HEALTH INSURANCE COMPANIES

Think the Unthinkable: A European Health Insurance Union

Solving the Healthy Longevity Challenge in the EU

As Europe faces one of the most profound demographic shifts in its history, the need to rethink the structure and mission of health insurance has never been more urgent. By 2030, for the first time in recorded history, older people will outnumber the young across the continent. This is not merely a healthcare issue—it’s a systemic challenge that threatens the economic stability, social cohesion, and wellbeing of the European Union as a whole.

In this context, it is time to ask the unthinkable: Should we evolve toward a small number of integrated “European Health Insurance Companies” that act not only as payers, but as proactive drivers of sustainable health across all 27 EU Member States?

The Case for a Converged European Health Insurance Architecture

Europe’s healthcare financing landscape is currently fragmented, largely rooted in national models shaped by historical, political, and economic legacies. However, most chronic diseases—and certainly ageing—do not respect national borders. The shift from reactive “sickcare” to proactive, personalized, and preventive “Lifecare” demands systemic alignment across public health, research, and finance.

A Europe-wide convergence of health insurance governance could:

• Address Healthy Longevity at scale by coordinating investments in prevention, early detection, and age-tech innovation.

• Improve risk pooling and cost efficiency, especially in rare diseases, high-cost ageing populations, and transnational care delivery.

• Ensure equitable access to next-generation precision medicine and health technologies across all EU citizens.

• Support cross-border healthcare mobility and digital patient data interoperability via a shared ethical and regulatory framework.

• Accelerate value-based care adoption by harmonizing reimbursement models focused on health outcomes and patient-reported measures.

The Optimal Number of Pan-European Health Insurance Companies

A fully centralized “single payer” model across the EU may be politically unrealistic in the short term. However, an optimized federated model built around 4 to 6 pan-European Health Insurance Platforms could be both feasible and transformative. This model could be structured based on population clusters, regional needs, or thematic priorities such as:

1. Healthy Longevity & Preventive Lifecare Platform – Coordinating geroscience, longevity medicine, and early intervention reimbursement.

2. Cross-Border Digital Health Platform – Focused on AI-based diagnostics, telehealth, cybersecurity, and data trust infrastructure.

3. Rare & Complex Disease Risk Pool – Joint coverage for low-incidence, high-cost treatment plans.

4. Value-Based Health Innovation Accelerator – Investing in outcome-based models and startup ecosystem integration.

5. Health Equity & Inclusion Platform – Focusing on underserved and migratory populations.

6. One Health Risk Sharing Consortium – Linking human, animal, and environmental health insurance logic under a climate-sensitive umbrella.

Each platform would act semi-independently but be unified by EU governance principles, shared digital infrastructure, and aligned incentives. Over time, some of these platforms could converge or evolve based on efficiency and public trust.

Economic Rationale: Investing in a Lifespan Economy

The European Commission projects that public health expenditure will rise from 8.0% of GDP today to 10.5% by 2060if current ageing trends continue unmitigated. However, studies show that a 1-year increase in healthy life expectancy could add 1-1.5% GDP growth across OECD countries due to extended workforce participation, reduced dependency, and delayed morbidity.

A coordinated EU-wide insurance effort would serve not only health goals but become a structural pillar of the Healthspan Economy—stimulating growth in biomedical innovation, digital health, long-term care, wellness services, and preventive ecosystems.

Policy Outlook: Toward an EU Lifecare Union

The idea of a “European Lifecare Union” echoes the spirit of Schuman’s vision for economic and political integration post-World War II. Just as the European Coal and Steel Community laid the foundation for the EU through shared infrastructure, a unified health insurance architecture could anchor social cohesion, public health resilience, and economic convergence in the 21st century.

To achieve this, European Health Insurance Companies must shift from administrative payers to strategic value creators—investing in health capital, empowering citizens, and aligning economic incentives with health outcomes.

Conclusion: From Fragmentation to Federation

Creating a small number of European Health Insurance Companies—built to scale, governed with integrity, and focused on prevention and healthspan—could become a transformative vehicle for Europe’s future. The Healthy Longevity Challenge is too vast, too complex, and too urgent for 27 separate insurance systems to tackle in isolation.

The time to think the unthinkable is now. A federated Lifecare Insurance Alliance—rooted in solidarity, sustainability, and science—may be Europe’s best shot at building a future-fit, inclusive, and resilient Health Union.