If you’ve ever worked with public hospitals, clinics, pharmacies, or distributors in Europe, you’ve probably asked yourself one simple question: why does it always take so long to get paid? It’s a common frustration. Invoices stretch out for months, reminders go unanswered, and there’s always some excuse. But the reasons behind these delays are more than just bad habits—they’re built into the way the system works.
Let’s start with public hospitals. They’re often the slowest payers, and not because they want to be. Their problem almost always comes down to cash flow. Public hospitals don’t run like businesses. They don’t make profits. They rely almost entirely on government funding, and that funding isn’t always available when they need it. Every year, hospitals submit their budget requests, and governments allocate funds—usually based on what they think the hospital needs, not always what it actually costs to run one.
Now here’s the issue: that budget might get approved, but it doesn’t mean the money shows up right away. In many countries, hospitals receive their funding in batches—sometimes quarterly, sometimes even less frequently. That means hospitals have to ration their cash and decide what to pay first. Often, it’s salaries, utilities, and critical care costs. Suppliers? They get bumped down the list.
Government treasuries also play a big part here. They’re the ones holding the purse strings. Even if the money has been approved on paper, the treasury might delay the release of funds to manage national cash flow. When they do release it, they also decide where it goes first. Maybe one hospital is in crisis mode, another one is building a new wing, or a third just has better political connections. The result? Suppliers can be left hanging for months waiting to get paid—even if the hospital itself wants to pay them.
Another big problem: hospital budgets often don’t match reality. Healthcare needs are hard to predict. A new wave of flu patients, a broken MRI machine, or a small local outbreak can completely throw off spending plans. Since hospitals don’t have a cushion of spare cash, they’re forced to delay payments or ask suppliers to extend credit while they scramble for funds.
Distributors and wholesalers also feel the ripple effect. They’re often stuck in the middle—waiting for hospitals to pay them while trying to manage their own payments to manufacturers. It becomes a chain of delays, where everyone is depending on someone else’s payment before they can make their own.
Then there are pharmacies. These might seem like smaller, more nimble players, but they’ve got their own cash problems. Most pharmacies rely heavily on reimbursements from national health insurance systems or private insurers. When a patient comes in with a prescription, the pharmacy dispenses the medication and then submits a claim to get reimbursed. But those reimbursements don’t happen overnight. It can take weeks—or longer—for the money to come in.
You’d think pharmacies could just cover the gap with their own cash, right? Not so simple. Most pharmacies operate with very tight margins, especially in countries where drug prices are regulated. They’re not sitting on piles of cash. If they were to buy all the medicines upfront with their own money, they’d risk running out of liquidity quickly. So instead, they wait. And while they wait, their suppliers wait too.
Why don’t pharmacies push harder to get paid faster? Because they often can’t. Dealing with insurance bureaucracy is slow, and negotiating faster payment terms isn’t always an option. Plus, many pharmacies rely on predictable but delayed payments—they build it into their operations. They take out short-term credit or arrange rolling payment terms with wholesalers to make things work. It’s not ideal, but it’s how the system functions.
So who actually gets paid on time? It’s usually whoever is the most essential—or the most vocal. Salaries come first. Electricity and water bills get paid. Emergency suppliers, those with exclusive products, or those who can’t be replaced easily, are more likely to see their money sooner. The rest? They’re told to wait. Sometimes for 60 days. Sometimes for 120. Sometimes longer.
This isn’t just an issue in one country—it’s widespread across Europe. Some countries are better at managing healthcare budgets than others, but the underlying structure is similar. Governments fund public healthcare. Hospitals, clinics, and pharmacies depend on those funds. Suppliers depend on all of them. And when there’s a hiccup in the chain—whether it’s a late budget, a government spending freeze, or a rise in patient demand—payments get pushed back.
The frustrating part is that none of these problems are new. Everyone knows the issues. Suppliers build late payments into their forecasts. Hospitals regularly juggle priorities. Pharmacies expect reimbursement delays. Yet the system keeps operating this way year after year, because no one has found a better structure that still ensures healthcare remains mostly free or affordable for patients.
So what’s the fix? It’s not an easy one. Governments could allocate more realistic budgets and release funds faster. Treasuries could improve transparency around how they prioritize payments. Reimbursement processes for pharmacies could be streamlined. Digital billing and centralized tracking could help reduce bottlenecks. But all of that requires coordination—and political will.
Until then, suppliers, distributors, pharmacies, and even hospitals themselves will keep living in a cycle of delays, reminders, and negotiations. It’s the cost of doing business in a system that’s not built for speed—but built, above all, for access and care. That mission is noble, but the operations behind it still have a long way to go.
