Country Briefs for Healthcare Managers

EAHM resources · Country briefs

Understanding health systems.
Strengthening management.

Explore healthcare systems through a management lens. EAHM Country Briefs connect governance, financing and service delivery with the careers, capabilities and decisions of healthcare leaders.

10
Country briefs available

Different health systems.
A shared framework for understanding management in practice.

Understand the system

See how governance, financing and provision shape the decisions managers can make.

Explore management careers

Discover national routes into leadership, professional development and senior responsibility.

Find lessons for practice

Connect reforms, performance and digital health with practical management questions.

Browse the collection

Choose a country

Explore the available briefs below, listed in alphabetical order.

10 country briefs

Austria

Federal social health insurance

Shared national steering, regional hospital responsibilities and a reform agenda linking primary care, financing and digital access.

Shared governancePrimary care

Belgium

Negotiated social health insurance

Federal and federated responsibilities, plural providers and hospital networks, with integration and financial protection in focus.

Hospital networksIntegration

France

Social health insurance & state stewardship

Regional planning, mixed provision and a distinctive national hospital-management career model, alongside territorial coordination.

Management careersRegional planning

Germany

Federalism & negotiated self-government

Plural hospital ownership and extensive capacity, with reform reshaping service capability, quality and organisational responsibilities.

Hospital reformSelf-government

Greece

Public services & national purchasing

Tax-supported public care and private provision, with reforms addressing access, accountable leadership, prevention and digital services.

AccessAccountable leadership

Ireland

Tax-funded public health system

Mixed public, voluntary and private provision, with regional reorganisation connecting hospitals, community care and population needs.

Regional integrationCapacity & access

Lithuania

Compulsory health insurance

National purchasing and municipal care networks, with a focus on stronger teams, leadership development and affordable access.

Local care networksLeadership development

Luxembourg

Centralised social health insurance

Strong public financing and provider choice, with cross-border care and workforce flows shaping capacity, coordination and management.

Cross-border careWorkforce

Portugal

Tax-funded national health service

A public national health service complemented by private and social-sector providers, with integrated, population-based care in focus.

Local Health UnitsPopulation health

Switzerland

Mandatory insurance & cantonal authority

Federal rules, cantonal responsibilities and regulated competition, with management challenges in cost, quality and care coordination.

Cantonal governanceCare coordination

Learn across countries

Compare systems. Understand management.

Explore how different arrangements shape authority, professional careers and the work of healthcare leaders.

Comparing: France, Ireland, Portugal.
Comparison ready.

Compare health systems

Compare financing, authority and delivery arrangements across the selected countries.

Health systems: France, Ireland, Portugal
Comparison dimension
Financing model

Statutory health insurance combines social contributions and earmarked taxes. Complementary insurance and household payments also contribute.

General taxation finances the public health service, complemented by private insurance and household payments. Entitlements differ by service.

General taxation finances the SNS. Occupational health subsystems, voluntary insurance and household spending coexist with the public service.

Decision-making authority

National stewardship remains strong. Regional health agencies plan, regulate and coordinate services within the national framework.

National policy and HSE stewardship coexist with regional budgets and leadership within a single HSE organisation.

National health authorities set the framework; Local Health Units combine primary and hospital care, with separate arrangements in the autonomous regions.

Purchasing and payment

National insurance arrangements and regulated payment mechanisms finance care; regional agencies have service-planning and allocation responsibilities.

The HSE delivers and funds statutory services and contracts or funds voluntary organisations, independent practitioners and other providers.

Public budgets and contracting support SNS delivery, with agreements involving private and social-sector providers for some services.

Provider landscape

Public hospitals, private not-for-profit and commercial hospitals coexist with largely independent ambulatory professionals.

Public, voluntary and private organisations coexist; hospital and community services operate through different employment and contractual arrangements.

Public primary and hospital services coexist with private and social-sector providers, particularly in ambulatory and complementary services.

Integration agenda

Territorial hospital cooperation and primary-care coordination must align organisations, professional practice and population needs.

Health Regions bring hospital and community responsibilities together, with a focus on population need, local decisions and pathway coordination.

Local Health Units bring primary and hospital care under common governance, requiring operational coordination around population needs.

What this means for managers

Editorial interpretations to support learning across systems.

