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European Health Forum Gastein 2015

The Commission of the EU defined three pillars: effectiveness, accessibility and resilience of health systems. Increasing accessibility to healthcare is one of the main parts of the EU agenda for health systems.

There are three identified areas to support Member States towards increasing accessibility:

  1. Optimal implementation of the cross-border healthcare directive;
  2. Health workforce planning
  3. Access to safe, effective and innovative medicines.

Mr. Vytenis Andriukaitis, Commissioner for Health and food safety, spoke at the European Health Forum in Bad Gastein about the view and the actions the Commission has taken and is still working on. The Commission defines access to healthcare as the capacity of a healthcare system to reach the population, without excluding part of it from receiving healthcare services.

What means accessibility?

Accessibility has many aspects – it includes infrastructure, pricing and reimbursement, health workforce, waiting times and others.

The department of health is cooperating with experts, stakeholders, professionals and politicians to improve knowledge on access to healthcare and its measurement. It participates in discussions within the Stakeholder Partnership launched by patients' organizations and the EP interest group on access to healthcare. In addition, work is starting on a pilot project on access to healthcare in rural areas.

The Commissioner stated: “I am pleased that a preliminary opinion is now open for public consultation – and I would invite you all to read it and to contribute with your ideas and analysis.” He expressed his hopes that in future, the EU and the Member States should be better able to identify access-related problems and take early action to resolve such problems.

Directive on cross-border healthcare

One of the 3 actions to improve accessibility to healthcare is:

Optimal implementation of the Directive on Cross-border Healthcare

Few weeks ago, the Commission published a first implementation report which identifies major obstacles such as low reimbursement tariffs and burdensome prior authorization systems. These barriers prevent patients from using their rights to cross-border healthcare. There is a clear need to enhance information on cross-border healthcare, because only a low number of citizens are aware of their rights. Commissioner Andriukaitis: “I have discussed this report with Ministers and I called on Member States to eliminate these obstacles and underlined the need to enhance information to citizens on their rights to cross-border healthcare.” The Commission will take appropriate action for ensuring the correctness of the Directive’s transposition into national law so that all citizens in all 28 EU countries are able to benefit.

Health workforce planning

Health systems of European member states cannot deliver high quality care without a skilled and engaged health workforce. The workforce has to able to adjust to complex patient needs, .technological changes and to new ways of work. Most countries face significant gaps both in terms of numbers and skills of their health professionals, which provokes risks as regards access to healthcare. Also the geographical distribution of health workers can threaten access to healthcare. Working and living conditions as well as the level of salaries play a crucial role.

Commissioner Andriukaitis: “So how can countries plan better to avoid a crisis in their healthcare systems? Improving planning and workforce forecasting can help guide investments into the education and training of health workers and ensure health professionals with the right skills to cope with future healthcare needs.”

Access to innovative medicines

Patients have very high expectations as regards medical treatments and call for the speedier translation of scientific progress into accessible and affordable therapies. But unfortunately, often do not have time to wait. This makes it even more frustrating if EU wide authorized medicinal products are not available to patients in all Member States. Prices of new drugs, for example for hepatitis or cancer treatment, are rising dramatically. “There is an increasing interest among Member States to reflect jointly on how to increase patient access to innovative medicines. And Member States start exploring possibilities of how to jointly negotiate prices for expensive drugs, such as the Dutch-Belgium initiative to which Luxembourg has just joined in.” Mr. Andriukaitis explained and continued: “The ongoing discussions show that patient access to innovative medicines not only depends on optimization of authorization procedures. It is also linked to health technology assessment and pricing and reimbursement decisions. In my view, it would be nice to have transparent lists of prices in each member state to have a common picture on pricing in Europe.”

The Commissioner truly believes that an open debate on medicine pricing is needed because when it is covered by commercial secret, it creates mistrust in the society. The question is – how to create partnerships between pharma industry, Member States, and health insurers? How to create mechanisms so that people understand that the profit does not play the main role in the pharma sector? Transparency is important!

Another important issue is – solidarity.

A balance between solidarity based health systems and industry’s interest to make profit for their drugs is needed. New and Innovative medicines are expensive. Sometimes they are so expensive that even rich countries cannot afford them because the compensation mechanisms are too weak. Financing of EU healthcare systems are solidarity based. Access to medicine creates a lot of tension in the society. It is necessary to know what resources are needed, why they are needed and how they will be compensated.

Clinical evidence

Access to 'innovative medicine' requires solid clinical evidence to justify public coverage. Health Technology Assessment (HTA) has proved to be an efficient tool for improving access to innovative technologies and for providing decision makers with such evidence. The Commissioner said: “I would like to stress the need for HTA cooperation to be sustainable from 2019 by turning the project based cooperation on HTA into a permanent mechanism. I encourage member states to use this tool more widely and frequently in the future.”

In addition to transparency and solidarity information is also very important. The Commission is supporting the exchange of information between all interested Member States and other relevant EU and national public and private stakeholders, including patients, with the objective to improve patient access to medicines.

Dr. Fink-Wagner
EHFG 2015; Oktober 2015


Left to right Vytenis Andriukaitis, EU –Commissioner Health & Food Safety, Karin Kadenbach, Member oft he European Parliament MEP, Antje-H. Fink-Wagner, PhD, GAAPP


Vytenis Andriukaitis, EU –Commissioner Health & Food Safety