# C_2015019EN.01002801.xml

| 21.1.2015 | EN | Official Journal of the European Union | C 19/28 |
| --- | --- | --- | --- |

21.1.2015

EN

Official Journal of the European Union

C 19/28

---

Opinion of the Committee of the Regions — Effective, accessible and resilient health systems

(2015/C 019/06)

| Rapporteur | Mr Karsten Uno Petersen, Regional Councillor (DK/PES) |
| --- | --- |
| Reference document | Communication from the Commission on effective, accessible and resilient health systems
  COM(2014) 215 final |

Rapporteur

Rapporteur

Mr Karsten Uno Petersen, Regional Councillor (DK/PES)

Reference document

Reference document

Communication from the Commission on effective, accessible and resilient health systems

COM(2014) 215 final

I.   POLICY RECOMMENDATIONS

POLICY RECOMMENDATIONS

General comments

General comments

THE COMMITTEE OF THE REGIONS

| 1. | values the Commission’s communication, which states that health systems should be able to add more years to life, but also to add more life to years, and thereby help to improve citizens’ health. A person’s health, defined as including both physical and psychological well-being, is also determined by factors other than healthcare measures; |
| --- | --- |

1.

values the Commission’s communication, which states that health systems should be able to add more years to life, but also to add more life to years, and thereby help to improve citizens’ health. A person’s health, defined as including both physical and psychological well-being, is also determined by factors other than healthcare measures;

| 2. | calls for health to be recognised as a value in its own right, so that health system expenditure is seen as an investment in population health, one which can have additional benefits in the form of greater productivity, increased labour supply and sustainable public finances; |
| --- | --- |

2.

calls for health to be recognised as a value in its own right, so that health system expenditure is seen as an investment in population health, one which can have additional benefits in the form of greater productivity, increased labour supply and sustainable public finances;

| 3. | notes that decentralised levels of government face the same challenges right across the EU: rising health care costs and ageing populations with an increase in chronic disease and multimorbidity, resulting in a growing demand for health care. The Committee points out that responsibility for addressing these challenges lies at national, regional and local level; |
| --- | --- |

3.

notes that decentralised levels of government face the same challenges right across the EU: rising health care costs and ageing populations with an increase in chronic disease and multimorbidity, resulting in a growing demand for health care. The Committee points out that responsibility for addressing these challenges lies at national, regional and local level;

| 4. | welcomes and endorses the right of EU citizens to have access to effective, good quality treatment and the fact that, in the light of experience in recent years, the Commission wishes to help the Member States to develop strategies to make health systems more efficient, improve access to care and create more resilient health systems; |
| --- | --- |

4.

welcomes and endorses the right of EU citizens to have access to effective, good quality treatment and the fact that, in the light of experience in recent years, the Commission wishes to help the Member States to develop strategies to make health systems more efficient, improve access to care and create more resilient health systems;

| 5. | confirms the need to comply with Article 168 TFEU, which stipulates that public health is in the first instance a national responsibility, and to uphold the subsidiarity principle in this area. The Committee takes this opportunity of reiterating that the Member States are responsible for health policy, and that in most cases a considerable part of the responsibility for health affairs lies with local and regional authorities; |
| --- | --- |

5.

confirms the need to comply with Article 168 TFEU, which stipulates that public health is in the first instance a national responsibility, and to uphold the subsidiarity principle in this area. The Committee takes this opportunity of reiterating that the Member States are responsible for health policy, and that in most cases a considerable part of the responsibility for health affairs lies with local and regional authorities;

| 6. | notes that in 2013, eleven Member States received a recommendation for reform in their health systems as part of the European Semester. In this respect, the Committee would like to draw attention to fact that differences in Member State health systems are a reflection of different societal choices and that under Article 168 TFEU, the EU’s role in the area of public health is meant to complement national policies; |
| --- | --- |

6.

notes that in 2013, eleven Member States received a recommendation for reform in their health systems as part of the European Semester. In this respect, the Committee would like to draw attention to fact that differences in Member State health systems are a reflection of different societal choices and that under Article 168 TFEU, the EU’s role in the area of public health is meant to complement national policies;

| 7. | agrees that the healthcare sector is strongly driven by innovation and acknowledges that it has major economic significance, but recommends that the common values underlying European healthcare systems — universality, access to good quality care, equity and solidarity — as recognised by the Council (health) in 2006, should always override concerns dictated by the current economic situation; |
| --- | --- |