France

Strong national stewardship still needs territorial agreements, workforce capacity and operational coordination to improve access.

Ireland

Translate regional responsibility into decisions about workforce, community alternatives, patient flow and access across the whole pathway.

Portugal

Make common governance visible in referral, staffing, information and accountability across primary and hospital services.

Compare management careers

Distinguish a professional career, appointment to an executive post and regulated clinical leadership.

Management careers: France, Ireland, Portugal
Comparison dimension
Professional framework

Directeur d’hôpital is a nationally regulated public-service corps, with responsibilities spanning executive leadership, management and expertise.

The HSE publishes a graded management and administration pathway. It is distinct from a separate nationally protected hospital-administrator profession.

Hospital Administration is a specialised statutory career. Its professional status is distinct from a mandate on an executive board.

Entry and qualification

Competitive recruitment and other statutory routes apply. The principal professional formation is the EHESP hospital-director programme.

Multiple entry routes exist, including qualifications and relevant experience. Requirements vary by grade, profession and the advertised post.

Decree-Law 101/80 links entry to the Hospital Administration diploma at the National School of Public Health or a recognised equivalent.

Career progression

The statutory framework provides grades and routes for mobility, promotion and appointments across public hospital-management functions.

The published pathway spans administrative and managerial grades, General Manager and regional or national leadership; progression involves relevant recruitment processes.

The legal career framework provides grades and progression arrangements. The existence of grades must be distinguished from actual recruitment and mobility.

Executive appointment

Joining the corps and appointment to a particular directorship are distinct decisions governed by the relevant national and institutional rules.

Senior posts are filled through the applicable recruitment and appointment arrangements; administrative progression does not automatically confer an executive role.

SNS and Local Health Unit executive-board appointments follow their own governance statutes; career membership does not automatically confer a board position.

Clinical leadership

The hospital-director corps is distinct from medical and nursing leadership. Governance requires collaboration across these professional responsibilities.

Medical, nursing and other regulated professions have their own leadership routes alongside general administrative and operational management.

Medical and nursing leadership depend on their professional and appointment frameworks. Multidisciplinary management connects these responsibilities with administrative expertise.

Continuing development

EHESP professional formation combines academic and practical learning; continuing development supports subsequent leadership and mobility.

HSE learning, leadership programmes and management education support capability. Professional disciplines and voluntary employers provide additional development routes.

Specialist postgraduate formation combines management knowledge and practice. Continuing learning should support operational and population-based responsibilities.

What this means for managers

Editorial interpretations to support learning across systems.

France

Compare the relationship between national recruitment, formation and career continuity, while preserving the distinction between status and a specific appointment.

Ireland

A visible graded pathway can support development; integrated leadership also needs clinical credibility, partnership and experience across organisational boundaries.

Portugal

Read specialist qualification, career continuity and executive appointment as connected but distinct elements of professional management.

How to read the comparison

The comparison uses eleven qualitative dimensions and was reviewed on 29 October 2026. System descriptions concern national arrangements; career entries identify the relevant public-service or provider context. Private providers, local law and individual posts may have different rules.

Framework labels are editorial summaries of the documented arrangements. A professional qualification, membership of a career and appointment to a leadership post are distinct. Management interpretations explain potential lessons and conditions for transfer. National rules and institutional scope are linked below.

Indicator scores, salary comparisons and country rankings are outside this qualitative comparison. The individual briefs retain their own update dates, source years and detailed evidence.

Evidence and national context

Sources and country notes

Open a country for its full comparison summary, scope and principal sources.

AustriaSources and scope

Scope: Career summaries focus on hospital administrative and economic leadership. Detailed requirements vary by Land, operator and post.

Health system

Financing model

Mandatory social health insurance and taxation finance care, alongside household payments and voluntary insurance.

Decision-making authority

The federation, Länder and social insurance share authority. Joint steering operates within distinct legal responsibilities.

Purchasing and payment

Social insurance contracts much ambulatory care; hospital financing combines regional funds and other public and insurance resources.

Provider landscape

Public, charitable and private hospitals coexist with independent ambulatory professionals and other care organisations.

Integration agenda

Joint planning and stronger primary-care teams must connect services whose financing and responsibilities remain divided.

Management interpretation

Map the authority, funding and professional agreements needed to change a pathway before setting a delivery commitment.

