Even so, the most recent health expenditure data shows an increase in out-of-pocket payments as a percentage of total health expenditure in the majority of European countries. However, this statement needs qualifying, as in several countries the provision of services is determined at the local or provider level, subject to resource constraints. As budgets are tightened, in these countries, it is possible that there have been changes in coverage, but in a manner difficult to quantify. Section 2 of this paper defines what is considered as “health coverage” in the sections that follow.