WRITTEN QUESTION E-3283/02

by Paul Rübig (PPE-DE) to the Commission

(19 November 2002)

Subject: Action to ensure the financial viability of health care systems

In its communication on the future of health care and care for the elderly(1), the Commission went into great detail about the fact that population trends over the next few decades will lead to serious funding problems not only in the area of pensions, but also in health care, though within health care other factors are making that trend even more pronounced. In that communication, the Commission cited financial viability as one of three objectives to be pursued simultaneously. To achieve that, what is needed above all is action to make systems more efficient and avoid efficiency shortfalls. In other sectors of the economy, market mechanisms ensure that such effects take place (up to a point). Health care lacks significant market features. Usually, for instance, it is not the patient the consumer who chooses the service, but, rather, the doctor; nor is there any resulting market-driven price formation process between patient and service provider, since the service is usually paid for by the state or a health insurance fund. It would nonetheless appear possible, to some extent at least, to embed or, as the case may be, enhance market principles within health care, e.g. fostering competition between providers plus greater price transparency for the patient, if necessary through percentage-based co-payments. The communication referred to also stresses the importance of greater international pooling of experience.

1. Does the Commission think that action to enhance market features within health care makes sense and is feasible?

2. Is the Commission contemplating making moves in that direction?

3. What further steps is the Commission intending to take to realise, in a tangible fashion, the objective of ensuring the financial viability?

4. Does the Commission intend to take initiatives to foster and structure the international pooling of experience?

(1) COM(2001) 723 final.

Answer given by Mrs Diamantopoulou on behalf of the Commission

(20 December 2002)

There is agreement that all Member States face a triple challenge of ensuring access to health care, high quality of care and the financial sustainability of health care systems. However, it is the responsibility of Member States to organise health care systems and their funding. Whether in the context of a national system market-based mechanisms are useful for cost-containment purposes and whether such mechanisms are compatible with the objective of universal access to high quality care needs to be decided at the level of each Member State. The Union has no powers to prescribe the use of such mechanisms. However, the Commission can play a useful role in encouraging the exchange of information on policies to ensure financially sustainable and universal access to high-quality health care.

The Commission supports the work of the Social Protection Committee and the Economic Policy Committee on health and long-term care for the elderly which has so far resulted in a first set of estimates of the budgetary impact of ageing on healthcare expenditure and on a common questionnaire that was submitted to the Member States in the first semester of 2002. The replies to the questionnaire are being examined and a draft joint Commission/Council report synthetizing the findings will be adopted by the Commission shortly. Options for a more structured co-operation among Member States in the field of healthcare and long-term care for the elderly will be considered further by the Commission in 2003 on the basis of the results of the ongoing co-operation at Union level.

Moreover, the Commission has launched a high level process of reflection on patient mobility and health care developments in the Union to discuss key health policy issues, including quality and access, information requirements, the scope for co-operation on health care matters, and how to reconcile national policies with European objectives in general.

The new public health action programme will provide opportunities to support some exploratory work in this context.