The EU nowadays has stronger influence and control over national health systems than it had in previous years. Consequently, EU interventions into management of health care systemsand budgets have increased markedly.

TheEurope 2020 strategy seeks to generate “smart, sustainable and inclusive growth” and identifies the health sector as a lever for controlling government debt, public expenditure and sustainability of national finances. Several reports have been published concerning health and its expenditure; most importantly in 2013 the Commission released its staff working document – “Investing in health”. This document states that health is a precondition for economic prosperity and is a “growth-friendly” form of expenditure. It establishes the link between health and the Europe 2020 strategyand identifies the European semester, Horizon 2020 and the Innovation Partnership as key EU tools for the promotion of investment in health systems.

The European Semesteris an annual programme intervention which coordinates economic policy and structural reform in member states. The Semester frames EMU processes so that the first half of the year is dedicated to coordinating at an EU level, whilst the second half of the year is reserved for incorporation of EU objectives and requirements into national budgets. The EU, through several reportsprovides the member states with numerous tips for improving their health systems and achieving the Europe 2020 strategy goals.

Reference to health can be found in most of the released documents. For example, the need for reform in the light of “demographic challenges and the pressure on age-related expenditure” is highlighted; the improvement in cost-effectiveness and sustainability of health systems is addressed; and the necessity to underpin the long term sustainability of public finances is also considered. The implementation of suggested reforms and interventions is the responsibility of each member state. As a result, progress among states is very inconsistent and implementing of new measures is questionable.

To conclude, the European Semester and the reform of EU economic governance have essentially changed the way in which fiscal and economic policy is made in the EU. Health competences are expanding into new areas of health system organisation and financing, pushing the nexus of health policy-making further and further upstream, into the realm of economic and finance ministries. The EU interventions are mainly focused on medium and long term reforms across all EU member states.

Civil society organisations planning to engage in the economic governance process should:


- Health, civil society and the reform of European economic governance - A call to action


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Last modified on May 1 2013.