The economic crisis has forced European governments to tighten their purse strings, and healthcare is not immune.
We are now headed to a healthcare crisis. It raises a number of critical questions. Are our healthcare systems sustainable? With chronic diseases on the rise, how can we better ensure the health of people in Europe? How can we stop healthcare budgets from spiraling out of control?
It looks like a perfect storm. An ageing population, the rise in chronic diseases and the spread of unhealthy lifestyles have already placed huge additional burdens on healthcare systems. Meanwhile, unemployment and overwhelming financial pressures are exposing many people to both physical and mental health problems; problems that must be paid for.
But it is not all doom and gloom. New medical technologies, with developments in genetics, biotechnology, personalised medicines, are offering hope in the fight against disease. This hope, however, has to be balanced with the reality that scientific progress is very costly. The EU through its research and development programmes in the health arena, is supporting the development of new medical technologies. Keeping people healthy will not only maximise human capital, but will have a positive impact on productivity and competitiveness.
Several countries have attempted to combat the effects of the economic downturn through extensive reform of their healthcare systems. Clearly, national governments have to make long overdue hard choices and get value for money from medicines.
Health Technology Assessment (HTA) provides a basis for governments to assess value before deciding to reimburse a new medication. The UK is for example looking to introduce value-based pricing, linking the price of a drug to its therapeutic value. Healthcare reforms in France mean new medication must show that it is at least as good as the therapeutic alternatives before it can be reimbursed.
Whilst Member States have the key competences on health matters, EU policy and legislation can shape delivery and access to care, and its coordinating role can help address some of the challenges, and support efforts on national healthcare reform. The EU needs to seize the opportunity now to demonstrate new thinking in addressing the key issues, working closely with Member States and patient representatives, healthcare professionals, the scientific community and the industry.
There is a window of opportunity to reform, to think about the bigger picture and develop new ideas and ways of doing things. It is therefore not surprising then that health matters feature hugely on the current EU policy agenda and there are clear steps being taken.
For example, the European Commission aims with the new EU Framework for Research and Innovation – Horizon 2020 to create a knowledge-based economy in Europe capable of competing on a global scale. Key elements of the proposals launched in November 2011 are a dedicated science budget of €24.6 billion, and €31.7 billion to address major concerns shared by all Europeans, including health, demographic change and well-being.
At the heart of EU research efforts in recent years has been an emphasis on public private partnerships.
The EU and the pharmaceutical industry association EFPIA are working together via the Innovative Medicines Initiative (IMI) scheme to make the drug discovery and development process more efficient. Research focuses on tackling today’s major scientific challenges in large-scale projects building new methods, models and tools that will speed up the development of novel therapies. IMI and the EU’s flagship Horizon 2020 programme can act as launch pads for exciting new discoveries that can benefit patients in the future.
As governments across Europe look to cut costs, there will be further cooperation on Health Technology Assessment (HTA) at EU level. A voluntary network connecting national authorities and bodies responsible for HTA appointed by the Member States, established by the 2011 Directive on Patients' Rights in Cross-Border Healthcare, will be set up in 2013. It is still unclear to what extent things will change radically in practice from the existing collaborative HTA network EUnetHTA.
One thing is for sure, further collaboration at EU level on HTA is a clear signal that the EU aims to establish more common approaches in assessing new treatments. Will this lead to the establishment one day of a Euro-NICE (the National Institute for Health and Clinical Excellence) body? We will just have to wait and see.
In order to increase the efficiency of our healthcare systems, the European Commission is looking at promoting the fuller use of technologies. It plans to present later this year proposals for a new EU legal framework governing medical devices to better deal with current and future technical and scientific progress. The better use of Information Technology should also help to drive down costs.
To this end, the European Commission has established the Network of National Authorities responsible for e-Health. This network will strengthen co-operation between Member States on e-Health and promote the need for interoperability between electronic health systems. The new EU Action Plan on e-Health for 2012-2020 is due by the end of the year. This will develop actions to kick-start the delivery of e-Health across the EU.
Whilst it is good news that we are all living longer, the ageing population represents a challenge in long-term care delivery. The matter of ageing is being addressed at EU level through the European Innovation Partnership on Active and Healthy Ageing. It involves stakeholders in the areas of prevention and health promotion, care and cure, and active and independent living of elderly people. The overarching target of this pilot partnership will be to increase the average healthy lifespan by two years by 2020.
Important pieces of healthcare legislation will be streamlined, with the aim to get rid of the red tape and improve access to care. This is critical if we are to get medicines more quickly to the patients that need them.
The European Commission has proposed to speed-up the timelines for national decisions on pricing and reimbursement of medicines in its new proposal for a revision of the Transparency Directive. The revision of Clinical Trials Directive should streamline procedures enabling patients to benefit in a timelier manner from innovative medicines which are still in development.
Through the EU Reflection Process on Chronic Diseases, and its new health programme Health for Growth, the EU is putting the spotlight on the importance of health promotion and prevention of chronic diseases. EU Member States are being encouraged to promote good health and prevent chronic diseases. The focus on prevention may be a particularly interesting way to off-set the increasing chronic disease burden in the first place.
In these financially uncertain times, increasing numbers of people suffer from depression and anxiety. The EU’s Joint Action on Mental Health and Well-being proposes that Member States across the EU work to assess the situation on mental health in various countries and put forward recommendations for action, as well identify best practices.
Will all these EU efforts pay off? The EU certainly seems to be trying with its forward thinking healthcare policy agenda, and by taking a collaborative approach with Member States and key healthcare stakeholders. Only time will tell if that will be enough.
By Anna Dé, Director, acumen public affairs (email@example.com)
Published in The European, issue 30, May 2012