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Brussels, 5 December, 2001

Healthcare : Commission proposes three common EU objectives for healthcare and care for the elderly - access for all, high quality, financial sustainability.

The Commission today agreed upon an analysis of healthcare provision and care for the elderly in the EU and identified three common objectives for all systems throughout the EU. The Commission concludes that national care systems, while very different in design, delivery and funding, are confronted with similar core challenges both now and for the future. First, people are living longer (thanks in large measure to healthcare systems themselves) and traditional family structures are changing. Second, care technologies are developing fast and cost money. Third, EU citizens have new demands of health and care systems as consumers of care. Faced with these three challenges, the Commission proposes three common objectives : achieving universal access to healthcare and care for the elderly, high quality of care and financial viability of care systems in the long run. This policy paper will now go forward to the Barcelona European Council in Spring 2002 and will ultimately feed into the EU's annual Broad Economic Policy Guidelines.

Commenting on this decision, Commissioner Anna Diamantopoulou said : "Access for all to decent healthcare and care for the elderly is part of our governments' contract with EU citizens. In order to deliver, we must plan ahead. And we must identify people's changing needs and act upon them".

The Commission has an essential role to play in fostering the sharing of best practices between Member States. This kind of co-operation makes a real contribution to finding better solutions to the common challenges faced by health care systems across Europe. Without action at a European level, every Member State would have to start from scratch - rather than building on shared understanding and experience.

The challenges

The Communication highlights that national systems have very different ways to provide care provision and to fund it but must nevertheless address increasingly similar issues.

Demographic ageing : First, the European population is ageing. People live longer: since 1970, life expectancy at birth has risen by 5.5 years for women and almost five years for men, which is a major achievement for healthcare systems. And the share of the total European population older than 65 is set to increase from 16.1% in 2000 to 27.5% by 2050 while those over 80 years (3.6% in 2000) are expected to account for 10% by 2050. Although it is difficult to predict the state of health that old people will experience in the future, or the life expectancy "in good health" of the generations due to turn 60 in around 2030, ageing will definitely have major consequences.

Public expenditure on health care could increase for the period 2000-2050 by between 0.7 and 2.3 GDP points, according to "snapshot" projections made by the Ageing Working Group of the Economic Policy Committee. However, the impact on long-term care for the elderly is likely to be much larger. The increase in the number of smaller and more unstable family structures could undermine the family networks of solidarity and endanger future provision of health and care within families. Consequently, if the number of people requiring long-term care increases, and in a context of rising employment rates for women (the primary informal care providers), professional care services for the elderly will have to be developed. Therefore, a distinction should be made between countries which already have more formal care (and thus a higher level of public expenditure) and the others: the former will face a twofold increase (of 1.7 to 2.5 GDP points).

Technological advance : In the face of ageing, technical progress will bring new products and treatments involving more R&D and technology. Whilst this entails large benefits for citizens, it also raises the question of funding and of who is to bear the burden of expenditure. In a context of limited available resources, clear, transparent and effective evaluation mechanisms must be developed, as this is the only way to guarantee accessibility to these new products and treatments.

Consumer expectations : In addition, patients expect ever-better quality from health care systems. The spread of the new information technologies offers greater opportunities for seeking medical information, but also of locating services (e.g. health counselling). Moreover, patients express a willingness to be considered as partners in healthcare systems, not only by health professionals but also by the public authorities. They also increasingly expect greater transparency on the performance and quality of care services.

The objectives

The Communication identifies three long-term objectives for national systems, which should be pursued in parallel :

Accessibility : Access to health care is a right enshrined in the European Union's Charter of Fundamental Rights and an essential element of human dignity. It must therefore be guaranteed for all. This is all the more important when new products and treatments are marketed which bring improvements in care at a higher cost.

Quality : Good quality healthcare means achieving public health objectives while striking a balance between the health benefits and the cost of medication and treatment. However, it is made complex by the diversity of patterns of care provision as well as of medical treatment throughout the Union. The policy paper therefore calls for more comparative analysis, making it possible to identify "best practice" and will, as a result, help improve the quality of health care systems.

Sustainability : Upward pressures on health costs make themselves felt irrespective of the way in which healthcare systems are organised - and Member States have been implementing reforms of their systems for many years now. However, it is often difficult to disentangle the shortterm and more structural effects of these measures, i.e. their ability to ensure that spending develops at a pace that is compatible with financial sustainability and the quality and effectiveness of the healthcare system. Here again, the policy paper calls for more exchanges of experience which would make it possible to keep track of the policies introduced over several years and would be a useful way of encouraging progress.

If these objectives are to be attained, it is crucial that all stakeholders in the health systems manage 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 continue to provide good quality health services. It also takes up the request made by the Gothenburg summit last June to prepare a progress report for the Spring 2002 European Council on guidelines in the field of health and care for the elderly. It will feed the forthcoming debate of the Council's Social Protection Committee and of the Economic Policy Committee and ultimately into the EU's annual Broad Economic Policy Guidelines.

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