During the last 30 years, health care expenditure (HCE) has been growing much more rapidly than GDP in OECD countries. In this paper, we review the determinants of HCE dynamics in Europe, taking into account the role of income, aging population, technological progress, female labor participation and public budgetary variables. We show that HCE is a multifaceted phenomenon where demographic, social, economic, technological and institutional factors all play an important role. The comparison of total, public and private HCE reveals an imbalance of European welfare toward the care of the elderly. European Governments should increasingly rely on pluralistic systems to balance sustainability and access and equilibrate the distribution of resources across the functions of the public welfare system.