al pompierilor, fie atribuie serviciile organizaiilor de drept privat care presteaz activitile respective n calitate de organizaie nonprofit sau societate nonprofit cu rspundere limitat (cea mai rspndit variant), respectiv firmelor private. OLANDA 60 mld. reprezint cheltuielile cu sntatea n Olanda. Sistemul de sntate este bazat pe asigurri private; Sistemul este operat de companii private de asigurri, care sunt obligate s accepte orice rezident din aria lor de activitate; Cu toate acestea, statul se implic n unele tratamente pe termen lung, ns aceste cheltuieli reprezint aproximativ un sfert din total; Sistemul este finanat din trei surse: n primul rnd angajatorul va plti o contribuie n funcie de salariu. Totodat asiguratul va plti direct asigurtorului (45%). Guvernul va contribui cu 5%; Serviciile de urgen sunt asigurate de companii private de ambulan, n contract cu guvernul olandez. Acestea funcioneaz pe regiuni i trebuie s ndeplineasc standardele impuse de autoriti.

SLOVENIA 3,4 mld. este suma cheltuit cu snttea n 2011. Asigurrile obligatorii de sntate acoper numai un anumit procent din costul serviciilor. Acoperirea complet a costurilor este prevzut numai pentru copii, elevi, precum i pentru anumite boli i condiii. Asigurrile complementare de sntate au fost introduse n 1993 i de atunci practic toi cetenii (98%) au optat pentru aceast form. UNGARIA 4,4 mld. reprezint suma cheltuit cu sntatea n Ungaria. Administraiile locale sunt responsabile pentru asistena medical primar; aproximativ 80% posed cabinete medicale particulare, care sunt contractate de autoritile locale. Acestea primesc sume din Fondul Naional al Asigurrilor de Sntate pe baza numrului de pacieni nregistrai. Ali 21% din medicii de familie sunt angajai de autoritile locale cu salarii fixe; Fondul National al Asigurrilor de Sntate este principalul mijloc de acoperire a cheltuielilor de sntate din Ungaria. Acesta este finanat din trei surse: contribuii directe din salarii, taxe generale (pentru acoperirea cheltuielilor pentru persoanele care au dreptul de asigurat, dar care nu pot s contribuie la alctuirea fondului). O parte din cheltuielile de sntate sunt acoperite de autoritile locale. O mare problem o reprezint nivelul prea sczut al investiiilor n aprare, statele UE (i membrii europeni ai NATO) ajungnd pentru prima dat n 2012 s fie depite de rile asiatice care au sporit nivelul cheltuielilor militare cu 4,94% n 2012. Europenii au redus cu 1,64% cheltuielile agregate pentru aprare n 2012 i cu 2,5% n 2011.5 Conform Military Balance 2013, cheltuielile agregate pentru aprare au sczut chiar cu 60% n rile europene, ceea ce a implicat reduceri masive ale forelor armate n multe state, cheltuieli reduse n domeniul cercetrii-dezvoltrii, achiziii diminuate. Aceste efecte negative nu au putut fi compensate prin politici precum Smart defense (NATO) i Pooling-Sharing (UE). n anii 2010-2011, doar cinci state membre ale NATO alocau pentru aprare mcar 2% din PIB iar Frana, Germania i Marea Britanie contribuiau cu circa 65% din totalul cheltuielor de aprare la nivelul UE. Health spending fell across the European Union in 2010, as cash-strapped governments curbed outlays to help cut budgetary deficits, according to Health at a Glance: Europe 2012, a new joint report by the OECD and the European Commission. This drop in spending per person and as a percentage of GDP reverses increases seen in the years before the economic crisis, when health spending per person grew two or three times faster than incomes in many countries. From an annual average growth rate of 4.6% between 2000 and 2009, health spending per capita fell to 0.6% in 2010. This is the first time health spending has fallen in Europe since 1975. In Ireland, health spending fell 7.9% in 2010, compared with an average annual growth rate of 6.5% between 2000 and 2009. InEstonia, health expenditure per person dropped by 7.3% in 2010, following growth of over 7% per year from 2000 to 2009, with reductions in both public and private spending. In Greece, estimates suggest that health spending per person fell 6.7% in 2010, reversing annual growth of 5.7% between 2000 and 2009. The report cautions that the reduction or slowdown in spending in nearly all EU countries may have a long-term impact on health care outcomes. Spending on disease prevention accounts for only 3% of total health spending Governments, under pressure to protect funding for acute care, are cutting other expenditures such as public health and prevention programmes. In 2010, on average across EU countries, only 3% of health budgets was allocated to prevention and public health programmes in areas such as immunisation, smoking, alcohol drinking, nutrition and