7.

agrees that the healthcare sector is strongly driven by innovation and acknowledges that it has major economic significance, but recommends that the common values underlying European healthcare systems — universality, access to good quality care, equity and solidarity — as recognised by the Council (health) in 2006, should always override concerns dictated by the current economic situation;

| 8. | realises that the economic crisis has put added pressure on Member States’ financial resources, but would also point out that healthcare systems must be sustainable, so as to safeguard common basic values in the future, while ensuring that they are met at the present time; |
| --- | --- |

8.

realises that the economic crisis has put added pressure on Member States’ financial resources, but would also point out that healthcare systems must be sustainable, so as to safeguard common basic values in the future, while ensuring that they are met at the present time;

| 9. | is pleased to see that, in its efforts to assist Member States in making use of health system effectiveness assessments, the Commission intends to cooperate more closely with international organisations, such as the WHO and the OECD; |
| --- | --- |

9.

is pleased to see that, in its efforts to assist Member States in making use of health system effectiveness assessments, the Commission intends to cooperate more closely with international organisations, such as the WHO and the OECD;

| 10. | advocates caution on the part of the Commission when it comes to introducing a comprehensive reporting system for evaluating health system outcomes and notes that one of the advantages of cooperating more closely with the WHO and the OECD could be to make better use of existing data; |
| --- | --- |

10.

advocates caution on the part of the Commission when it comes to introducing a comprehensive reporting system for evaluating health system outcomes and notes that one of the advantages of cooperating more closely with the WHO and the OECD could be to make better use of existing data;

| 11. | encourages Member States to strengthen, and where necessary expand, existing capacity so as to ensure ongoing and regular collection of health-related data, as this will contribute to the quality of international data available in organisations such as the WHO and the OECD; |
| --- | --- |

11.

encourages Member States to strengthen, and where necessary expand, existing capacity so as to ensure ongoing and regular collection of health-related data, as this will contribute to the quality of international data available in organisations such as the WHO and the OECD;

| 12. | draws attention to the need for health outcomes to be based on general and easily accessible indicators, such as survival rates for certain types of disease or waiting times, and would welcome a framework containing a number of common EU criteria for assessing health outcomes on which Member States can base policy debates and set priorities; |
| --- | --- |

12.

draws attention to the need for health outcomes to be based on general and easily accessible indicators, such as survival rates for certain types of disease or waiting times, and would welcome a framework containing a number of common EU criteria for assessing health outcomes on which Member States can base policy debates and set priorities;

| 13. | agrees that increasing mobility on the part of patients and health professionals means that Member State healthcare systems interact more closely with each other, and points out that, if they are to work more closely in addressing this development, they will need to draw on the knowledge available at regional and local administrative level; |
| --- | --- |

13.

agrees that increasing mobility on the part of patients and health professionals means that Member State healthcare systems interact more closely with each other, and points out that, if they are to work more closely in addressing this development, they will need to draw on the knowledge available at regional and local administrative level;

| 14. | notes that a well-trained workforce with good opportunities for skills development, availability of skills, good leadership and a correct flow of information in the system are to a large extent the hallmark of healthcare systems in which delegating competence to regional and local levels is an established feature; |
| --- | --- |

14.

notes that a well-trained workforce with good opportunities for skills development, availability of skills, good leadership and a correct flow of information in the system are to a large extent the hallmark of healthcare systems in which delegating competence to regional and local levels is an established feature;

| 15. | draws attention to the fact that integrated care should go hand in hand with increased focus on patient involvement and quality of care, and observes that the work of the Commission’s expert panel in this and other areas should be discussed with local and regional authorities, possibly in the form of public hearings on the panel’s findings; |
| --- | --- |

15.

draws attention to the fact that integrated care should go hand in hand with increased focus on patient involvement and quality of care, and observes that the work of the Commission’s expert panel in this and other areas should be discussed with local and regional authorities, possibly in the form of public hearings on the panel’s findings;

| 16. | recognises that healthcare systems need to demonstrate resilience, the capacity to adapt to different environments and to rise to considerable challenges at a time of limited resources, and considers that these qualities should be secured from the outset by giving regional and local authorities responsibility for public health; |
| --- | --- |

