4.1. EU Public Health Service Capacity
From the perspective of the dynamic evolution of the public health service capacity of the 27 countries of the EU, there has been a gradual increase trend. This is closely related to the development of science and technology, people’s growing medical and health needs. The scores of some countries greatly improved between 2008 and 2017, especially Latvia, which is basically ranked in the bottom three, but its score increased by 36.79% from 38.19 in 2008 to 52.24 in 2017. This is because the total land area of Latvia is 62,046 square kilometers and the total population remains at about 2 million. The demand for public health service capacity is small, so it has a low base starting point and large room for improvement. However, there are significant differences in the capacity of public health services among different countries of the EU. As a country with a relatively high level of medical and health care, Germany’s public health service capacity score increased by 15.27% from 2008 to 2017 [
30]. In particular, the score in 2008 was 82.69, which is about 1.5 times that of other countries. In terms of phases, the growth rate of countries from 2008 to 2010 was slower. The growth rate was relatively fast from 2011 to 2013, and it remained basically stable afterwards. It can be seen that countries in the EU have paid more and more attention to public health services.
From the perspective of horizontal spatial differentiation, the absolute range of the public health service capacity of countries in the EU in 2008 and 2017 remained within 17, which was not greatly improved or decreased.
Figure 1 shows that the countries with the highest public health capacity scores are Germany, France, Italy, the Netherlands, and Spain. Countries with weaker public health services are Cyprus, Estonia, Latvia and Bulgaria. The capacity of public health service has agglomeration characteristics in regional distribution. From the point of view of the average score of public health service capacity, the Western European countries (0.689) are sequentially higher than Northern Europe (0.658), Southern European (0.563) and Eastern European (0.539). This is closely related to the larger areas, larger populations and better economies of Western European countries. From the perspective of the standard deviation, Western Europe is the highest, followed by Southern Europe, Eastern Europe and Northern Europe. It can be seen that although the overall public health service capacity in Western Europe is relatively high, the development is not balanced and stable, while Northern Europe has remained stable and balanced at a high level.
4.2. Analysis of Driving Factors
From the above results, it can be seen that the Tobit model’s fixed effect regression results of population density, degree of opening up, education level, economic development level, urbanization level, technological innovation level and degree of aging are significant. They are driving factors for the public health service capacity of countries in the EU [
31]. However, per capita GDP and the Gini coefficient did not pass the significance test, indicating that there is no direct correlation between per capita GDP and Gini coefficient and public health service capacity. Per capita GDP is the ratio of GDP to the country’s permanent population. It is inseparable from the country’s permanent population and cannot directly reflect the relationship between the economic development level and public health service capacity. The Gini coefficient is an important indicator to measure the income gap of residents. The medical and health resources of economically developed countries are mostly provided to people with a certain economic foundation. Low-income people cannot universally and comprehensively enjoy public health services [
31]. This shows that the gap between the rich and the poor is not related to the capacity of public health services.
The increase in population density promotes the improvement in public health service capacity. Countries with high population density can trigger the agglomeration effect of funds, goods and talents. It strengthens the construction of public health services from the dimensions of funds, goods, and talents, thereby promoting the country’s public health service capabilities. On the one hand, countries with higher population densities have a stronger ability to serve the hinterland and can meet more public health service needs [
32]. On the other hand, for areas with low population density and sparse population distribution, in order to ensure that people can enjoy basic public health services, the government will open small health service stations in relevant areas. While increasing the popularity of public health services, it has also dispersed the supply of public health materials, reduced the utilization rate of medical resources, and reduced the public health service capacity of relevant areas. However, in terms of population density, bigger is not better. Only by scientifically controlling the population density can we ensure the long-term development of national public health services.