physical activity. The report notes that spending on prevention now can be much more cost-effective than treating diseases in the future. More than half of adults in the European Union are now overweight, and 17% are obese. Obesity rates have doubled since 1990 in many European countries, and now range from 8% in Romania and Switzerland to over 25% in Hungary and the United Kingdom.Obesity and smoking are the major risk factors for heart disease and stroke which accounted for over one-third (36%) of all deaths across EU countries in 2010. Finland, France and Hungary have recently introduced taxes on unhealthy food and drink as part of their efforts to counter obesity. These fat taxes are designed to change eating habits, while at the same time generating public revenues that may be used to support other public health and prevention programmes. Health spending as a share of GDP was highest in the Netherlands (12%) in 2010, followed by France and Germany(11.6%). The share of GDP allocated to health was 9.0% on average across EU countries, down from 9.2% in 2009. Reductions in public spending on health were achieved through a range of measures. In Ireland, most of the reductions have been achieved through cuts in wages and a reduction in the number of healthcare workers as well as the fees paid to professionals and pharmaceutical companies. Estonia cut administrative costs in the Ministry of Health and the prices of publicly-reimbursed health services. Investment in health infrastructure has also been put on hold in a number of countries, including the Czech Republic, Estonia, Iceland and Ireland, while gains in efficiency have been pursued through mergers of hospitals or accelerating the move from inpatient care in hospital to outpatient care and day surgery. Other measures have been introduced to make people pay more out of their pockets. For example, Ireland increased the share of direct payments by households for prescribed pharmaceuticals and appliances, while the Czech Republic increased users charges for hospital stays. In 2010, EU member states devoted on average (unweighted) 9.0% of their GDP to health spending in 2010 (Figure 5.3.1), up significantly from 7.3% in 2000, but down slightly from the peak of 9.2% reached in 2009 following the economic crisis which started in many countries in the middle of 2008. In many countries, public spending on health was maintained in 2009 while GDP was falling strongly, but this was followed in 2010 by the implementation of a range of measures to reduce government health spending as part of broader efforts to reduce large budgetary deficits and debts. The Netherlands had the highest share of its GDP allocated to health in 2010 (12%), followed by France and Germany (both at 11.6%) With the exception of Cyprus, public funding remains the main source of financing of health expenditure in all EU member states, with close to three-quarters of all spending being paid by public sources (see Indicator 5.6). The ranking of countries in terms of public expenditure on health as a share of GDP is not very different from total expenditure on health. The Netherlands (9.6%) and Denmark (9.5%) had the highest share of public expenditure on health to GDP, followed by France (9.0%) and Germany (8.9%). Cyprus had the lowest share of public spending on health to GDP (3.2%), followed by Bulgaria (4.0%) and Latvia (4.1%). The allocation of spending by type of care varies significantly across European countries. Spending for inpatient care, day care and outpatient care depends on the institutional arrangements for health care provision. In Portugal and Sweden, for example, the majority of curative and rehabilitative spending is on outpatient care, with relatively low levels of hospital inpatient activity. In some other countries, such as Bulgaria and Romania, inpatient activity (including day care) plays a more dominant role accounting for over two-thirds of all curative and rehabilitative care expenditure. The other major category of health expenditure is on medical goods, mainly pharmaceuticals (see Indicator 5.5). In Hungary and the Slovak Republic, expenditure e on medical goods is in fact a larger spending category than inpatient care or outpatient care, represent ing 37% of current health expenditure. In Norway and Switzerland, on the other hand, spending on medical goods represents only 12% of total health spending. Differences in the consumption pattern of pharmaceuticals and relative prices play a role

