Explaining the EU’s

economic surveillance of

healthcare systems

Rita Baeten

28 January 2016

Overview

1. EU macroeconomic surveillance

What-why?

2. Healthcare in the EU macroeconomic surveillance

3. Conclusions

Since 1997 : Stability of the

Economic and Monetary Union

Stability and Growth Pact (SGP) • Fiscal discipline in public finances

• Broad Economic Policy Guidelines – Reform public expenditure on healthcare

– No guidance on content of reforms

↔ Pensions: specific guidance

EU responses to the Eurozone crisis Reinforced economic and fiscal surveillance

• Conditionality linked to financial assistance

– Memorandums of Understanding

• Greece, Cyprus, Portugal, Ireland, Romania

• European Semester for economic policy coordination

– Annual cycle of surveillance

• Integrates, synchronises and reinforces SGP and Europe

2020 strategy

– Country-specific Recommendations (CSRs)

• All other EU Member States

“Six Pack” and the “Two Pack”

• Excessive deficit procedure (EDP)

Deficit 3% and public debt 60% of GDP

– Extra monitoring

• Macro-economic imbalance procedure (MIP)

• Macro-economic conditionality linked to

the use of EU structural funds

Enhanced surveillance

Healthcare

in EU Economic Governance

Since 2010

• Healthcare in the Memorandums of Understanding

– Greece, Portugal, Ireland, Cyprus and Romania

• Council conclusions on health systems

– Adopted by the Ministers of Finance

Healthcare In the European Semester

Healthcare in the

Memorandums of Understanding

Improve cost-effectiveness

Reforms on public procurement, the hospital

sector, eHealth and rationalise pharmaceutical

spending

Cuts in expenditure

Reduction of salaries, fees, benefit packages,

number of healthcare facilities.

Increasing co-payments

Expenditure cap

Ensure universal coverage

Healthcare in the

CSRs

Improve cost-effectiveness and sustainability

Where more specific:

↓ Hospital care

↓ Pharmaceutical spending

↑ Improve financing systems

↑ Coordination/ integration

↑ Primary care

↑ E-health

Improve access to care

Remove restrictions on access to professions

0

2

4

6

8

10

12

14

16

2011 2012 2013 2014 2015

number of countries with a CSR on healthcare

number of CSRs

Healthcare related CSR 2011-2015

* Country under MoU ** EU accession in July 2013 *** CSRs proposed by the Commission

2011 2012 2013 2014 2015***

Austria x x x x x

Belgium x

Bulgaria x x x x

Croatia** x x

Cyprus* x x

Czech Republic x x x

Denmark

Estonia

Finland x x x

France x x x

Germany x x x x

Greece*

Hungary

Ireland* x

Italy

Latvia x x

Lithuania x

Luxembourg

Malta x x

Netherlands

Poland x x

Portugal* x

Romania* x x x

Slovakia x x x

Slovenia x x

Spain x x x

Sweden

United Kingdom

TOTAL 3 5 11 16 13

MS without

CSR

MS with non-

specific CSR

MS with

detailed CSR

MS reliant on

ESIF funding

MS under EDP ex-program MS MS under MoU

Impact of EU prescriptions on healthcare reform

Enforceability

weak

strong

Invo

lve

me

nt

Imp

act

low

high

‘the more you need from Brussels, the more weight

the EU prescriptions carry’

Involvement of the

health authorities?

• Working Party Public health at Senior Level

• Involved in amending CSRs and monitoring

implementation

– in the Social Protection Committee

But

• No willingness to deal with issues related to access

to and quality of care at EU level

• No substantial amendments to health related CSRs

Building country knowledge

• Selection of countries for a CSR

– Country knowledge and quantitative data are decisive

• Comparable data on access to and quality of

healthcare are lacking Expert group on Health Systems Performance Assessment

Application of the Joint Assessment Framework to health

systems

• To inform policies at European and/or national level?

• To be used in the European Semester?

Conclusions

• Health system reform is at the core of EU

economic surveillance

• Finance actors are in the driving seat – Both at EU and national level

• Main focus is on fiscal consolidation

• Health authorities caught in a paradox: – EU interference in health systems exclusively from the

perspective of fiscal consolidation

– Or allow the EU to be involved in quality and access issues

Thank you!