16.

recognises that healthcare systems need to demonstrate resilience, the capacity to adapt to different environments and to rise to considerable challenges at a time of limited resources, and considers that these qualities should be secured from the outset by giving regional and local authorities responsibility for public health;

| 17. | is pleased that the Commission recognises the importance of the health sector in combating the social consequences of the economic recession, but stresses that decisions intended to tackle over-arching economic crises/problems must be analysed with respect to their potential negative impact on public health, so that such effects can be avoided; |
| --- | --- |

17.

is pleased that the Commission recognises the importance of the health sector in combating the social consequences of the economic recession, but stresses that decisions intended to tackle over-arching economic crises/problems must be analysed with respect to their potential negative impact on public health, so that such effects can be avoided;

| 18. | welcomes and endorses a social inclusion strategy, including broad access to affordable and high-quality health services with the aim of stemming the rising health inequalities among the Member States; |
| --- | --- |

18.

welcomes and endorses a social inclusion strategy, including broad access to affordable and high-quality health services with the aim of stemming the rising health inequalities among the Member States;

Strengthening the effectiveness of health systems

Strengthening the effectiveness of health systems

THE COMMITTEE OF THE REGIONS

| 19. | welcomes and endorses the ongoing work on patient safety at EU level, and calls for work on patient experience and patient involvement — a key aspect here — to be given higher priority in future EU health initiatives, along with efforts to develop human resource skills; |
| --- | --- |

19.

welcomes and endorses the ongoing work on patient safety at EU level, and calls for work on patient experience and patient involvement — a key aspect here — to be given higher priority in future EU health initiatives, along with efforts to develop human resource skills;

| 20. | draws attention to the fact that health outcomes are difficult to define, making comparisons among Member States a tricky exercise, but agrees that it is appropriate to measure and compare the effectiveness of healthcare systems; |
| --- | --- |

20.

draws attention to the fact that health outcomes are difficult to define, making comparisons among Member States a tricky exercise, but agrees that it is appropriate to measure and compare the effectiveness of healthcare systems;

| 21. | also thinks that the exclusive purpose of making comparisons among Member States should be to learn from, and exchange, best-practice experiences; this will give Member States the opportunity to track their own progress from an international perspective in their efforts to make ongoing improvements; |
| --- | --- |

21.

also thinks that the exclusive purpose of making comparisons among Member States should be to learn from, and exchange, best-practice experiences; this will give Member States the opportunity to track their own progress from an international perspective in their efforts to make ongoing improvements;

| 22. | acknowledges that in some areas, where data from international organisations such as the WHO and the OECD is not sufficient, there might be a case for setting up an EU database for Europe; |
| --- | --- |

22.

acknowledges that in some areas, where data from international organisations such as the WHO and the OECD is not sufficient, there might be a case for setting up an EU database for Europe;

Increasing the accessibility of health systems

Increasing the accessibility of health systems

THE COMMITTEE OF THE REGIONS

| 23. | sets store by the fact that the Commission’s communication reiterates the principles underpinning the European Social Pact, which highlights the importance of transparent criteria for access to medical treatment and the obligation to ensure that no segments of the population are excluded from access to healthcare; |
| --- | --- |

23.

sets store by the fact that the Commission’s communication reiterates the principles underpinning the European Social Pact, which highlights the importance of transparent criteria for access to medical treatment and the obligation to ensure that no segments of the population are excluded from access to healthcare;

| 24. | agrees that it is difficult to measure access to healthcare services, but would make the point that indicators based on feedback of people’s personal experiences are an important weathervane in terms of the public’s perception of access to healthcare services; |
| --- | --- |

24.

agrees that it is difficult to measure access to healthcare services, but would make the point that indicators based on feedback of people’s personal experiences are an important weathervane in terms of the public’s perception of access to healthcare services;

| 25. | agrees that in assessing access to healthcare services, the focus should be on both the proportion of the population with health coverage and the extent of this coverage, but reiterates the point that discrepancies in the type and scale of coverage are a reflection of societal choices made nationally, regionally and locally; |
| --- | --- |

25.