in explaining some of the variations between countries. There are some large differences between countries in their expenditure on long-term care. Countries such as Denmark, the Netherlands and Norway, which have established formal arrangements for the elderly and the dependent population, allocate more than 20% of current health spending to long-term care. In countries with less comprehensive formal long-term care services such as Portugal, the expenditure on long-term care accounts for a much smaller share of total spending. There are some large differences between countries in their expenditure on long-term care. Countries such as Denmark, the Netherlands and Norway, which have established formal arrangements for the elderly and the dependent population, allocate more than 20% of current health spending to long-term care. In countries with less comprehensive formal long-term care services such as Portugal, the expenditure on long-term care accounts for a much smaller share of total spending. over the past decade, but the growth in inpatient services exceeded outpatient care. On average across EU member states, the growth in inpatient spending was slightly above the growth in outpatient spending during the past decade. Pharmaceutical expenditure accounted for almost a fifth (19%) of all health expenditure on average in EU member states in 2010, making it the third biggest spending component after inpatient and outpatient care. Increased spending on pharmaceuticals has contributed to the overall rise in total health expenditure over the past decade, although the growth rate turned negative in several countries in 2010. The relationship between pharmaceutical expenditure and other health expenditure is a complex one, in that increased expenditure on pharmaceutical s to tackle different diseases may reduce the need for costly hospitalisations and interventions now or in the future. The total pharmaceutical bill across the European Union reached more than EUR 190 billion in 2010. However, there are wide variations in pharmaceutical spending per capita across countries, reflecting differences in volume, structure of consumption and pharmaceutical prices (Figure 5.5.1, left panel). At EUR 528, Ireland spent more on pharmaceuticals than any other European country on a per capita basis. This is 50% above the average across EU member states of EUR 349. Other countries with relatively high pharmaceutical expenditure include Germany (EUR 492), Belgium (EUR 479) and France (EUR 468). At the other end of the scale, Romania spent only EUR 164 per capita. Denmark, Estonia, Latvia and Poland are also among the countries that have relatively low pharmaceutical spending per capita, at less than 70% of the EU average. Pharmaceutical spending accounted for 1.6% of GDP on average across EU member states, ranging from below 1% in countries such as Denmark, Luxembourg and Norway, to more than 2% in Bulgaria,Hungary, the Slovak Republic and Serbia Many European countries have attempted to control pharmaceutical expenditures even before the recession via a mix of price and volume controls directed at physicians and pharmacies, as well as policies targeting specific products (OECD, 2010b). In Germany, pharmaceutical companies must now enter into rebate negotiations with health insurance funds for new innovative medicines, putting an end to the previous free-pricing regime. Spain mandated a price reduction for generics and introduced a general rebate applicable for all medicines prescribed by NHS physicians in 2010. In France, price reductions or rebates on pharmaceuticals have often been used as adjustment variables to contain health spending growth while in the United Kingdom caps were introduced on pharmaceutical companies profits relating to NHS sales. Main findings: The analysis shows that social protection is generally the main expenditure item across the EU, followed by health care, education, general public affairs and economic affairs. The combined share of spending items that are presumed to be more growth-friendly (education, health care, R&D etc.) varies across countries. With respect to the economic composition, the share of public capital expenditure is higher in recently acceded Member States of Central and Eastern Europe, signalling the importance of catching-up dynamics.

Main findings: while there are considerable differences across countries, the shares of social protection in public spending have generally increased, with a corresponding reduction in the shares of several other functions, including education, whereas the cross-country pattern is less clear-cut for health care and economic affairs. Overall, these changes, albeit partly reflecting the role of social protection as automatic stabiliser and its responsiveness to the social needs induced by the crisis, do not appear to go in the direction of a more growth-friendly expenditure structure. In terms of economic types of spending, recent cuts mainly affected investments (confirming this is an easy target for consolidation), compensation of employees and intermediate consumptions. Compared to other European countries, the Slovak public sector is relatively small. Last year, public expenditure measured as a share of the economy reached 37.4% of GDP, one of the lowest figures in the European Union. The room for cuts in public spending is thus significantly smaller compared to countries where the public sector makes up more than half of the economy (See Graph 1).

Graph 2 - Government expenditure by function

As we can see, spending on some public services in Slovakia, such as education, is significantly lower compared to the European average. These areas are definitely not suitable for cuts. Slovakias public spending on social welfare is far below average as well. The only area in which public spending in Slovakia exceeds the European average, is spending on public order and safety (2.7% of GDP in Slovakia compared to 1.9% of GDP in the EU). This category of public expenditure includes spending on the police, firefighters, courts, prisons and other institutions responsible for maintaining public order and safety. In fact, spending on public order and safety in Slovakia exceeds that of all other

EU states

Exactly which areas of public order spending could potentially be reduced? Well, the entire Slovak court system (excluding the Highest Court and the Constitutional Court) costs Slovak taxpayers just 150 million euro annually, or 0.2% of GDP, a number similar to many other European states. As there doesnt seem to be much room in the court system, lets take a look at the police. The Ministry of Interior is responsible for the police in Slovakia. Its annual budget in 2013 was roughly 900 million euro ( or 1.2% of GDP), almost three times the budget of the Ministry of Justice, with a total staff of around 36 thousand people for a country with a population of 5.4 million, making it the largest of all Slovak ministries. In comparison, the Austrian Interior Ministry only employs slightly more than 31 thousand people on a budget of 0.8% of GDP for a population of 8.4 million.