Management careers

Professional framework

A statutory administrative and economic leadership function sits within careers shaped by employers and Länder, rather than one national ladder.

Entry and qualification

KAKuG §11 requires a suitable administrative leader and provision for training. Specialist management programmes support role-specific preparation.

Career progression

Managers develop through functional, site, group, public-service and insurance roles; progression depends on the relevant organisation.

Executive appointment

Hospital operators and governing bodies select senior leaders under the applicable organisational and Länder framework.

Clinical leadership

Administrative, medical and nursing responsibilities are distinct; collegial arrangements depend on the applicable hospital law and governance.

Continuing development

Hospital law provides for education and continuing development. Specialist university and sector programmes complement workplace learning.

Management interpretation

A legally defined management function needs credible formation, transparent appointments and clear shared decisions with clinical leaders.

Principal sources
BelgiumSources and scope

Scope: Career summaries concern hospital general management. The statutory director’s office is distinct from a uniform national management career.

Health system

Financing model

Compulsory social insurance combines contributions and public transfers, with household payments and complementary voluntary cover.

Decision-making authority

Federal and federated authorities share responsibilities; insurance, professional negotiation and regional competences shape implementation.

Purchasing and payment

NIHDI/INAMI/RIZIV and sickness funds administer compulsory reimbursement within negotiated benefits, tariffs and hospital-financing arrangements.

Provider landscape

Independent professionals and public and private not-for-profit hospitals provide care, with broad patient choice.

Integration agenda

Hospital networks and integrated-care programmes must connect organisations and authorities with separate budgets and decision rights.

Management interpretation

Connect federal financing, federated responsibilities and clinical agreements in one implementable pathway or network plan.

Management careers

Professional framework

Hospital law defines a director accountable to the governing entity. Career routes and education remain plural and employer-based.

Entry and qualification

Management, economics, law, public health and clinical backgrounds can feed general-management careers; individual posts specify their requirements.

Career progression

Progression runs through institutional functions, hospital leadership, networks, insurance and public bodies, under the relevant employment framework.

Executive appointment

The hospital governing entity appoints leadership within its legal and governance arrangements; appointment is separate from professional qualification.

Clinical leadership

The director works with the chief physician, nursing head and other professional leaders under statutory consultation and organisational arrangements.

Continuing development

Universities, employers and the Belgian Association of Hospital Managers offer specialist education and continuing professional exchange.

Management interpretation

Formalising the director’s responsibility works best when boards also make selection, capability development and network accountability explicit.

Principal sources
FranceSources and scope

Scope: The career comparison centres on the directeur d’hôpital corps in public hospitals. Private providers and other public leadership tracks follow different arrangements.

Health system

Financing model

Statutory health insurance combines social contributions and earmarked taxes. Complementary insurance and household payments also contribute.

Decision-making authority

National stewardship remains strong. Regional health agencies plan, regulate and coordinate services within the national framework.

Purchasing and payment

National insurance arrangements and regulated payment mechanisms finance care; regional agencies have service-planning and allocation responsibilities.

Provider landscape

Public hospitals, private not-for-profit and commercial hospitals coexist with largely independent ambulatory professionals.

Integration agenda

Territorial hospital cooperation and primary-care coordination must align organisations, professional practice and population needs.

Management interpretation

Strong national stewardship still needs territorial agreements, workforce capacity and operational coordination to improve access.

Management careers

Professional framework

Directeur d’hôpital is a nationally regulated public-service corps, with responsibilities spanning executive leadership, management and expertise.

Entry and qualification

Competitive recruitment and other statutory routes apply. The principal professional formation is the EHESP hospital-director programme.

Career progression

The statutory framework provides grades and routes for mobility, promotion and appointments across public hospital-management functions.

Executive appointment

Joining the corps and appointment to a particular directorship are distinct decisions governed by the relevant national and institutional rules.

Clinical leadership

The hospital-director corps is distinct from medical and nursing leadership. Governance requires collaboration across these professional responsibilities.

Continuing development

EHESP professional formation combines academic and practical learning; continuing development supports subsequent leadership and mobility.

Management interpretation

Compare the relationship between national recruitment, formation and career continuity, while preserving the distinction between status and a specific appointment.

