EFPIA welcomes the publication by the European Commission of the Country Reports as part of the European Semester 2016. The reports highlight, among other things, issues relating to health status and healthcare systems in the EU Member States – albeit primarily from a perspective of financial sustainability – and will hopefully lead to important discussions around healthcare reform in the EU Member States that improves health outcomes of patients.

The reports underline the long-term challenges that all Member States face, relating to ageing populations. 24% of the European population is already aged 60 years or over (2015), and that proportion is projected to reach 34% in 2050. These demographic trends are an enormous challenge for the sustainability of pension systems, healthcare and long-term care if the right actions are not taken.

EFPIA welcomes the fact that in several cases the reports look at the structural factors of Healthcare Systems, such as the need to reduce hospitalisation in order to reduce costs, and the need for several countries to move from a hospital-centric system to a system with a focus on primary and community care. In order to tackle the increasing burden on health systems from chronic diseases, more integrated and patient-centered care models are needed to reduce the barriers between primary and secondary care services, as well as community care and social care services, and ultimately deliver better health outcomes.

Fragmentation in terms of responsibilities, information systems and payment models are barriers to achieving the best outcomes for patients, in particular for patients with chronic diseases and co-morbidities. EFPIA asserts that, in addition to such structural changes, it is important to implement clinical guidelines and optimal care pathways for patients, based on the latest scientific and clinical knowledge on how to achieve the best possible health outcomes.

EFPIA would furthermore like to underscore that investments are often needed in order to reform health systems to achieve long-term sustainability. As the report shows, some countries, primarily in Central- and Eastern Europe, have under-funded health systems, with access problems, high levels of co-payment, too few healthcare professionals and overall poor health outcomes compared with the EU average. These countries would need to spend more on health, including prevention, in order to achieve healthier populations and sustainable finances over time. But also systems that are facing less pressing challenges today, will have to invest to become fit for the future.

EFPIA welcomes the ambition to include health status and quality of care indicators in the reports, but notes that data on health outcomes are often lacking in both quality and quantity, to provide a sufficiently clear analysis of how health system reform should be undertaken in order to achieve a higher health status for the population. For example, it is difficult to draw any actionable conclusions by comparing two countries in terms of total health spending as a percentage of GDP, and healthy life expectancy at birth. The latter depends on many factors, several of them outside of the healthcare system.

More granular and disease-specific health outcomes data, linked to particular interventions within the healthcare system, are needed in order to identify potential inefficiencies. For example, the outcomes standards developed by the International Consortium for Health Outcomes Measurement (ICHOM) provide a number of simple, patient-centric and clinically relevant outcomes measurements that allow a system to meaningfully assess the results it achieves with its healthcare investments.

EFPIA calls on the Commission to recommend that all Member States implement systems for Health Systems Performance Assessment, with a strong focus on health outcomes measurements, as a way to identify areas to improve health outcomes, reduce inefficiencies, and achieve the best value for money. Data show that there are substantial differences in health outcomes also within countries, which cannot be explained due to differences in funding levels, but rather in terms of what the money is spent on and sometimes sub-optimal treatment methods and pathways. Comprehensive and interlinked health information systems, including electronic health records and registries, for collecting real world evidence on health outcomes throughout the health system, have for this reason an important role to play. Such data will allow health systems to make better funding decisions in the future, ultimately enabling a situation where money is spent on tangible health outcomes, rather than inputs.