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The future of health care and care for the elderly: guaranteeing accessibility, quality and financial viability
All national health care systems are today faced with three major challenges, as the population of Europe is ageing, health care is increasingly effective but also becoming more expensive, and patients, having become true consumers, are also more demanding. Faced with these three challenges, the Commission has proposed three long-term objectives: access to health care for all, a high level of quality in health care and ensuring the financial viability of health care systems.
Communication from the Commission of 5 December 2001 - The future of health care and care for the elderly: guaranteeing accessibility, quality and financial viability [COM(2001) 723 final - Not published in the Official Journal].
The EU's overall health situation and health care systems are among the best in the world, thanks to the widespread extension of cover against sickness and invalidity, the rise in the standard of living, improved living conditions and better health education.
Total health care spending rose from around 5 % of GDP in 1970 to over 8 % in 1998. Public health care spending followed the same trend of growing faster than GDP in most countries.
ISSUES COMMON TO ALL EU HEALTH CARE SYSTEMS
The impact of demographic ageing on health care systems and expenditure
The ageing of the population in Europe involves two aspects:
- since 1970, life expectancy at birth has risen by 5.5 years for women and almost 5 years for men. This trend also means higher life expectancy in "good health" and in the absence of disability;
- there are more elderly people. The proportion of the total European population older than 65 is set to increase from 16.1 % in 2000 to 27.5 % by 2050, while the proportion of the population aged over 80 years (3.6 % in 2000) is expected to reach 10 % by 2050.
If Eurostat's basic scenarios are confirmed, public expenditure on health care could increase by between 0.7 and 2.3 GDP points in the period 2000-2050.
The increase in the numbers of elderly people will thus increase the pressure on the public sector for long-term care.
In light of these needs, health care structures, methods of financing and the organisation of services will have to evolve. It will be particularly important to deal with the increased need for skilled manpower, as smaller and more unstable family structures make it increasingly difficult to rely on the support of family networks.
The growth of new technologies and treatments
Developments in medical technology (gene therapies, growing replacement organs, new medicinal substances, etc.) provide benefits for patients, for example by reducing the risks of serious illness by means of preventive treatment. However, these innovations come at a cost, and financing is an issue that must be considered. In the context of prudent budget management, clear, transparent and effective evaluation mechanisms must be developed, as this is the only way to guarantee greater accessibility to these new products and treatments.
The increase in patients' demands
It has been observed for half a century that the demand for health care tends to increase more than proportionally to the per capita income. Demand is determined by standard of living and level of education. This has three main consequences:
- patients are better educated and are able to adopt healthier lifestyles and a prevention-based attitude which in the long run makes it possible to avoid the need for costly care. This is why health care systems are focusing increasingly on education and prevention;
- patients expect ever better quality and efficiency from health care systems. The spread of information technologies gives patients access to more information on services available at European level and allows them to make an increasingly well-informed choice;
- health care consumers feel that they need to be considered as partners and players in health care systems, not only by health professionals but also by the public authorities. They also expect greater transparency on the performance and quality of care services.
THREE LONG-TERM OBJECTIVES: ACCESSIBLITY, QUALITY, VIABILITY
While the organisation of health care systems, their funding (ratio of public/private funding) and planning as a function of the needs of the population are a matter for the Member States, this responsibility is exercised increasingly within a general framework on which many Community policies have a bearing (research, public health policy, free movement of persons and services, viability of public funds). This is an argument for strengthening European cooperation.
The Communication identifies three long-term objectives for national systems, which should be pursued in parallel.
Access to health care is a right enshrined in the Charter of Fundamental Rights of the European Union. However, it is often affected by an individual's social status. It is therefore particularly important to ensure that access to health care for disadvantaged groups and for the poorest members of society is guaranteed.
The joint report to evaluate the national action plans for social inclusion proposes three categories of measures:
- measures to develop disease prevention and promote health education (mother and child care, medical care at school and medical care at work);
- providing less expensive and even free care for those in low-income brackets;
- measures aimed at disadvantaged groups, e.g. the mentally ill, migrants, the homeless, alcoholics and drug addicts.
In order to provide quality health care, national governments are required to achieve an optimum balance between the health benefits and the cost of medication and treatment. Ascertaining quality in this way is made complex by:
- the diversity of the structures and levels of health care, which often influence demand for health care and consequently the level of expenditure;
- the different approaches to medical treatment.
Comparative analysis of health care systems and medical treatment should make it possible to identify "best practice" and thus to help improve the quality of health care systems.
A certain level of financing is required to ensure the availability of high-quality health care that is accessible to the population. There is upward pressure on these health care costs, irrespective of the way in which Member States' health care systems are organised. Member States have been undertaking reforms since the early 1990s, based mainly on two methods:
- regulation of demand, by increasing contributions or by ensuring that the final consumer bears an increasingly large share of the costs;
- regulation of supply, by determining budgets or resource envelopes for health care providers, creating a contractual relationship between "buyers" and "providers" of health care.
It is often difficult, however, to distinguish the short-term effects from the more structural effects of these reforms, which allow spending to develop at a sustainable pace. This Communication recommends more exchanges of experience, which would help to keep track of the policies introduced and would be a useful way of comparing health care systems and encouraging progress.
In order to achieve these objectives it is essential that all parties concerned (local authorities, health care professionals, social protection bodies, supplementary insurance companies, consumers) work together to build strong partnerships.
This Communication is a response to the conclusions of the Lisbon European Council of March 2000, which stressed that social protection systems needed to be reformed in order to be able to provide high-quality health care services. It also takes up the request made by the Gothenburg summit (June 2001) to prepare a progress report for the Spring 2002 European Council suggesting guidelines in the field of health and care for the elderly.