Principal sources
GermanySources and scope

Scope: The career comparison focuses on hospital commercial and executive management. Public, charitable and commercial providers have different governance and employment arrangements.

Health system

Financing model

Compulsory coverage is provided through statutory health insurance or substitutive private insurance; taxation supports additional public responsibilities.

Decision-making authority

Federal and Länder powers coexist with negotiated self-government by insurers, provider associations and other statutory bodies.

Purchasing and payment

Insurers and self-governing institutions shape contracts and reimbursement. Hospital operating finance and capital responsibilities follow different routes.

Provider landscape

Public, charitable and commercial hospitals operate alongside predominantly independent ambulatory practices and other providers.

Integration agenda

Coordination across ambulatory and hospital sectors must accompany hospital planning, service reconfiguration and workforce decisions.

Management interpretation

Read hospital strategy together with payer incentives, Länder planning and the coordination required between care settings.

Management careers

Professional framework

Hospital commercial and executive management follows plural employer-led routes, rather than a single nationally managed hospital-administrator career.

Entry and qualification

Business, economics, law, health management and clinical backgrounds can lead to management; employers set the requirements of individual posts.

Career progression

Careers develop through functions, sites, hospital groups, insurers and public institutions, with mobility governed by organisational and employment arrangements.

Executive appointment

Owners, boards and supervisory structures select senior executives according to legal form, governance and role requirements.

Clinical leadership

Commercial, medical and nursing leadership have distinct responsibilities. The precise executive model varies by organisation and Land.

Continuing development

University programmes, the German Hospital Institute, employers and professional networks support specialist and continuing management education.

Management interpretation

Plural recruitment can draw on varied expertise; transparent mandates and effective commercial, medical and nursing partnership remain central.

Principal sources
GreeceSources and scope

Scope: Executive-selection summaries concern public hospital governors and deputies under the applicable national framework. Other employment and private-sector routes are distinct.

Health system

Financing model

General taxation and compulsory-insurance resources finance public care and EOPYY purchasing, alongside substantial household and private spending.

Decision-making authority

The Ministry of Health has a strong central role; regional health authorities coordinate public services, while EOPYY undertakes purchasing functions.

Purchasing and payment

Public-service budgets and EOPYY reimbursement and contracting support different parts of the care pathway.

Provider landscape

Public hospitals and primary-care services coexist with private hospitals, diagnostic providers and independent professionals.

Integration agenda

Stronger personal-doctor arrangements, referral coordination and information exchange must connect public and contracted services.

Management interpretation

Connect access initiatives with staffed capacity, reliable referrals, affordability and accountability across public and contracted providers.

Management careers

Professional framework

Public hospital governors follow a structured executive-selection framework; this appointment route is distinct from an underlying administrative or clinical career.

Entry and qualification

Law 5062/2023 and the relevant call set executive-selection requirements, combining assessment, qualifications and experience; eligibility is post-specific.

Career progression

Administrative, financial, clinical and operational managers progress through their employment routes; governor selection is a separate senior pathway.

Executive appointment

The public hospital process uses ASEP assessment and selection stages leading to shortlists and ministerial appointment under the applicable rules.

Clinical leadership

Medical and nursing leadership require the relevant professional qualifications and organisational appointment; these routes differ from hospital-governor selection.

Continuing development

Postgraduate healthcare-management education and continuing professional development can support leadership; selection itself does not establish completed management formation.

Management interpretation

Read assessment, appointment and subsequent delivery together; a transparent competition should connect to a clear mandate and performance review.

Principal sources
IrelandSources and scope

Scope: The graded pathway described here is within the HSE. Voluntary and private providers, clinical professions and external senior recruitment follow additional routes.

Health system

Financing model

General taxation finances the public health service, complemented by private insurance and household payments. Entitlements differ by service.

Decision-making authority

National policy and HSE stewardship coexist with regional budgets and leadership within a single HSE organisation.

Purchasing and payment

The HSE delivers and funds statutory services and contracts or funds voluntary organisations, independent practitioners and other providers.

Provider landscape

Public, voluntary and private organisations coexist; hospital and community services operate through different employment and contractual arrangements.

Integration agenda

Health Regions bring hospital and community responsibilities together, with a focus on population need, local decisions and pathway coordination.

Management interpretation

Translate regional responsibility into decisions about workforce, community alternatives, patient flow and access across the whole pathway.

