EFPIA opinion on European Semester Country Reports

In March 2018 the European Commission published the Country Reports as part of the European Semester, the EU’s annual cycle of economic and financial policy coordination.[1] The Country Reports review economic and social developments, challenges and opportunities in the Member States and form the basis of a dialogue between the Commission and the Member States and subsequent policy recommendations adopted by the Council.
EFPIA notes that the reports have further broadened in scope to take into account not only fiscal sustainability but also the need for social convergence in the EU, in line with the European Pillar of Social Rights, and the capacity of EU health systems to sustain healthy populations and deliver high-quality health outcomes for patients. EFPIA regards this as a very positive development towards a more comprehensive view of health and healthcare systems in Europe. The new EU process for assessing and comparing health systems – the State of Health in the EU – has brought valuable insights also to the Semester process in this regard.
The Commission[2] identifies healthcare and long-term care as one of the fastest growing public spending items among EU countries, together with pensions, which primarily are a consequence of ageing populations and the growing incidence of chronic diseases and multi-morbidity. This scenario underscores the need for healthcare reform to maximise the return on healthcare expenditure in terms of population and patient health outcomes, both in the short and long term.
In this context, it should be noted that public expenditure on health as a percentage of GDP (including medicines) varies greatly among EU countries, ranging from 2.6% to 8.6%[3], and EFPIA welcomes that the Country Reports recognise that some EU countries underspend on health, leading to health outcomes below or much below the EU average, and often also to health inequalities. The reports further recognise that health, in addition to being a value in itself, is a prerequisite for economic growth and sustainable societies.
Although European healthcare systems are different in terms of organization and resourcing, many of the factors identified in the reports causing challenges in terms of future fiscal sustainability are similar across countries, in particular:
  • Over-reliance on relatively costly hospital care;
  • Underdeveloped primary and community care;
  • Lack of integration and coordination between care services, and between healthcare and social care, in particular for chronic disease management and care.
The Country Reports also show that the sustainability of healthcare can only be addressed through a holistic perspective, tackling issues such as health promotion and disease prevention, healthcare organization, integrated care, workforce challenges and e-health deployment.
EU countries need more knowledge-based and data-driven healthcare systems to support decision-making and reforms. As recognized by the State of Health in the EU report[4], a key gap in this regard is high-quality and comparable data on health outcomes. Comprehensive collection and analysis of such data would be needed to better inform policymakers on healthcare reform, guide resource allocation and make healthcare services more effective and patient-centered. EFPIA encourages the Commission to recommend that all Member States implement systems to collect standardised data on outcomes, and to support such investments through appropriate EU funding instruments. Initiatives like the OECD Patient-Reported Indicators Survey (PaRIS) are useful to more comprehensively capture and compare the characteristics of healthcare systems, and national level investments are needed to support such initiatives, including through integrating Patient Reported Outcomes in health informatics systems.
Reforming healthcare systems requires both political leadership and buy-in of stakeholders. The Commission notes that there are particular challenges in implementing such reforms when the economic conditions are poor, which is particularly the case for reforms of public policies relating to social protection and healthcare, and that the current positive economic outlook presents a window of opportunity in this regard. Similarly, the Commission positively insists that reforms require “sound preparation” from governments and that national stakeholders need to be included to achieve sustainable reforms.[5]
The Country Reports also show that most countries are likely to miss their EU2020 target of investment in R&D. Healthcare is a highly innovative sector, and innovation in products, services and organisation is needed to continuously improve patient outcomes and tackle unmet health needs today and in the future. Representing one of the industry sectors with the highest levels of investment in R&D, EFPIA would like to stress the importance of the healthcare and broader life-science sector not only for improving the health of European citizens, but also for driving innovation, growth and job creation in Europe.

[2] Source: European Commission – Directorate General for Economic and Financial Affairs. 2017. The 2018 Ageing Report – underlying assumptions and projection methodologies. [ONLINE] Available at: [Accessed 9 April 2018]
[3] Source: Eurostat. 2016. Total general government expenditure on health, 2016 (% of GDP and % of total expenditure). [ONLINE] Available at: [Accessed 9 April 2018].
[4] Source: European Commission. 2017. State of Health in the EU. [ONLINE] Available at: [Accessed 9 April 2018].
[5] Source: European Commission 2018. 2018 European Semester: Assessment of progress on structural reforms, prevention and correction of macroeconomic imbalances, and results of in-depth reviews under Regulation (EU) No 1176/2011. [ONLINE] available at: