EU countries singled out for misguided healthcare budget cuts

Homeless immigrant. Germany, undated.

While some cuts in national healthcare budgets may have improved the sector's efficiency, some doctors say EU countries' choices were often misguided and ended up harming patients.

Between 2008 and 2011, 17 out of the EU’s 28 member states have slashed their public spending on healthcare due to austerity policies, delegates heard at the annual conference of the European Public Health Alliance (EPHA), organised in Brussels on Thursday (5 September).

While countries such as Germany, France, the UK and Luxembourg only experienced a decline for one year, Ireland experienced austerity cuts for three years.

Forced cuts are not always bad and can create more efficient healthcare systems, said Sarah Thomson, a senior research fellow at the European Observatory on Health Systems and Policies and deputy director at LSE Health. But unfortunately there were also many missed opportunities in EU member states, she added.

"Though the crisis presented some severe challenges for some countries, I think it’s also fair to say that it has been an opportunity for countries to make changes that they knew they needed to make, but they were not making at a time of relative plenty," she told the EPHA conference.

Sensible efficiency response could have focused on eHealth, co-ordinated care or to rationalise hospitals, she mentioned.

However, the most widely used responses were cuts in salaries, staff, training and research as well as social benefits, she said. Other strategies included delaying investments or introducing user charges, Thomson said.

Permanent austerity

Raed Arafat, Romanian secretary of state for health, said that before the crisis, Bucharest spent less than 4% of its GDP on health, much lower than the European average of 8.4%. Therefore, to implement austerity measures when already in a state of permanent austerity was a real challenge for the country, he said. 20% of the nurses in Romania have left the country during the crisis, while access to certain types of drugs has become very difficult.

"A significant amount of the money is spent wrongly which could be spent better, but at the same time there is a need for more spending on health in Romania," Arafat said.

The health secretary said there were even discussions in Romania about letting those suffering from infectious diseases such as HIV and tuberculosis, who often come from poor and marginalised groups, co-pay for their own medicines, but the idea was eventually dropped.

"This could have created a public health disaster," Arafat said.

Calling for courageous politicians

In Greece, the entire public healthcare system has also been under enormous pressure during the crisis while Spanish authorities have legally restricted access to care for undocumented migrants.

Groups that were already vulnerable before the crisis, such as undocumented migrants, asylum seekers, drug users, sex workers, destitute European citizens and homeless people, have seen a reduction in social safety nets which provide them with basic help.

Dr Kathia van Egmond, board member Doctors of the World, a humanitarian group, added that austerity measures have affected health systems and undermined the principles of solidarity and equality.

"On one hand we have seen a decline in access to healthcare, especially for vulnerable groups, the first victims of the austerity measures. The second consequence has been the rise of xenophobia which we now see everywhere in the European Union," van Egmond said.

Among the patients at the Doctors of the World's clinics, 20% have reported being denied access to healthcare by providers in the last 12 months, with 62% in Spain.

In Greece before the crisis, most of the patients were migrants. But in the last year, almost half of the patients have been Greek citizens. Many of them can no longer afford healthcare services.

"We need strong and courageous politicians to speak out against all this, who will not for one moment abandon the fight against social inequality, racism and xenophobia," van Egmond stressed.

Sarah Thomson, senior research fellow at the European Observatory on Health Systems and Policies and deputy director at LSE Health, said:

"Though it was not always the case during the crisis, some countries reacted very quickly in many cases to potential for cuts in the healthcare budget and they used a very wide range of tools to try to maintain levels of public spending on health. Some countries were able to respond and some of them showed that through financing reforms, it was possible to protect the health budget. It was also possible to make changes that protected the labour market and to introduce more targeted policies."

The eurozone debt crisis has forced some governments to drastically cut their public health budgets in an effort to contain deficits.

Greece was among the countries taking the toughest measures, but Spain and other countries such as France and the Czech Republic have also taken similar steps.

>> Read our LinksDossier: Austerity: Healthcare in hardship

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