Abstract Background Various studies have shown the ebb of the political spectrum when determining entry into the European Union. The objective of this study was to determine the key differences between the European Union (EU) and the current EU-candidate countries through the lens of the financial burden of the public healthcare system. Methods The most complete and available EUROSTAT data describing health-related burden (13 indicators) for current EU- candidate countries (Serbia, Turkey, the Republic of North Macedonia and Montenegro) were evaluated and compared. Results Total health expenditures (Purchasing Parity Power) per capita in EU candidate countries is almost one-third of that in the EU. General government health expenditure for all four countries was below the EU average with Montenegro spending the highest and North Macedonia spending the least. Turkey, with a significantly higher gross domestic product (GDP), allocated the smallest percentage of its GDP on health (4.31%), while Serbia the highest percentage (8.55%), both being below the EU average (10%). The private health expenditure for all of the countries was higher than the EU average, with Serbia's proportion being double that of the EU average. Assessing the burden of disease for these countries, Serbia has the highest disability-adjusted life years (DALY) rate per 100,000 (25,468.38), while the average DALY rate of the other three countries was 23,656.33 and the EU average was 16,390. Turkey and North Macedonia tying for the highest infant mortality rate, three times the EU average. Of the candidate countries, Serbia contains the highest density of physicians and nurses and Turkey, the lowest. Conclusions The process of entry to the EU is a varied experience for each country since attaining benchmark standards affects the time needed to achieve them. This study on a selected number of public health indicators contributes to the evidence on the current health-related burden of EU-candidate countries. Key messages All EU candidate countries have a much higher burden of disease and a much lower health workforce and health expenditure than the EU average. The challenge for countries in the accession process is to reach a level of quality and achievement in health care in the EU.