Opening up plays a positive role in promoting public health service capabilities. The globalization index is an important index to measure the degree of opening up. It includes trade openness, capital flow, exchange of technology and ideas, labor mobility, and cultural integration. It not only promotes the accumulation of capital, technology, culture and labor, but also promotes the development of trade, affects the optimal allocation of production factors and resources, and promotes the improvement of public health service capabilities [
33,
34]. Among the 27 countries of the EU, France, Italy, Belgium and other countries have higher globalization indexes. France, which pursues a free trade policy, has a relatively high degree of opening up. Its medical and health system is an internationally recognized excellent system, covering medical, social services, and technological innovation. It has high operation efficiency and strong public health service capabilities. Therefore, countries in the EU need to continue to improve the level of opening up, promote economic cooperation, attract foreign investment, and introduce medical and health personnel, advanced technology and management experience, so as to enhance the public health service capacity [
35].
The level of education can effectively promote the improvement in public health service capacity. From 2008 to 2017 in countries of the EU, the number of years of education basically showed a steady increase trend, which matched the gradual increase in public health service capacity. The higher the average number of years of education per capita, the higher the overall quality of the talents. They need a higher quality of life and are able to undertake public health services of a certain quality. To some extent, this has increased the demand for public health services and promoted the development of the public health service system. Therefore, we should continue to strengthen talent education and increase investment in education. It is necessary to focus on cultivating high-quality talents and promote the exchange and cooperation of relevant talents among the countries, so as to improve the public health service capabilities [
36].
The total GDP is an important feature of national economic development level. The two influence and promote each other. The results show that the level of economic development of countries in the EU is positively correlated with the public health services’ capacities. The capacity of public health service is considered from the whole country. A country with stronger economic power can establish a more complete public health service system and have a higher public health service capacity [
37,
38]. In the EU, Germany, France, Italy, and Spain have higher levels of economic development, and their public health service capabilities are stronger. From a geographical perspective, Western Europe and Northern Europe, where the overall economic development level is relatively high, have relatively strong public health service capabilities. Therefore, the level of economic development is the top priority for improving the public health service capacity. It is necessary to promote economic system reform through the development of science and technology and strengthening the infrastructure construction. Promoting the development of the public health service system through continuous economic development is an essential choice.
The level of urbanization is negatively correlated with the capacity of public health services, which is consistent with the phenomenon of “reverse urbanization” that has generally appeared in Europe. People with a certain economic level have a preference for the rural environment. Urban people buy land and houses in rural areas one after another, causing the population to flow back from urban to rural areas, resulting in a decline in the urbanization rate [
39]. Countries with high levels of economic development and public health service capabilities, such as Germany, France and Italy, all have a low urbanization rate. In addition, countries with high urbanization rates have large urban populations and relatively dense distribution. This puts greater pressure on regional public health services, and, to a certain extent hinders, the improvement of public health service capabilities. Therefore, we should rationally plan the distribution of urban population, control the urbanization rate in relevant areas of the country, and ensure the effective supply and steady development of public health services [
40].
Studies have shown that technological innovation can obviously promote the improvement of public health service capacity. Technology is an important driving force for the progress and development of human society, bringing advanced medical equipment, diagnostic technology and medical resources which are more tailored to the needs of the country [
41]. This can meet the individual needs of people regarding public health services. Countries in the EU with stronger technology, such as Germany, Austria and Sweden, have strong public health service capabilities. Therefore, to improve the public health service capacity, it is necessary to continuously carry out technological innovation with service as the center and increase the investment in research and development funds. We ought to introduce, produce and use advanced materials to meet individual needs for public health services [
42].
There is a positive correlation between the degree of aging and the capacity of public health services. This indicates that countries of the EU with a higher degree of aging now have relatively strong public health service capacities, which are in line with the reality of the EU. The degree of aging is closely related to the capacity of public health services. In the EU, Portugal, Spain, Germany, Greece and Finland are countries with more serious aging. The public health service capacity of these countries is relatively strong. This is because the more serious the aging, the greater the demand for public health services in the country. As a result, the government will invest in a series of elements such as funds, manpower and materials to improve public health service capabilities. Therefore, to a certain extent, public health service capacity is positively correlated with the degree of aging. However, it is still important to reasonably control the number of aging population to ensure sufficient labor force in the country.