Bulgaria (BG)

Letonia (LV)

Lituania (LT)

Polonia (PL)

Croaia (CR)

For the EU-27, general government expenditure, including central, state and local governments and social security funds amounted to around 6 200 billion euro in 2011, or 49.1% of GDP. The proportion for the euro area was almost identical at 49.4% of EA-17 GDP (nearly 4 666 billion euro).

In ten Member States, share of government expenditure in GDP was higher than the weighted EU-27 average. The highest levels were found in Denmark, France, Finland and Belgium, all with proportions above 53%. After having had by far the highest proportion in 2010, reaching 66.6% of GDP (a result of the economic and financial crisis), Ireland's public expenditure was reduced to 48.7%. On the other end of the scale, Switzerland was the country with the lowest government spending relative to GDP (34.2%). The share did not exceed 40% in Bulgaria, Slovakia, Lithuania, Romania, Estonia and Latvia as well. In ten out of the twelve Member States that joined the EU in 2004 and 2007, total general government expenditure remained below 48% of GDP. Among the 'old' EU Member States, Luxembourg had the lowest proportion at 42.0% of its GDP. The division 'general public services' includes expenses related to executive and legislative organs, financial and fiscal affairs, external affairs, foreign economic aid, basic research and expenses related to debt. The function 'defence' includes both military and civil defence, as well as foreign military aid, while the public order and safety function covers police and fire services, law courts and prisons. Spending on these traditional functions amounted to 1 224 billion euro, 10.0% of EU-27 GDP in 2010 (or 19.7% of all government expenditure), which was the same proportion as in 2002. Within this group, 'general public services' is the most

important with 6.5% of EU-27 GDP in 2010. 'Defence' and 'public order and safety' have fairly similar shares, 1.6% and 1.9% of GDP respectively in EU-27, all quite stable compared with 2002. Among countries, expenditure on traditional functions is relatively homogeneous within the EU: most of the countries had figures between 8% and 12% of GDP. It is essentially Luxembourg and Ireland at the lower end (6.0% and 6.3% of GDP respectively) and Cyprus and Greece at the top end (15.4% and 15.0% of GDP) that diverge from the global picture For the latter two, this divergence is explained by a relatively high share of spending in general public services (more than 10% of GDP in both cases), combined with a relatively high share of expenditure in the defence function. Cyprus and Greece together with France and the UK are the only countries for which the public expenditure on defence exceeds 2.0% of GDP although it has substantially decreased in Greece where it was over 3% of GDP in 2002. Government expenditure on culture and education Expenditure relating to 'recreation, culture and religion' and 'education' accounted for 6.7% of EU-27 GDP in 2010, compared with 6.3% in 2002. Education alone represented 10.8% of total government expenditure in the EU-27. This

function embraces the various levels of formal education (from pre-primary to tertiary education). At the level of EU27, government expenditure on education increased in relative terms, moving from 5.2% of GDP in 2002, to reach 5.5% of GDP in 2010. General government expenditure on education, as a percentage of GDP was highest in Iceland (8.3% in 2010), Denmark (8.1%), Cyprus (7.5%), Sweden and the United Kingdom (both 7.0%). The lowest percentages were found in Romania (3.4%), Bulgaria and Greece (both 3.8%), Germany (4.3%), Italy and Slovakia (both 4.5%), generally indicating on the basis of detailed data either some relative public under-investment in preprimary or in tertiary education facilities or sometimes in both. Compared with 2002, education expenditure by government increased by 1.5 percentage points in Ireland and Cyprus. In the case of Ireland, it seems that more funds have been dedicated to primary and secondary education while tertiary education has profited as well in Cyprus. On the other hand, government spending on education decreased by 0.6 pp in Romania and by 0.4 pp in Poland and Norway.Concerning the nature of spending in education, compensation of employees is the most significant item, representing more than 60% of total expenditure at EU level. For 'recreation, culture and religion', operating costs are dominant as well, followed by an equal sharof compensation and intermediate consumption, which account for 30% each of total spending in this function. The COFOG function ''recreation, culture and religion' represented 2.3% of total government expenditure or 1.2% of EU-27 GDP in 2010. Iceland was the country with the largest proportion of government expenditure in this function (3.7% of GDP). Within the EU, Slovenia and Estonia were the only two Member States for which this share exceeds 2%.