How can we keep European healthcare systems sustainable? According to the World Bank, healthcare expenditure in the European Union has gone from roughly 8% of GDP in 2000 to almost 10% by 2015. How long can a trend like this continue?
As the demands of an ageing population put increased pressure on public health systems, how can we be sure that standards don’t slip? Maintaining quality will require either greater efficiency (i.e. “do more with less”, probably with the help of e-health and new technologies), focusing more on prevention and public health measures to ensure a healthier population, cutting expenditure in other areas of government spending, increasing government debt, growing the economy, or raising taxes. The solution, in practice, is likely to involve some messy combination of all of the above, with different EU countries relying on different policy mixes.
Exacerbating the problem is the fact that doctors are retiring faster than they are being replaced with new trainees, right at the moment when the average age of patients is going up. In France, for example, the number of practising family doctors has declined by 10% over the last decade, while in Austria roughly 40% of doctors are due to retire over the coming 6-7 years.
What do our readers think? We had a comment sent Edward saying he thinks Europeans would accept higher taxes if it meant better healthcare. Is he right? Do Europeans value public healthcare so much that they would be willing to contribute more in order to maintain standards?
To get a reaction, we put Edward’s comment to Fiona Godfrey, Secretary-General of the European Public Health Alliance, an association of non-profit organisations active in public health. How would she respond to the suggestion that Europeans might be willing to pay higher taxes for better healthcare?
I think, as a European myself, I would be happy if we could see multinationals paying higher taxes, which could be used for better healthcare. I think, if you look at taxation trends over the last ten or fifteen years, the average level of corporate taxation in the EU has gone down; it’s now just over 20%, whereas the average level of personal taxation for a citizen living in the EU has either been stable or it’s gone up, and the average is almost 40%.
So, I think there is a need for higher taxes; I’m not sure that there’s a need for individuals to pay higher taxes, because I think they’re already paying enough. And I think, on top of that, a lot of companies – McDonald’s, for example – who don’t always produce the healthiest food, and whose products contribute to a lot of ill health in children and in adults, and they’re not always paying their fair share, either in general, or in certain countries where they’re making a profit but not paying taxes.
To get another perspective, we put the same comment to Pedro Pita Barros, Professor of Health Economics at the Universidade Nova de Lisboa in Portugal. Did he agree with Edward?
No, not really, on a broad basis. I’ll take that observation by Edward by saying that people in Europe value a lot the government intervention in healthcare, and so they value what the government does in that field.
The point here is that if the economy grows slightly, or grows at a reasonable pace [as it has done in] the past, you’re going to have more tax revenues anyway, that you can use in healthcare more than using in other areas. And I think it’s true that people would like the extra revenue that comes from the natural growth of the economy to be spent on healthcare.
Increasing current tax rates is probably very hard to do, because in some of the countries they are already quite high, so increasing further could actually face resistance. I would take the comment as saying that people would like more emphasis on healthcare expenditure by governments more than saying we want higher taxes to be spent into the healthcare sector.
So, the feasibility [of higher taxes] is probably low, but the willingness of Europeans to have more government money [going] into healthcare instead of other areas is probably true.
Would you pay higher taxes for better healthcare? Should multinational corporations contribute more, rather than individuals? Or is keeping taxes low and growing the economy at a reasonable rate enough to keep healthcare systems sustainable? Let us know your thoughts and comments in the form below and we’ll take them to policymakers and experts for their reactions!