As a consequence of the current economic crisis many changes have been introduced to health systems on national levels to reduce expenditure and to introduce more cost-effective methods. However, the health community urges decision makers to ensure that all changes introduced are in accordance with European Health System Values which are:

The health community urges decision makers to ensure the right to health for all regardless of social status, geographic location or ethnic origin. Our vision is equal access for all to national immunisation schemes, paediatric care and that all pregnant women have equal access to pre and post natal care. Our request is for a coherent EU public health policy for the prevention and treatment of diseases. We encourage the European Commission to make full use of its role as coordinator of best practices and guardian of the Treaty to protect health systems and social protection mechanisms during these times of austerity.

In most countries the focus is on the reduction of healthcare spending on the supply side, through budget cuts, shrinking care ‘packages’ and the increasing involvement of the private sector. Unfortunately, needs on the demand side are at the same time increasing, due to the growth of non-communicable diseases, an ageing population and higher expectations of patients. This might cause a situation where demand exceeds supply and health systems are not fit for purpose. In some European countries costs have shifted from public spending to private spending.

Some countries attempted to lower expenditure through reductions in the salaries of health professionals, (salary freezes, reducing rates of salary increases). These policies may exacerbate wage imbalances across countries, increasing health worker migration in Europe and other regions, and adding to problems of human resource shortages. This runs the risk of undermining quality and efficiency in the health system, while not achieving financial sustainability. This also highlights the importance of the health sector as an economic motor.

Reforms to health systems should focus on cost-effectiveness, expenditure and sustainability with clear links to better patient safety, higher quality care and accessibility, in line with EU values for health systems. Effectiveness in the health care sector refers to the extent to which the health system attains its chosen objectives. Health promotion and preventative measures should be prioritised. We recommend that:

  • Reforms should be evidence-based and policy makers should consider novel sources of funding for health
  • Investing in healthand preserving budgets for disease prevention and health promotion should entail a greater financial reallocation for these measures. EPHA regrets the fact that 97% of health budgets are earmarked for the treatment of disease and only 3% for investment in prevention, at a time when the cost of treating and managing non-communicable diseases is increasing
  • Health Ministries and health actors should be consulted on non-health policies that directly affect the social and commercial determinants of health.
  • Civil society organisations advocating for investment in public health and health systems should undertake a rapid programme of training on EU Economic Governance so that they can engage actively in national debates about economic policy
  • Changes made to health systems and healthcare provision should be based on the overarching values of universality, access to good quality care, equity, and solidarity.
  • In times of crisis investments in health systems should continue; significant reductions in healthcare budgets risk creating new inefficiencies, undermining access and quality of care, and damaging health outcomes. The impacts of health system reforms on health outcomes should be monitored at the EU-level and a Health Impact Assessment conducted on policy responses to the economic crisis and cost-containment measures.

- EPHA Position Paper­- Reforming Health Sy­stems in Times of Austerity

Related EPHA articles
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- [Press Release] Economic policies must address the real impact of crisis on people living in Europe
- European doctors send open letter on the effects of austerity on the health of people
- New WHO study on Policy responses to the Financial Crisis
-  Towards an effective implementation and delivery of the Health 2020 strategy in times of austerity
- European Health Forum Gastein - 2012 Edition Highlights Austerity Impacts on Health
- EPHA Press Release: MEPs lead urgent plea from health community to prevent health crisis in Europe
- New evidence on access to healthcare: austerity marginalises Europe’s weakest
- The economic crisis & EPHA fact & figures on the impact of the financial crisis on health
- EPHA Press Release: MEPs lead urgent plea from health community to prevent health crisis in Europe

Last modified on September 23 2013.