When it comes to health care in the European Union, power and responsibility rests with national governments. But that doesn’t mean that there aren’t areas where Brussels can make important contributions. A survey by POLITICO in November ranked access to and affordability of health care as the No. 1 priority for the EU’s health policymakers by 2024.
Over the course of the year, POLITICO will be conducting a series of symposiums, asking leading experts to weigh in on the health care priorities for the next European Commission. In this first installment, we asked five health care experts: What is your radical suggestion for how the EU can reduce the cost burden on national health systems?
Democratize health care
Jean-Pierre Thierry is medical adviser for the health and consumer NGO France Assos Santé, based in Paris.
Giving patients and consumers a voice would make an important contribution to tackling health care costs.
The EU should put in place a network of citizens’ juries on health, comprising representatives of patient organizations and an equal number of randomly selected people to tackle questions about the fair cost of treatments in every member country. These juries would cooperate with health assessment bodies to weigh the value of new treatments. They would raise the bar for real-life evidence on innovation, preventing money from being spent on treatments that aren’t yet proven and limiting the “hype curves” that have led to the explosion of costs around exciting but premature drugs or technologies.
Even the richest European countries are being confronted by the dire consequences of cost bubbles in health care. Brussels must help by enforcing EU antitrust laws in the pharma industry and blocking the repeated “evergreening” of patents on treatments.
A true démocratie sanitaire would push politicians to reassess the commoditization of public health — shifting productivity gains back into the health system, instead of permitting the distribution of large dividends to industry shareholders and payouts on overvalued biotech stocks.
Band together
Jayasree K. Iyer is executive director of the Access to Medicine Foundation, based in Amsterdam.
Health care systems are heavily burdened by the high price of medicines — and Europe is behind the curve in tackling the problem.
Setting up an EU-wide system for pooled procurement to buy medicines and vaccines in bulk, like the Pan American Health Organization already does for South American countries, could drastically reduce costs. Combining buying power would help payers in Europe purchase larger volumes at lower, more affordable prices and give them stronger negotiating leverage against the drugmakers that for now hold most of the cards.
This would be especially important for countries where the volume of patients may be small and thus struggle to negotiate low prices.
It would also suit the mosaic of socio-economic groups living in EU countries. There’s huge variety in the bloc in people’s abilities to pay. It’s the responsibility of governments to ensure that medicines are available to all groups. Companies need to be encouraged to set prices according to the ability to pay, not on what some are willing to pay.
Promote solidarity
Menno Aarnout is former executive director of AIM, an international association of non-profit health care payers based in Brussels.
Brussels must constrain the ability of profit-driven health insurers to drive up prices.
With increasing budget constraints, some national governments leave the responsibility for aspects of health care coverage to private entities. Unfortunately, private for-profit insurers pick “good” risks and differentiate insurance premiums between young and old, healthy and unhealthy, leading to higher prices and limiting access to care.
Health care mutuals are private entities too but they are based on solidarity. They accept everybody as their members; they don’t differentiate premiums and they don’t have shareholders to please with profits.
The EU needs to use its insurance solvency rules, state aid laws and influence over tax policy to support solidarity-based health care mutuals over for-profit insurers. That includes facilitating legal recognition so that mutuals can work across borders. In some countries mutuals have existed for 200 years but in others, they never have.
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How the EU can reduce the cost burden on national health systems
By Reinier Schlatmann, CEO Philips Central Eastern Europe
Poland belongs to one of the fastest aging countries in the EU with cardiovascular diseases and cancers as the leading causes of death. With a relatively high level of unmet needs for medical care in combination with staff shortages, as well as a primary care system in need of further development to relieve hospitals, Poland is looking for solutions to address its most burning health care challenges.
Digital, connected technologies and health care informatics based on big data offer huge potential in simultaneously addressing the need for an improved patient experience, better health outcomes, an improved staff experience, and lower cost of care. Therefore, if I were to choose the one area where the EU could have the biggest impact, it would be through the role the EU could play in strengthening cooperation between member countries to develop economic models and infrastructure for digital, integrated care solutions, and reimbursement models that reward outcomes.
At the same time, it would be equally important to support digital transformational and connected care solutions with EU funds. Only by addressing both needs in parallel, will this bring meaningful and measurable results to Poland, enabling us as well as other EU countries to address the pressing challenges of today’s health care.
Take a multi-faceted approach
Clemens Martin Auer is Austria’s special envoy for health.
There is no single magic bullet to Europe’s rising health care costs, but there are several areas where the EU can act.
To begin with, unless Europe tackles its crisis in primary health care, there will be little prospect of affordable care for the chronically ill and the elderly. The EU can push governments to invest in frontline services and support cultural change within staff groups, including through new curricula in the bloc’s universities.
Another problem is the growing increase in superbugs. It’s an enormous threat to modern medicine and could be the most expensive issue facing Europe. The EU has initiatives addressing the problem on its books, but it needs to persuade pharma companies and governments to buy into them.
Finally, when it comes to funding affordable drug development, the business models of the pharmaceutical industry have little future. Everything has to be done in the EU to support a new partnership of the public health systems with industry and to strengthen the role of public funding in research on new drugs.
Be bold
Julia Chamova is senior director of global networks at the U.S.-based ISPOR, the Professional Society for Health Economics and Outcomes Research, and lives in Sweden.
The EU must continue an assertive push for cooperation between health systems and stakeholders across European borders on technical issues. Health must be kept high on the political agenda — and policymakers must communicate well and often in lay terms with patients and consumers on the benefits of cooperation, enlisting articulate experts to explain those benefits. Advancing the bloc’s digital agenda has the potential to make an important contribution to reducing costs.
The EU must also work on breaking the silos in understanding how health is maintained, delivered and protected — it extends beyond isolated solutions made possible by individual providers to an isolated recipient. This is one area where the whole is much greater than the sum of the parts.
The EU must also be a leader in advancing an understanding of a health care E(U)cosystem. It is in the interest of every country to see its health care system as European, as this is what will bring opportunities to manage costs.
This article is part of “Health Care 2024,” a survey-driven series of online debates in which POLITICO will explore how the European Union can best tackle health policy.
