Malta stands out within the European Union for its unusually high spending on retail pharmaceuticals, a pattern that places a significant financial burden on households.
Retail medicines accounted for 18% of Malta’s total health expenditure in 2023, well above the EU average of 13%. On a per capita basis, spending reached €648, the second highest in the bloc after Germany. Around 90% of this expenditure was on prescribed medicines, with the remainder spent on over-the-counter products.
This emerges from the State Of Health In The EU: Malta – Country Health Profile 2025, issued in December by the Organisation for Economic Co-operation and Development (OECD) and the European Observatory on Health Systems and Policies.
Yet, despite high retail prices and a substantial out-of-pocket burden, Malta records exceptionally low levels of unmet medical need. In 2024, just 0.5% of the population reported being unable to access medical care due to cost, distance or waiting times, seven times lower than the EU average. Among people at risk of poverty, the rate remains among the lowest in the EU at 1%.
Breakdown of pharmaceutical expenditure
Pharmaceutical spending in Malta is split almost evenly between public and private sources. In 2022, government funding covered 55% of total retail pharmaceutical expenditure, while out-of-pocket payments accounted for a substantial 41%, above the EU average of 39%.
A small share, around 4%, is covered by voluntary health insurance or other private schemes. By contrast, in France, 83% of expenditure on medicines is covered directly by the state and only 12% is paid directly by households.
This reflects a broader reliance on private spending within the health system. Overall out-of-pocket health expenditure in Malta stands at 31%, nearly double the EU average of 16%. This includes costs such as dental care and private medical consultations.
On average, governments or compulsory insurance schemes cover 35% of dental care costs in the European Union, but only 11% of these costs in Malta. For outpatient care, public or mandatory insurance covers 77% of costs across the EU, compared with just 59% in Malta.
In the case of medicines, 59% of expenditure across the EU is financed by government or mandatory insurance schemes, compared with 55% in Malta.
By contrast, inpatient hospital care in Malta is in line with the EU average, with 92% of costs publicly financed.
According to the report, this trend is driven by long waiting times in the public sector and a preference for continuity of care and the wider range of medicines offered by private providers. Consequently, public coverage for most services remains below EU averages.
Targeted assistance
The report notes that only individuals on low incomes and those with certain eligible chronic conditions, around 30% of the population in 2023, received free outpatient medicines through yellow or pink cards. These cards cover treatments listed on the Government Formulary List.
The list of scheduled chronic conditions, defined under the Social Security Act, is regularly updated and relatively comprehensive, covering conditions such as hypertension and diabetes. Pink cards are intended to provide additional protection for particularly vulnerable groups, but only 3% of the population held a Pink Card in 2025.
As a result, roughly two-thirds of the population do not qualify for either a yellow or pink card and must pay the full cost of outpatient prescriptions. However, the report suggests that the low proportion of people with unmet medical needs shows that the system is functioning despite its reliance on the private sector.
Moreover, to mitigate disadvantages linked to its small market size, Malta relies on international collaboration to improve affordability and access to new medicines.
Life expectancy rebounds
Malta’s health system delivers several strong outcomes, most notably life expectancy at birth, which reached 83.3 years in 2024, 1.6 years higher than the EU average. This represents a successful rebound following a temporary decline during the pandemic.
Malta ranks fourth in the EU for life expectancy, behind Italy, Sweden and Spain, and is on a par with Norway. The gender gap is also narrower than the EU average, with women living 3.5 years longer than men, compared with a 5.2-year gap across the EU.
Maltese citizens also enjoy a higher number of healthy life years than the EU average, reporting fewer activity limitations after the age of 65.
Persistent vulnerabilities
Despite high life expectancy, the report identifies major vulnerabilities, particularly lifestyle-related risk factors. Malta has the highest rates of overweight and obesity in the EU for both adults and adolescents, driven by poor nutrition and low physical activity, especially among 15-year-olds. Adult smoking rates also remain above the EU average.
These risks are unevenly distributed, with people with lower levels of education twice as likely to be obese or to smoke daily.
Workforce and infrastructure pressures persist. While physician numbers are high, the proportion of general practitioners is declining and nurse density remains below the EU average. The report also flags a recent spike in antibiotic consumption, placing Malta off track to meet its 2030 reduction targets.
As a small island state, Malta is also highly vulnerable to climate change, with rising temperatures projected to lead to a 300% increase in heat-related deaths by the end of the century.
Shortage of hospital beds
Malta has fewer hospital beds per capita than most EU countries, contributing to overcrowding and pressure on emergency departments. In 2023, Malta had 4.1 hospital beds per 1,000 population, down from 4.4 in 2020 and well below the EU average of 5.1.
Hospital discharge rates are also lower than the EU average, but bed occupancy rates for curative care are higher, indicating limited reserve capacity. These pressures are most evident at Mater Dei Hospital, which has faced persistent overcrowding and long emergency department waiting times, driven largely by population growth.