Management careers

Professional framework

The HSE publishes a graded management and administration pathway. It is distinct from a separate nationally protected hospital-administrator profession.

Entry and qualification

Multiple entry routes exist, including qualifications and relevant experience. Requirements vary by grade, profession and the advertised post.

Career progression

The published pathway spans administrative and managerial grades, General Manager and regional or national leadership; progression involves relevant recruitment processes.

Executive appointment

Senior posts are filled through the applicable recruitment and appointment arrangements; administrative progression does not automatically confer an executive role.

Clinical leadership

Medical, nursing and other regulated professions have their own leadership routes alongside general administrative and operational management.

Continuing development

HSE learning, leadership programmes and management education support capability. Professional disciplines and voluntary employers provide additional development routes.

Management interpretation

A visible graded pathway can support development; integrated leadership also needs clinical credibility, partnership and experience across organisational boundaries.

Principal sources
LithuaniaSources and scope

Scope: Career summaries concern institutional leadership in public and municipal healthcare. Competition criteria and continuing-development duties depend on the role and legal scope.

Health system

Financing model

Mandatory health-insurance contributions and state transfers finance the public benefit framework, alongside household payments and limited voluntary cover.

Decision-making authority

The Ministry of Health sets policy and regulation; national and municipal authorities have provider and local service responsibilities.

Purchasing and payment

The consolidated NHIF administers compulsory insurance and contracts services nationally, retaining regional service functions after the 2025 merger.

Provider landscape

Public hospitals and municipal providers coexist with contracted private primary and outpatient care, including independent professional practices.

Integration agenda

Municipal health-centre arrangements aim to connect primary, specialist and other services through cooperation or organisational restructuring.

Management interpretation

Turn unified purchasing and local cooperation into agreed pathways, staffed teams, reliable information and observable access improvements.

Management careers

Professional framework

Institutional leadership combines public competition, post-specific requirements and development duties; appointment is distinct from a general management career.

Entry and qualification

Relevant education and leadership experience are specified by the competition. Published hospital notices illustrate differing academic and experience requirements.

Career progression

Managers develop through services, functions and projects; a director’s competition is a separate selection process rather than an automatic career promotion.

Executive appointment

Public or municipal governance arrangements provide for institutional selection and appointment. Published examples include competition followed by a fixed-term mandate.

Clinical leadership

Medical, nursing and specialist-management responsibilities have distinct qualification and organisational requirements; general-management experience does not replace professional eligibility.

Continuing development

Mandatory continuing-development duties apply to covered public and municipal institution leaders; university management programmes offer additional formation.

Management interpretation

Compare appointment criteria and continuing-development duties separately, and check their institutional scope before transferring a model.

Principal sources
LuxembourgSources and scope

Scope: Broad management careers must be distinguished from hospital general-director eligibility. Article 29 of the Hospital Act includes medical and management requirements, with exceptions.

Health system

Financing model

Statutory social insurance combines income-related contributions and state support, complemented by household payments and voluntary cover.

Decision-making authority

National ministries oversee health and social-security policy and hospital planning; CNS and institutional governing bodies hold distinct operational responsibilities.

Purchasing and payment

CNS reimbursement, conventions and negotiated hospital budgets finance care within the statutory-insurance framework.

Provider landscape

Hospital institutions and independent ambulatory professionals serve residents and insured cross-border workers; specialised care also crosses national borders.

Integration agenda

Coordination must connect hospitals, ambulatory practice, long-term care and neighbouring systems, supported by shared information.

Management interpretation

Plan capacity and continuity across national boundaries, joining workforce, patient flows, payment and clinical-information requirements.

Management careers

Professional framework

Employer-led management routes coexist with statutory hospital-leadership offices. General-director eligibility is narrower than the wider management labour market.

Entry and qualification

Hospital Act Article 29 sets medical authorisation, certified management formation and experience requirements for covered general-director posts, with specified exceptions.

Career progression

Functional, administrative-financial, clinical and system roles offer different routes. A healthcare-management certificate alone does not establish general-director eligibility.

Executive appointment

The hospital governing entity appoints the general director, who is accountable to it; statutory eligibility and the relevant exceptions must also apply.

