Why we need increased healthcare spending in Central and Eastern Europe (Guest blog)
Countries in Central and Eastern Europe (CEE) initially weathered the effects of the COVID-19 pandemic, suggesting their populations and healthcare systems were surprisingly robust (among other factors). But their vulnerability to the ongoing "second wave" has dispelled that illusion.
Indeed, on a series of measures, CEE countries continue to lag behind their equivalents in western Europe by a considerable margin when it comes to health. This is despite substantial social and economic progress in the last 30 years and notably since 2004 when eight joined the EU.
Although between 2010-2019 government healthcare spending in absolute numbers increased in all CEE countries[1], still, on average, they spend significantly less on healthcare (5% of GDP) than the five biggest economies in western Europe (8%), let alone Switzerland (around 12%)[2]. The increase in health spend lags far behind that of growth in the CEE economy as a whole: a gap that is widening, unfortunately.
One obvious policy conclusion is that these countries should devote a greater proportion of their national output to healthcare. After all, investing in health creates wealth. It boosts economic growth as fewer people take time off work through sickness and individual and collective productivity rise. Paradoxically (at first sight), one invests more to spend less. And the public finances (fiscal stability) improve.
The bigger picture
This conclusion holds true but there's more to it than that, of course. Major reasons why life expectancy in CEE countries, even (relatively) richer ones such as Poland, is lower by up to five years than in western Europe[3] are poor adherence to medical precepts regarding obesity, alcohol and smoking and limited access to innovative treatment options. Premature deaths in the region come at multi-billion cost to the economy.
Efficiency and effectiveness are key issues. Commentators point to lack of investment in primary healthcare and below-par use of out-patient/community health services as one reason why countries fail to get enough "bang for their buck". At the same time, poor levels of public provision can mean that out-of-pocket spending on health is punitively high.
Take Poland as an example. There, out-of-pocket spending accounts for more than 20% of overall spending on health[4], with around three in ten low-income households badly hit[5]. The country also suffers from below-average numbers of doctors and nurses per 1000 of population while spending on preventive care is less than half the EU average.[6]
In other CEE countries as well, the healthcare service is seriously hampered by the emigration of trained (and untrained) professionals such as specialists like paediatricians and anaesthetists, general practitioner doctors and nurses who have been attracted by better pay and working conditions in the west. Romania reportedly lost half its doctors between 2009 and 2015 while it cannot treat very young children for cancer owing to staff shortages[7].
Investment in prevention is another area where most CEE countries do not perform well. For example, Slovakia has is below many other EU Member States in investing in health promotion and disease prevention. In 2017, only 1 % of current health expenditure was allocated to prevention, a share much lower than the EU average (3 %).[8] Similar low investment in prevention is noted in Hungary (2.6%)[9].
Cancer and beyond
First, it is the case that CEE countries display poorer outcomes when it comes to a range of indicators about cancer, including survival rates and access to innovative new drugs. But the same holds true for other non-communicable diseases (NCDs) such as cardiovascular, diabetes and respiratory illnesses – some of this for the reasons, including lifestyle issues, outlined above.
Overall in Europe, according to a study by EFPIA, the number of people diagnosed with cancer has risen by around a half in the last 20 years and cancer causes one in four deaths, making it the biggest killer after cardiovascular disease. This trend is set to continue as ageing becomes even more prevalent.
At the same time, deaths are slowing down compared with the number of cases. Survival rates are on the up. But CEE countries still lag behind. Take colon cancer: here "only" 50% of Croatian sufferers survive five years after diagnosis compared with 70% of Icelanders. In CEE countries as a whole survival rates are rising but still significantly fail to match those in western partner countries for, say, lung, prostate and breast cancers.
According to the World Cancer Research Fund, Hungary has the fourth highest cancer rate (368 age-standardised rate per 100,000) in the world, while Serbia and Slovenia also figure in the top 20[10] – but so do Ireland, Belgium, France...But outcomes, as for other diseases, are worse in the CEE – there are severe "cancer inequalities."[11]
Lower levels of research and screening combined with the 'brain drain' witnessed in the healthcare field are among the most important factors. Another is access to innovative treatments, with CEE patients having to wait months more than their west European counterparts – and far fewer of the novel treatments approved by the EMA available. If you're a cancer victim in Sweden, your chances of surviving five years are 60%; in Bulgaria it's just 40%.[12]
Looking at lung cancer, which is a race against time and kills nearly as many people in Europe as breast, colon and prostate cancer combined, the data collected for EU27 show that 5 year survival for lung cancer in the Czech Republic and Slovakia is, with 11%, among the lowest in Europe, compared to the 15% average.[13] In addition, looking at the availability of innovative medicines for lung cancer, again the Czech Republic and Slovakia perform poorly, with only 30% (Czech Republic) and 10% (Slovakia) of innovative lung cancer medicines available compared to a European average of 65%.[14]
What I had mentioned last year, still holds true: "... (CEE) policymakers need to start prioritizing healthcare and view increased health budgets as an investment, rather than a cost." The pandemic has rendered this statement even more pertinent today.
[1] Analysis of OECD data from: https://data.oecd.org/healthres/health-spending.htm
[2] Analysis of WHO data ‘Health expenditure financed by government schemes & compulsory
contributory health insurance schemes’’ for public spend per capita (PPP) and World Bank Data for GDP per capita - https://apps.who.int/nha/database/ViewData/Indicators/en
[3] Data extracted from OECD – Better Life Index: http://www.oecdbetterlifeindex.org/
[4] Analysis of OECD data from: https://data.oecd.org/healthres/health-spending.htm - refers to 2017
[5] https://www.euro.who.int/__data/assets/pdf_file/0004/425785/Can-people-afford-to-pay-for-health-care_New-evidence-on-financial-protection-in-Poland-_summary.pdf
[6] https://www.euro.who.int/__data/assets/pdf_file/0007/419470/Country-Health-Profile-2019-Poland.pdf
[7] https://www.euro.who.int/__data/assets/pdf_file/0009/419472/Country-Health-Profile-2019-Romania.pdf
[8] https://www.euro.who.int/__data/assets/pdf_file/0010/419473/Country-Health-Profile-2019-Slovakia.pdf
[9] https://www.euro.who.int/__data/assets/pdf_file/0007/419461/Country-Health-Profile-2019-Hungary.pdf
[10] https://www.wcrf.org/dietandcancer/cancer-trends/data-cancer-frequency-country
[11] https://efpia.eu/media/413442/infographic-comparator-report-on-cancer-in-europe.pdf & https://www.efpia.eu/media/554526/patients-wait-indicator-2019.pdf
[12] https://www.efpia.eu/media/554526/patients-wait-indicator-2019.pdf
[13] EIU report: https://www.eiu.com/n/campaigns/breathing-in-a-new-era-a-comparative-analysis-of-lung-cancer-policies-across-europe/ (page 15
[14] EIU report: https://www.eiu.com/n/campaigns/breathing-in-a-new-era-a-comparative-analysis-of-lung-cancer-policies-across-europe/ (page 37)
