A level playing field for EU health – an achievable future for patients and caregivers?

A look at how the EU is managing cross-border health and the impact its having under the 'Together for Health' strategy

In her closing statements at the Health Collaboration Summit held by the European Federation of Pharmaceutical Industries and Associations in October, the Secretary General of the European Patients Forum, Nicola Bedlington, emphasised the need for a level playing field between member states if patients, industry, health care providers and legislators alike were to address the challenges facing Europe’s health systems today.

In what resembled a direct answer to this plea, on December 10 the Director General of DG Health and Food Safety, European Commission, Xavier Prats Monné announced that they had reached an important milestone in their Cross-border Healthcare Directive. They have opened National Contact Points in every EU country offering people all the relevant information on patient rights and options in cross-boarder care.

What else indicates the increased interconnectivity in EU health systems?

The European Commission sites the following factors as indicating increased interconnectivity:

• Patients getting healthcare across the EU
• Health professionals working in different EU countries
• Higher expectations for healthcare
• New developments in health technologies.

It also mentions the following challenges, which it believes the National Contact Points are addressing:

• Providing clear rules and reliable information to patients
• Meeting patients’ expectations of the highest quality healthcare
• Ensuring EU countries work closer together in the interest of patients
• Clearing up years of legal uncertainty

And how does the Cross-border Healthcare Directive fit in the overall EU health strategy?

In the wider view of things, this European Commission Directive is a part of the EU Health Strategy  “Together for Health” adopted in 2007 that now also supports the current overarching Europe 2020 strategy. It is implemented by the Consumers, Health, Agriculture and Food Executive Agency which is currently administering the Third EU Health Programme with a budget of € 449.4 million. This third programme started in March 2014.

Is it having an impact? What do the EU health statistics say?

With these seemingly dizzying figures and a dedicated directive, interconnectivity and reduced inequality in health across the EU looks hopeful but is it reflected in health statistics? The following key findings from the 2014 OECD report ‘Health at a Glance: Europe 2014’* show that further work is needed and that maybe it’s too early to say:

Key Findings

• Life expectancy continues to increase in the EU, reaching 79.2 years on average in 2012 (82.2 years for women and 76.1 for men) – an increase of 5.1 years since 1990. However, inequalities persist with a gap of 8.4 years between the highest and lowest Member State.
• Between 2009 and 2012 health spending in real terms (adjusted for inflation) decreased by 0.6% per year on average. This was due to cuts in health workforce and salaries, reductions in fees paid to health providers, lower pharmaceutical prices, and increased patient co-payments.
• Since 2000, the number of doctors per capita has increased in all EU countries except for France where it has remained stable. The number of practising nurses has also increased in all but two Member States.
• There are wide variations across EU countries in waiting times for non-emergency surgical interventions. While some countries have made progress in reducing waiting times over the past few years, in other countries such as Portugal and Spain, they have started to rise.
• Patients are increasingly moving across borders to pursue medical treatment. Both imports and exports of health care services have grown in most EU countries between 2007 and 2012. Patient mobility in Europe may see further growth as a result of the entry into force in 2013 of the EU Directive on Cross-border healthcare , which supports patients in exercising their right to cross-border healthcare and promotes co-operation between health systems.
• Smoking rates stand at an average of 22.8% in the EU (2012 data) – a 12% reduction since 2002.
• The EU has the highest level of alcohol consumption in the world – average of 10.1 litres per person. The countries with the highest level of consumption are Lithuania, Estonia and Austria, and the lowest are Italy, Sweden and Malta.
• Overweight and obesity is increasing in the EU. 53% of adults in the EU are now either overweight or obese. Obesity, which presents even greater health risks than being overweight currently affects one in six adults (16.7%) in the EU, an increase from one in eight a decade ago. However, there are considerable variations between countries.

* OECD (2014), Health at a Glance: Europe 2014, OECD Publishing.