agrees that in assessing access to healthcare services, the focus should be on both the proportion of the population with health coverage and the extent of this coverage, but reiterates the point that discrepancies in the type and scale of coverage are a reflection of societal choices made nationally, regionally and locally;

| 26. | agrees that accessibility is a prerequisite for accessing healthcare and that ‘accessibility’ includes waiting times, distance and the size of the workforce in the health sector; nevertheless, it would point out that concentrating specialist treatment centrally, even though it might involve making longer journeys, may be necessary in order to provide adequate expertise in specific fields of treatment. However, steps must always be taken to ensure that populations in regions that suffer demographic and geographical disadvantages also have access to specialist health services of this kind; |
| --- | --- |

26.

agrees that accessibility is a prerequisite for accessing healthcare and that ‘accessibility’ includes waiting times, distance and the size of the workforce in the health sector; nevertheless, it would point out that concentrating specialist treatment centrally, even though it might involve making longer journeys, may be necessary in order to provide adequate expertise in specific fields of treatment. However, steps must always be taken to ensure that populations in regions that suffer demographic and geographical disadvantages also have access to specialist health services of this kind;

| 27. | points out that regions with geographical and demographic disadvantages (highly dispersed population, low population density, acute demographic ageing, island or mountain regions) present specific challenges that are particularly sharply felt in the health field; |
| --- | --- |

27.

points out that regions with geographical and demographic disadvantages (highly dispersed population, low population density, acute demographic ageing, island or mountain regions) present specific challenges that are particularly sharply felt in the health field;

| 28. | recognises that integrated care models and e-health options are a way of solving the problem of health service accessibility in the Member States, and that this is particularly the case for regions with geographical and demographic disadvantages; |
| --- | --- |

28.

recognises that integrated care models and e-health options are a way of solving the problem of health service accessibility in the Member States, and that this is particularly the case for regions with geographical and demographic disadvantages;

| 29. | misses in this context a reference to the fact that especially people with disabilities sometimes have limited access to health-care services and reminds the European Commission against the backdrop of Article 9 of the United Nations Convention on the Rights of Persons with Disabilities of its commitment [COM(2010) 636 final] to pay special attention to people with disabilities when implementing strategies to fight health inequalities; |
| --- | --- |

29.

misses in this context a reference to the fact that especially people with disabilities sometimes have limited access to health-care services and reminds the European Commission against the backdrop of Article 9 of the United Nations Convention on the Rights of Persons with Disabilities of its commitment [COM(2010) 636 final] to pay special attention to people with disabilities when implementing strategies to fight health inequalities;

| 30. | finds it encouraging that the European Parliament and Council directive on the application of patient rights in cross-border healthcare has focused more clearly on health system responsibility for access to treatment; |
| --- | --- |

30.

finds it encouraging that the European Parliament and Council directive on the application of patient rights in cross-border healthcare has focused more clearly on health system responsibility for access to treatment;

| 31. | is pleased that the Commission is focusing on the important counselling role that health personnel will have the future, in cooperation with other sectors, and reiterates that regional and local authorities have a wealth of expertise in this type of cooperation that can usefully be brought to bear in further developing this aspect; |
| --- | --- |

31.

is pleased that the Commission is focusing on the important counselling role that health personnel will have the future, in cooperation with other sectors, and reiterates that regional and local authorities have a wealth of expertise in this type of cooperation that can usefully be brought to bear in further developing this aspect;

| 32. | welcomes the exchange of information on how to improve access to medication, but again points out that decisions on pricing and patient reimbursement are the result of societal choices and national, regional and local priorities. The Committee draws attention, however, to the fact that greater transparency in pricing medical products will make for more efficient use of resources; |
| --- | --- |

32.

welcomes the exchange of information on how to improve access to medication, but again points out that decisions on pricing and patient reimbursement are the result of societal choices and national, regional and local priorities. The Committee draws attention, however, to the fact that greater transparency in pricing medical products will make for more efficient use of resources;

| 33. | notes the Commission’s intention to continue to support Member States in their workforce planning in the health sector as a way of helping them to meet the challenges posed by health personnel mobility; |
| --- | --- |

33.

notes the Commission’s intention to continue to support Member States in their workforce planning in the health sector as a way of helping them to meet the challenges posed by health personnel mobility;

| 34. | agrees that the Member States should ensure that the European Parliament and Council directive on the application of patient rights in cross-border healthcare is properly implemented; |
| --- | --- |

