European Semester’s increased target on healthcare reform


The European Commission's country-specific recommendations for economic reforms in member states are increasingly targeting the healthcare sector, but they are not always working, experts say.

The so-called European Semester, the cycle of economic and fiscal policy coordination in the EU, has focused on reforming national healthcare systems since 2011, even though this is an area in which the EU has few powers over member states.

Rita Baeten, senior policy analyst at European Social Observatory, highlighted that only three EU member states had received country-specific recommendations on healthcare in 2011, in addition to the four countries under the economic adjustment programme (Greece, Portugal, Ireland and Cyprus). A year later, that number had increased to six member states, and rose to sixteen member states in 2013, she said.

Besides these 20 member states, four other countries proposed extensive healthcare reforms by themselves.

Baeten mentioned that only Denmark, Sweden and the UK had not yet received country-specific recommendations which she reckons might have to do with the fact that these three countries have explicitly opted out of the eurozone. This means that the policy instruments could be less forceful for these countries than the others.

The policy analyst also remarked that recommendations came with an increasing level of detail.

"In 2013, there were quite some similarities in the recommendations: For example, reduction of home care for elderly people, hospitalisations and reduction of pharmaceutical spending and reduction of prescriptions of professional services," she said, adding that the Commission also often calls for better cooperation and implementation of prevention programmes.

Baeten was speaking at a panel debate in Brussels organised on Wednesday (12 February) by Confrontations Europe, a think-tank, and the French pharma company Sanofi.

Some countries 'do nothing' about recommendations

Richard Torbett, chief economist at the European Federation of Pharmaceutical Industries and Associations (EFPIA), said that the European Semester undoubtedly had a huge positive potential.

However, he cautioned about the over-reliance on cost-cutting. "Even the best-intended programmes, unfortunately in the name of efficiency, have overly focused on getting rid of costs in a very short-term way," Torbett said, calling on the Commission to reflect more broadly about how healthcare markets work.

Elena Flores, director for Policy Strategy and Coordination at the Commission's economic and financial affairs directorate (DG ECFIN), acknowledged that there are "weaknesses" with the European Semester, but that the intention was to prevent and avoid problems.

"The idea behind the policy coordination is not to say that we should do everything together no matter what. But we should work together on things that would otherwise create problems for the good functioning of the EU, in particularly within the euro area," Flores stressed.

She underlined that country-specific recommendations were still not part of the national debate in many countries, and that, as a consequence, many tend to do nothing about them.

"This is a problem because of the way the recommendations will be seen by those who have to implement them. That's an issue where we're discussing how it can be improved," Flores said.

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

  • May 2014: Commission proposes country-specific recommendations (CSRs) for budgetary, economic and social policies.
  • June 2014: National ministers to discuss the CSRs.
  • July 2014: EU leaders to endorse final CSRs.

Subscribe to our newsletters