The prognosis is not good. Unless Europe’s healthcare systems change how they operate, there is a big question mark over how sustainable they really are. As Europe’s population ages, chronic diseases grow more widespread, and public spending fails to keep up with demand, healthcare systems are being asked to do more (and better) with less.
Europe’s ageing population is forecast to push up health and long-term care spending in the EU by up to 10% of GDP by 2060, according to the European Commission. Already there are signs that the various healthcare models employed by different EU Member States are struggling to cope.
We had a comment sent in by Mac, who wonders why the cost of healthcare systems keeps going up and up. According to the World Bank, public healthcare within the European Union was 12% of total government expenditure in 1995. That has risen to 16% in 2014. Is this trend likely to continue? And is it sustainable?
To get a response, we spoke to John Bowis, former British Conservative MP and MEP, and British Health & Social Services Minister (1993-1996). What would he say to Mac?
To Mac, I would say the current forecasts are that it’s not sustainable unless we do something different in terms of planning and initiating health policy. And the reason, of course, it’s not sustainable is the fact that people are living longer, and as they live longer they develop some very expensive neurodegenerative illnesses and so forth. We know that science moves on a pace, and that’s good news, but it brings ever-increasing costs in terms of drugs and devices and therapies, and that puts more and more pressure on public spending at a time when, as we know, there’s been a mood of austerity around Europe, trying to recover from the economic problems of recent years.
These pressures are going to go on. So, what do we do about? I believe we do need to spend more, but to do that we need to convince governments and the European Union that health is not just a cost, it’s an investment. Investing in good health, and investing in the recovery from poor health, is actually a contribution to economic growth because if you have sick people not only do they cost in terms of medicines and care and so forth but they’re not able to go out and earn money and pay taxes and so forth, so it’s a vicious circle. We need to get government’s understanding that they need to invest in health and then we get the rewards later.
I think we also need to see how the individual can play a bigger part in his or her own health management. It needs health literacy, and a concerted effort to recognise that patients are in fact experts in their own health, in the sense that they experience it directly, unlike any academic study. So, they should be partners with health professionals in managing their own health. If we manage that better, it can ultimately reduce costs…
We also had a comment from Rita, arguing that more public money should be invested in prevention. At the moment, roughly 3% of total healthcare budgets in Europe are being spent on prevention. Instead of spending more money on hospitals, doctors and pharmaceuticals, should we be investing more in public health campaigns, free exercise structures in parks, more bike lanes, etc?
To get a reaction, we put Rita’s comment to Ain Aaviksoo, Deputy Secretary General for E-services and Innovation at the Estonian Ministry of Social Affairs. Health spending as a share of GDP in Estonia is 6%, well below the average in the OECD (8.9%). The country has a mixed record on health outcomes in general, but it does perform very well in some areas (for example, it has among the best child health indicators in the OECD). So, what would Ain Aaviksoo say to Rita?
I would say to Rita that she’s exactly the kind of person we need to hear more from, to demand these kind of actions from policymakers. Believe it or not, one of the problems is that people tend to think about their health more only when they actually become sick. So, there is very clear demand to have services when people knock at the door of a doctor, and we also need to realise there is a very strong industry behind all of this health technology and pharmaceuticals.
We need a paradigm shift, but it won’t happen without very clear support from different stakeholder groups, including from citizens. I would say that the glass is perhaps not yet half-full, but it’s at least increasing… People like Rita can encourage change by talking to their friends and neighbours, because prevention only happens if people do their part. It’s easy to expect that a doctor will prescribe a pharmaceutical, you go and buy it, the government pays for it, and then you become healthy again. But when the doctor tells you that you need to go and run or ride a bike, nobody but that patient herself can actually take the bike and go and actually ride it. So, it’s a combination of a new kind of social contract between citizens and policymakers, but it starts with the demand from citizens that was so well expressed by Rita asking this kind of question.
Are European healthcare systems collapsing? Are some models more sustainable than others? Why aren’t policymakers investing more in disease prevention? Let us know your thoughts and comments in the form below and we’ll take them to policymakers and experts for their reactions!