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European Commission

John Dalli

Commissioner for Health and Consumer Policy

Health in an age of austerity

European Health Forum/Gastein

5 October 2012

Minister Stöger,

Dr Leiner,

Professor Brand,

Ladies and Gentlemen,

I am very pleased to be here with you today – my third time in Gastein – to speak about Health in an age of Austerity; and what the European Commission is doing to help Member States in this regard.

Five years ago marked the onset of the so-called subprime crisis in the United States. This progressively spread to the global financial markets. And five years on, we are still feeling the after-shocks. A feeling of uncertainty stubbornly remains as we strive to get back on track.

Under austerity rules, belts are tightened and budgets are cut, in an effort to reduce debts by making savings. At governmental level, all areas of expenditure come under scrutiny. Health, of course, is not immune.

In 2010, for the first time in decades, we saw growth in health spending fall worldwide. In some countries, public spending on healthcare even dropped to below 2007 levels.

And this despite a growing demand for healthcare linked with the ageing population and the growing burden of chronic diseases. (And I understand that you have had productive discussions here on these two issues: healthy and active ageing, and how health systems tackle chronic diseases.)

The response to the crisis across Europe as regards health systems has varied across the Member States – as you have heard during "session one" on Wednesday. It is clear, however, that any consideration of future reform of health systems must take a long-term perspective.

I would argue that we can do this by looking at the system of healthcare delivery and see how to cut inefficiencies and how to build efficiencies. I would argue that when we speak about equity, we have a responsibility to not only look at building bridges within our generation; but it is also a question of equity across generations.

We have to recognize that, in order to ensure that our children, and our children's children continue to enjoy a high level of health, we must make our systems more sustainable.

Similar to pension reform, policy makers must keep long-term inter-generational equity in mind when making health-related decisions today. This is clearly not an easy or straightforward task but it is certainly achievable if we start now.

Yet, at the same time, I believe crises can provide opportunities to think creatively and push in-depth reforms, to investigate ideas that might not have been feasible in normal times.

Clearly, we need to work together to find innovative solutions to address today's challenge of delivering more healthcare with fewer resources.

How can we do this?

Co-ordination and dialogue is called for at EU level to add value to national efforts to increase the efficiency of health systems, provide economies of scale and make better use of expertise.

This is why the Commission is working with Member States on a reflection process aiming to identify effective ways of investing in health, so as to achieve modern, responsive and sustainable health systems.

This process seeks to highlight the role of health systems towards reaching the targets of the Europe 2020 strategy. Consider the following points:

  • The health sector – together with the social sector - already employs 1 in 10 Europeans and is one of the few sectors generating new jobs throughout the crisis.

  • The health sector holds the potential for health-related R&D to reach 0.3% of GDP, as it already does in some countries, such as France and the USA.

  • Health contributes to employability by enhancing the productivity of the workforce and offering quality jobs.

This is why I believe that health sector reforms need to be enshrined in the overall national reform plans in the context of the European Semester:

  • to better reflect the importance of health within the policy agendas of Member States; and

  • to reflect the key importance of the potential of health in boosting economic growth.

Clearly, the role of health as a key economic contributor and as a motor of societal wellbeing must be recognised more widely.

As part of the reflection process I mentioned earlier, Member States are exchanging expertise and good practices to define the 'success factors' for high-impact health investments under the EU Structural Funds.

Indeed, the EU Structural Funds aim to eliminate disparities in Europe and can make an important contribution to the health sector; and thus help redress some of the consequences of the crisis.

To further increase the potential of Structural Funds for health, the Commission has proposed health-related action throughout the various headings of the Funds from 2014 onwards.

Once this new Structural Funds package has been agreed by the European Parliament and the Council, Member States will be able to use the Funds, for example, to invest in eHealth and health technology; to support health education and prevention campaigns; or to train health professionals.

I take this opportunity to encourage Member States to seize this opportunity. Health authorities and stakeholders need to work hand-in-hand with regional development authorities to use EU Structural Funds for future investments in health.

I should add that investments need to be coupled with efficiency gains to ensure sustainability.

There are indeed many ways in which we can build efficiency into today's health systems. It is not about spending more money, but about spending our money more wisely; and cutting costs where efficiencies can be found.

For example, losses from fraud and error account for over 5% of health budgets. Just think how much we can save if we introduce efficient systems such as patient electronic records or electronic prescriptions, which can eliminate error.

This brings me to innovation. To improve efficiency in our health systems we need more innovation. Innovation in how we organise and manage our health systems, and innovation in terms of maximising the use of technology to deliver better care while triggering efficiency gains.

One way to do this is through the use of Health Technology Assessment – a means of sharing knowledge on the effectiveness of treatments, enabling decision makers to make optimal choices.

I strongly support HTA co-operation in Europe. Limited resources can be better used if work-sharing and re-using HTA information were to be increased.

Another way to promote sustainability is eHealth. Many Member States and regions are putting in place a range of eHealth solutions.

It is important that while doing so, they do not reinvent the wheel or develop solutions which are incompatible with other solutions in the same country or in another Member State. We need interoperable systems.

This is why I have brought together this Spring an eHealth Network to improve cooperation between all Member States in this area. The Network will foster a mutual learning process, promote interoperability, and help push the uptake of eHealth solutions.

The European Commission is also increasingly channelling the modest budget of the Health Programme to support Member States in pursuing innovation, efficiency and sustainability in health.

Between 2008 and the end of this year, the Health Programme will have invested close to 23 million to finance projects in this area.

The Commission's proposal for the new Health Programme as from 2014 makes support to innovative and sustainable health systems the number one objective of the programme. This includes actions on Health Technology Assessment, eHealth and the health workforce.

We are also determined to continue supporting Member States – via the Health Programme and other EU instruments – to invest in promoting good health.

In times of austerity we need to keep up and upscale our approach to promoting good health and preventing diseases. Working on the main causes of diseases that drive up our healthcare bill – I am talking here about smoking, alcohol abuse and nutrition – is a key investment in the future. An investment which we need to sustain.

Now, finally let me say a few words about regulation. By regulation I mean less red tape, not more.

I am convinced that regulation in the health sector can provide incentives to future sustainability and growth while safeguarding patient safety and public health.

For example, in summer this year the Commission adopted a proposal to revise EU law on Clinical Trials, with the aim to make Europe more attractive for clinical research by facilitating multi-national approaches.

This review seeks to foster innovation and ensure safety in health systems; and as such, it also contributes to efficient and sustainable health systems.

Ladies and Gentlemen,

The path towards a sustainable future lies not through spending more, but through spending better.

We need innovative solutions to deliver better healthcare, to more people, in a more efficient manner. We need smart and long-term investment in health.

We must address, head on, the health-related challenges arising from the financial crisis. Overcoming these challenges will take patience, stamina and resolve.

Let us seize the moment and make full use of every opportunity to build, together, more sustainable and equitable health systems for the future.

Thank you.


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