34.

agrees that the Member States should ensure that the European Parliament and Council directive on the application of patient rights in cross-border healthcare is properly implemented;

Improving resilience of health systems

Improving resilience of health systems

THE COMMITTEE OF THE REGIONS

| 35. | notes that the Commission recommends that Member States undertake health system reforms as part of the European semester, and draws attention here to Article 168 TFEU, stipulating that the EU’s role in the area of public health should complement national policies; |
| --- | --- |

35.

notes that the Commission recommends that Member States undertake health system reforms as part of the European semester, and draws attention here to Article 168 TFEU, stipulating that the EU’s role in the area of public health should complement national policies;

| 36. | welcomes the fact that the Commission is assisting Member States in their health system reforms by introducing initiatives to help them learn from and exchange best practices with the other Member States and regions; |
| --- | --- |

36.

welcomes the fact that the Commission is assisting Member States in their health system reforms by introducing initiatives to help them learn from and exchange best practices with the other Member States and regions;

| 37. | points out that adequate long-term investments in health systems can, in the long run, be cheaper than short-term investments determined by cyclical financial constraints, and thinks that there should be a more forward-looking focus on identifying the short- and long-term effects of health investments; |
| --- | --- |

37.

points out that adequate long-term investments in health systems can, in the long run, be cheaper than short-term investments determined by cyclical financial constraints, and thinks that there should be a more forward-looking focus on identifying the short- and long-term effects of health investments;

| 38. | recognises that health systems must be financially resilient; cautions that health as a value in itself, patient safety and participation, and the development of human resource skills should not be eclipsed by short-term, cyclical financial considerations; |
| --- | --- |

38.

recognises that health systems must be financially resilient; cautions that health as a value in itself, patient safety and participation, and the development of human resource skills should not be eclipsed by short-term, cyclical financial considerations;

| 39. | acknowledges and endorses the work carried out by the Commission in identifying six resilience factors that can help health systems safeguard accessible and effective healthcare services for their population; |
| --- | --- |

39.

acknowledges and endorses the work carried out by the Commission in identifying six resilience factors that can help health systems safeguard accessible and effective healthcare services for their population;

| 40. | subscribes to the Commission’s support for setting an ambitious objective for the HTA (Health Technology Assessment) network established under the European Parliament and the Council directive on cross-border healthcare and agrees that this will reduce duplication of work by the authorities; |
| --- | --- |

40.

subscribes to the Commission’s support for setting an ambitious objective for the HTA (Health Technology Assessment) network established under the European Parliament and the Council directive on cross-border healthcare and agrees that this will reduce duplication of work by the authorities;

| 41. | takes note of the Commission’s focus on channelling patient-level information flows to the necessary healthcare providers and calls on the Commission to assist Member States in this task by promoting knowledge-sharing and exchange of best practices in information flows; |
| --- | --- |

41.

takes note of the Commission’s focus on channelling patient-level information flows to the necessary healthcare providers and calls on the Commission to assist Member States in this task by promoting knowledge-sharing and exchange of best practices in information flows;

| 42. | reiterates that there is a wealth of regional and local knowledge on the public’s perspective of healthcare and believes it is more important to draw on this knowledge than to explore the potential of a comprehensive European research infrastructure consortium; |
| --- | --- |

42.

reiterates that there is a wealth of regional and local knowledge on the public’s perspective of healthcare and believes it is more important to draw on this knowledge than to explore the potential of a comprehensive European research infrastructure consortium;

| 43. | believes that the potential synergies between health services in border regions have not yet been fully harnessed. This would however help to make health systems more accessible, benefiting patients. The Committee of the Regions urges the public authorities of the Member States to encourage cooperation agreements in this regard; |
| --- | --- |

43.

believes that the potential synergies between health services in border regions have not yet been fully harnessed. This would however help to make health systems more accessible, benefiting patients. The Committee of the Regions urges the public authorities of the Member States to encourage cooperation agreements in this regard;

| 44. | observes that making use of existing data through closer cooperation with the WHO and the OECD will also benefit research infrastructure. |
| --- | --- |

44.

observes that making use of existing data through closer cooperation with the WHO and the OECD will also benefit research infrastructure.

Brussels, 3 December 2014.

The President of the Committee of the Regions

Michel LEBRUN

---