October 2013

Sustainable Health Systems for Inclusive Growth in Europe:
Session I Overview

A conference organised by the Lithuanian Presidency of the Council of the European Union, Vilnius, 19-20 November 2013.

Sustainable Health Systems: Visions and Strategies

The pressures that an ageing population, the increasing incidence of chronic disease and the cost of adopting new technology is putting on Europe’s health systems have been evident for some time.

But it has taken the financial crisis to force patients, payers and providers to confront these realities, and acknowledge that budgets simply cannot keep rising to meet growing demand.

This has forced the debate about the sustainability of Europe’s healthcare systems to the top of agenda. It is against this background that the Lithuanian Presidency of the European Union is devoting its conference in Vilnius on November 19 – 20 to the topic, ‘Sustainable Health Systems for Inclusive Growth in Europe’.

The aim is to identify existing best practice and point the way to reforms, modernisation and innovations that will make healthcare systems responsive, resilient and sustainable into the future.

As Europe’s healthcare systems come under pressure from many angles, one of the keys to promoting sustainability will be to maintain the core principles of universality, equity and solidarity on which they are founded.  An absence of equality of access – based on need - will generate social and economic pressures that undermine longer-term financial stability. The importance of respecting these principles will be discussed in the opening session of the conference by Vytenis Povilas Andriukaitis, Minister of Health of the Republic of Lithuania, in his talk ‘Universality, equity and solidarity: the core values of health systems’.

Increasing resilience

It is the case that austerity-driven cuts have led to some uncomfortable – if isolated – illustrations of what happens when these core principles come under stress. But at the same time, there are examples of how cuts have paved the way for sensitively-handled restructuring that increases resilience.

There is also a growing body of evidence that reforms, such as moving care from clinical settings to the home, encouraging the self-management of chronic conditions and easing the demarcations between health and social care, can both increase the quality of care and promote sustainability of health systems.

In setting out an agenda and vision for promoting sustainability, it is important to recognise the impact that austerity is having on health systems and draw lessons from that. In a joint investigation, the European Observatory on Health Systems and Policies and the World Health Organisation (WHO) Regional Office for Europe examined how Europe’s healthcare systems are dealing with the financial crisis, what impact there has been on performance and on health, and what the lessons are for policy.

As Zsuzsanna Jakab, Regional Director, WHO Regional Office for Europe, noted in her foreword in the programme for the 16th European Health Forum in Gastein, Austria on 2 – 4 October, two broad observations stand out, “First, the economic crisis has adversely affected many of the social determinants of health; second, given that health needs tend to increase when unemployment rises and household incomes fall, the policy responses introduced may themselves have an added impact on population health,” Jakab said.

Since the onset of the financial crisis, the WHO Regional Office for Europe has worked directly with countries and partners in Europe to help them reform and adapt their health systems. Part of the mandate of the WHO Regional Office for Europe is to put forward innovative approaches that strengthen core health system functions and make them more resilient to economic downturns. Jakab will discuss the ‘Impact of Austerity on Health Systems’ to set the scene in the opening session of the Vilnius conference, highlighting policy lessons and recommendations arising from this experience and from the evidence gathered.

Promoting sustainability

The role of innovation in promoting sustainability will be underlined by Martin Seychell, Deputy Director General of the Directorate General for Health and Consumers of the European Commission, in his presentation, ‘Towards modern, responsive and sustainable health systems’. Amongst many actions being supported by the Commission to promote sustainability of health systems is the European Innovation Partnership on Active and Health Ageing, which has the ambition of working at a European level to increase the ‘healthspan’ of Europe’s citizen’s by 2020.

This will result in a ‘triple win’, improving the health and quality of life of European citizen’s, supporting growth and expansion of European industry and promoting efficiency and sustainability of health and care systems.

In setting the stage and pulling together the best evidence on how to foster the development of sustainable health systems in Vilnius, inspiration can be drawn from the significant progress made in recent years to reduce health inequalities in Europe - as a result of a concerted strategy. New statistics released by the European Commission in September 2013 show the wide variation in life expectancy and infant mortality, historically found between EU countries, is narrowing.

The gap between the longest and shortest life expectancy found in EU-27 decreased by 17 per cent for men between 2007 and 2011, and 4 per cent for women between 2006 and 2011, while the gap in infant mortality went down from 15.2 to 7.3 per 1,000 live births between 2001 and 2011. More needs to be done of course. In a February 2013 paper, ‘Investing in Health’, the Commission set out the case for stronger links between EU health policies and national health system reforms, and presented the case for investing in people's health, investing in reducing inequalities in health and for making smart investments to build sustainable health systems.

As the opening session of the Lithuanian Presidency conference in Vilnius will hear, dealing with the shock of the financial crisis has prepared the ground for further reforms. What is needed now is to face up to the new reality, gather the evidence to underpin new policies and use this opportunity to bring in structural reforms that will build in resilience to any further shocks - and make our healthcare systems sustainable into the future.