The European Commission published on February 22nd the 2017 European Semester Country Reports, that considers also issues to be addressed as per health and healthcare systems in the different Member States.

According to the comment published by the European Federation of the Pharmaceutical Industry Associations (EFPIA), the document might assist the on going debate upon healthcare reforms in different countries.

UE is living a recovery phase after the economic crisis, states the Commission, which is the result of an accommodative monetary policy, a broadly neutral aggregate fiscal stance, pro-growth fiscal adjustment and the impact of structural reforms.

High unemployment, poverty and inequality remain key concerns in some countries, and socioeconomic convergence across the EU has yet to resume fully.

The reform of healthcare systems is among critical measures needed to ensure cost-effectiveness and access to services while safeguarding sustainability, states the Country Report.

Progress toward this goal varies among the Member States. A group of 15 countries (including Ireland, Lithuania, Austria, Portugal, Romania, Slovenia and Finland) addressed some country-specific recommendations, among which are improvement of cost-effectiveness, shifting to and using less costly care, and curbing informal payments.

Others countries showed only limited progress, says the report, and an acceleration is needed in order to support the population’s health, economic prosperity and social cohesion. EU Commission’s required reforms listed in the reports include: ensuring access to timely and good-quality healthcare for all; shifting from in-patient to outpatient care; investing in health promotion, primary care and integrated care; improving the governance of the systems; using medicines more rationally; using Health Technology Assessment; more centralised public procurement; and e-health and health information tools.

The Commission also requests to speed up the reform of pensions, an important item to ensure medium- and long-term sustainability coupled to population ageing. Healthcare and pensions risk relates, according to the document, to fiscal concern and accessibility issues. Finally, the Country Reports also highlight the importance to achieve a better public procurement in the healthcare sector.

The publication rate is still low in some countries, says the Commission, resulting in insufficient openness to cross-border business opportunities.

In its comment, EFPIA highlights that under-funded healthcare systems are still present in many countries, such as Bulgaria, the Czech Republic, Croatia, Latvia, Hungary, Malta, Romania, Slovenia and Slovakia.

Some others are experiencing poor health outcomes (Bulgaria, Czech Republic, Estonia, Croatia, Latvia, Lithuania, Hungary, Poland and Romania). The high proportion of out-of-pocket expenditure is also identified to prevent access to healthcare and medicines in many cases (i.e. Lithuania, Latvia and Bulgaria).

Over-use of hospital and specialist care is still a problem in the Czech Republic, Estonia and Hungary, even if for different reasons. According to EFPIA, strengthening primary care, increasing care coordination and aligning financial incentives to health outcomes rather than unnecessary procedures are all important measures to be taken in mind while projecting reforms.

The industrial think tank also refers to the recent report from the OECD, Tackling Wasteful Spending on Health”,   that mentions all different sources of “low-value care” expenditure. From this point of view, EFPIA welcomes measures to increase value-for-money in health systems, including health technology assessment (HTA). According to EFPIA, this latter instrument is still too often limited just to medicines.

The Country Report also discusses the different approaches chosen by member States in order to contain pharmaceutical expenditure. But, suggests EFPIA, the issue is addressed as “a cost only, without any reflection on the value pharmaceuticals bring to patients, healthcare systems and societies”. Possible examples are the savings achievable thanks to extensive vaccination schemes.

According to EFPIA’s comment, there is a danger in focusing too much on fiscal sustainability while assessing healthcare systems.

Cost-containment is not the only possible solution, suggests the Federation, and also interventions that brings the most value for money and implement more effective and comprehensive resource allocation should be considered.

According to EFPIA, the Country Reports still excessively build on various fiscal, structural and process indicators. “More disease-specific health outcomes data are needed in order to identify potential inefficiencies and analyse which interventions that bring the most value to patients”, suggests the think tank. From this perspective, EFPIA asks that all Member States implement instruments for the Health systems performance assessment, with a strong focus on health outcomes measurements.

Electronic health records and registries are examples of the possible measures to be considered, which could be implemented with the assistance of available EU funds and financial instruments including the European Fund for Strategic Investments, the European Structural and Investment Funds and the Connecting Europe Facility.