A new start for European health systems

The COVID-19 crisis has put the resilience and agility of European health systems to the test in an unprecedented way. The crisis has cast light on their strengths as well as weaknesses, in several cases a lack of preparedness, equipment and infrastructure to deal with an event of these proportions, but also great solidarity, inventiveness and resilience, not the least on part of the health workforce which has led the way in fighting the pandemic on the ground. Ultimately, the crisis has reminded us about the crucial importance of health and wellbeing for our societies, that health threats know no borders and that these challenges can only be faced if we work together, across borders and across sectors.
As we are continuing the fight against COVID-19 together we also need to start reflecting on what this crisis has taught us so far together, about the state of European health systems and European health collaboration, and what could be done better or differently in the future. EFPIA believes that once we emerge from this crisis, we should not only rebuild our economies and get our societies back on their feet, but also take the opportunity to implement an ambitious reform agenda for European health systems, including discussing the mandate of the EU in the field of health. Going back to the status quo would not be an appropriate or realistic option.
This reflection needs to be open and forward-looking and involve all stakeholders and policymakers at regional, national and EU level. EFPIA and its members are looking forward to coming together with partners, stakeholders and policymakers at both European and national level, including within the EU Health Coalition, to discuss how to improve the resilience, responsiveness and readiness of health systems, and also how the European pharmaceutical industry can contribute to this effort together with other stakeholders. Looking forward, EFPIA would like to highlight a number of themes and questions which we believe will be important to address in this context. 

The societal and economic value of health
COVID-19 has clearly demonstrated the fundamental link between health and the wellbeing of our societies and economies. It shows that a lack of investment in health systems, while saving money in the short term, can have devastating effects on the economy and society in the long term. Investments are also needed to reduce the inequalities in health that still persist both within and between countries in Europe, and which are exacerbated by the COVID-19 crisis. We should once and for all stop regarding health expenditure as a cost, and instead see it as an investment for our societies, and absolutely avoid that health budgets are cut as a consequence of the economic recession caused by the COVID-19 containment measures. The pandemic crisis management has furthermore led to a pent-up demand for healthcare for other patient groups which urgently needs to be met.
The crisis has also shed a clear light on the consequences of confusing short-term cost savings with efficiency gains through improved care delivery design. For example, reduction of the work force and implicit attrition in service delivery have left some countries ill-equipped to deal with the spike in demand for healthcare. This calls for an open public debate regarding society’s needs and expectations regarding healthcare spending.
European solidarity and capacities
Infectious diseases know no borders, and in a closely integrated Europe we must deal with health threats and other important health issues based on close collaboration and a common purpose. More solidarity is needed to support all Member States in strengthening their health systems and public health capacities in order to achieve common preparedness as well as equal access to healthcare and comparable outcomes for patients. An important aspect is more collaboration in organising healthcare delivery across borders, including through treating patients across borders and increasing mobility of healthcare professionals. Crucially, in emergency situations like the one we are facing today, the EU needs reinforced capabilities to monitor and assess national and regional healthcare demands and capacities, through the ECDC or another EU structure, in order to better inform the supply of essential medicines and medical equipment, and other healthcare resources. This would strengthen the resilience of all health systems in Europe. In addition to solidarity across borders, health inequalities need to be addressed also within Member States, including the specific needs of marginalised communities such as the homeless and migrants.
Integrated budget frameworks for health investments and efficient resource use
National health systems in Europe are still to a large extent fragmented in different silos. They operate on annual budgets where the value and long-term benefits of health investments are not assessed or considered when evaluating health interventions. This crisis is an opportunity to design a new way of financing health systems based on an integrated budget, including both health and social care, which would also provide appropriate incentives to direct investments into services and technologies that bring benefits in the longer term. Such an integrated approach would enable greater leverage of the amount spent, and make health systems more resilient and more agile in responding to people’s needs and external shocks.
Integrated and long-term financing instruments would also create incentives for prevention and innovative practices and interventions that free up resources in other parts of the system, but are hard to justify under an annual budget process. If we believe that hospitals should have the capacity to care for patients in need of emergency or intensive care, they would need to be freed from treating complications related to chronic conditions which could have better been managed at other levels of the health system, or by the patients themselves in their own homes.
A concerted investment in a European health data infrastructure and digital health
Ehealth and telehealth solutions have been shown to be crucial to enable remote consultations and monitoring, thus avoiding people going to hospitals unnecessarily. Since the start of the COVID-19 crisis we have seen an accelerated deployment of telemedicine solutions at a speed previously unheard of to meet the new challenges. Once the pandemic is over, digital health solutions will have the potential to free up resources in health systems thus making them more resilient, as well as enabling cross-border health services, access to expert advice through remote consultations and more patient-centric solutions where people can receive care in their own homes, as well as new and more efficient models for clinical research. However, the deployment of digital health tools and infrastructure is still fragmented across Europe, sometimes due to lack of clarity regarding regulatory frameworks or reimbursement.
The COVID-19 crisis is furthermore showing us the vital importance of sharing high-quality health data for analysis and decision-making. The ability to rapidly access  real-time and comparable data on how patients and populations are affected by disease, and on the effectiveness of different public health measures and treatments, is of crucial importance. The crisis has also highlighted some of the current weaknesses, when in some cases not even mortality data can be fully compared as different countries have different ways of collecting and classifying data across care settings including for elderly and home care.
The EU should take the lead in driving standardisation of health data quality, collection and interoperability, investing in national but interoperable Electronic Health Records, and accelerate the creation of a European Health Data Space with a clear governance framework for access to data including for secondary use for research. The European Health Data and Evidence Network, set up through the Innovative Medicines Initiative, is already proving how a federated approach can enable rapid analysis of large data sets in a GDPR-compliant way. The EU should also build a European capacity to analyse health data for risk assessment, monitoring, projections and performance assessment building on health outcomes relevant for people and patients. The recommendation of the EU Health Coalition to set up a European Health Data Institute is highly relevant in this context. An ambitious and concerted investment in a European health data infrastructure would not only lay the ground for more resilient and responsive health systems, but also play an important role in the recovery of Europe after the COVID-19 crisis and its economic fallout by helping to spur innovation.
Health literacy
Health concerns everyone, and the COVID-19 crisis has shown an unprecedented engagement from the general public in seeking reliable information on the pandemic, its spread, consequences and potential remedies. Our society’s response to the pandemic has involved everyone, and demonstrated the need for clear and reliable information on health issues from trustworthy sources. Long before COVID-19, patients have increasingly sought information, often online, to better inform themselves about their health and manage disease. In the future, whether it is for informing the public about health threats or helping patients with chronic diseases better manage their health and wellbeing, more concerted efforts could be done to improve health literacy and combat misinformation, including through the latest digital tools.
Needs of people and patients in the centre
Last but not least we should  put the commitments about people- or patient-centred healthcare fully into practice. All European health systems should have a plan for how to integrate a patient perspective in decision-making at all levels, developed in close collaboration with patient organisations. This should include a strategy for the collection of data on outcomes important for people and patients for use in patient care, healthcare improvement and research as well as health system performance assessment, planning and resource allocation. The EU could play an important role in creating a common framework and driving the alignment of how to measure patient-relevant outcomes across countries, as well as leveraging the data for benchmarking and cross-border comparisons. As independent patient organisations play an important role in channelling the perspectives of patients, and should be closely involved when assessing access to and quality of healthcare, there should be a sustainable framework for their support.