Clinical leadership

General-director eligibility for covered hospitals includes medical requirements. Medical, nursing and administrative-financial leadership retain distinct responsibilities.

Continuing development

The university, Competence Centre and FHL offer sector-specific management education; development should address statutory duties and cross-border coordination.

Management interpretation

Separate broad professional development from eligibility for a legally defined post; open education and employer selection do not remove statutory requirements.

Principal sources
PortugalSources and scope

Scope: The specialist Hospital Administration career is compared separately from appointment to SNS or Local Health Unit boards. Private and social-sector employers follow other arrangements.

Health system

Financing model

General taxation finances the SNS. Occupational health subsystems, voluntary insurance and household spending coexist with the public service.

Decision-making authority

National health authorities set the framework; Local Health Units combine primary and hospital care, with separate arrangements in the autonomous regions.

Purchasing and payment

Public budgets and contracting support SNS delivery, with agreements involving private and social-sector providers for some services.

Provider landscape

Public primary and hospital services coexist with private and social-sector providers, particularly in ambulatory and complementary services.

Integration agenda

Local Health Units bring primary and hospital care under common governance, requiring operational coordination around population needs.

Management interpretation

Make common governance visible in referral, staffing, information and accountability across primary and hospital services.

Management careers

Professional framework

Hospital Administration is a specialised statutory career. Its professional status is distinct from a mandate on an executive board.

Entry and qualification

Decree-Law 101/80 links entry to the Hospital Administration diploma at the National School of Public Health or a recognised equivalent.

Career progression

The legal career framework provides grades and progression arrangements. The existence of grades must be distinguished from actual recruitment and mobility.

Executive appointment

SNS and Local Health Unit executive-board appointments follow their own governance statutes; career membership does not automatically confer a board position.

Clinical leadership

Medical and nursing leadership depend on their professional and appointment frameworks. Multidisciplinary management connects these responsibilities with administrative expertise.

Continuing development

Specialist postgraduate formation combines management knowledge and practice. Continuing learning should support operational and population-based responsibilities.

Management interpretation

Read specialist qualification, career continuity and executive appointment as connected but distinct elements of professional management.

Principal sources
SwitzerlandSources and scope

Scope: The comparison concerns general hospital and health-service management. Cantonal law, institutional legal form and regulated clinical professions create additional requirements.

Health system

Financing model

Mandatory basic insurance is financed through premiums and cost sharing, with public premium subsidies and public financing responsibilities, including hospitals.

Decision-making authority

Federal insurance rules coexist with substantial cantonal planning and public-health responsibilities and autonomous provider governance.

Purchasing and payment

Authorised insurers reimburse covered services within tariff and contractual arrangements; cantons have hospital planning and co-financing responsibilities.

Provider landscape

Public, private and other autonomous hospitals operate alongside independent ambulatory professionals, insurers and community providers.

Integration agenda

Care coordination must bridge insurers, cantons, providers and professions through workable agreements and information exchange.

Management interpretation

Create shared objectives and workable contracts across cantons, insurers and providers, with responsibility for the complete patient pathway.

Management careers

Professional framework

General-management careers are plural and employer-led, with organisational, cantonal, insurance and professional routes rather than one national hospital-administrator ladder.

Entry and qualification

Business, law, economics, public administration and clinical backgrounds can feed management. Requirements depend on the post, organisation and applicable law.

Career progression

Progression and mobility run through provider functions, hospital groups, insurance, public administration and transformation roles.

Executive appointment

Boards and governing bodies appoint provider executives according to legal form and ownership; public administrations use their applicable appointment processes.

Clinical leadership

Medical, nursing and other regulated leadership routes have distinct professional requirements alongside organisational management responsibilities.

Continuing development

Universities and sector organisations offer executive and specialist programmes, including CAS, DAS and MAS routes, alongside employer development.

Management interpretation

Develop leaders across clinical, payer and public-governance settings so that institutional autonomy supports coordination and public value.

Principal sources
About the collection

A shared structure. A national perspective.

Each brief follows twelve sections: country overview; system model; financing and provision; reform history; organisation and integration; management careers; care sectors; performance; digital health; management signals; lessons for Europe; and what to watch next.

Read the sources in context

Each brief identifies its update date, sources and indicator reference years. Definitions and reporting periods can differ across countries. Use the collection to understand national contexts and inform learning across systems.