European Semester: Country Reports 2019

In February 2019 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 welcomes that the reports in many instances 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 supports a development where the Semester process can be further informed by for instance the State of Health in the EU process, supported by a sustainable health information system and performance assessments of European health systems.
The Commission[2] has identified 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.
The Commission notes in its summary Communication on the reports[3] that “health system reforms are targeting greater effectiveness, accessibility and resilience”, and that “many Member States are pursuing efforts to refocus health systems towards preventive care, whilst bolstering primary care and better coordination across care settings.” Reviewing the Country Reports, it is however clear that many countries still have a long road ahead towards making their health systems more effective while optimizing expenditure in terms of population health and health outcomes for patients.
Furthermore, several EU countries do not invest enough in healthcare, and are clearly underperforming both in terms of health expenditure per capita and in terms of health status of the population. Notable examples as highlighted in the reports include Bulgaria, Croatia, Cyprus, Estonia, Hungary, Latvia, Lithuania, Poland, Romania and Slovenia. EFPIA also notes with concern that many countries still have very high out-of-pocket rates for medicines, which exacerbates unequal access to treatment, and that some countries have yet to achieve full healthcare coverage for their populations.  
EFPIA welcomes that Greece has exited the economic adjustment programs and re-entered the European Semester process. EFPIA would however like to point out that several of the healthcare reforms which were mandated under the Memorandums of Understanding with the troika has not necessarily been implemented fully and that the healthcare system is therefore not yet on a long-term sustainable footing. Among the reforms which would need to be more effectively pursued are measures to strengthen prevention and primary care, reduce the dependence on hospital care, develop a modern system for assessing the value of innovative medicines, control overconsumption and increase the effectiveness of the market for off-patent medicines.
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 efficiency and 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.
  • Lack of adequate health IT and informatics systems to support care integration, collection of data on health outcomes and personalized care.
Indeed, the Annual Growth Survey for 2019 notes that Member States need to “increase cost-effectiveness by investing in innovation, improving the integration of healthcare at the primary, specialised outpatient and hospital care levels and strengthening links with social care” in order to meet the needs of an ageing population, maintain universal access to quality healthcare and ensure fiscal sustainability. EFPIA agrees that long-term sustainability of healthcare systems and improvement of health outcomes for patients needs to be tackled through smart investment and resource allocation, not through a narrow focus on cost-containment.
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. This is why EFPIA fully supports the recommendation of the EU Health Summit for the EU to support Member States in adopting and implementing standards for measuring patient-relevant health outcomes [5].

[2] Source: European Commission – Directorate General for Economic and Financial Affairs. 2017. The 2018 Ageing Report – underlying assumptions and projection methodologies. [ONLINE] Available at:
[4] Source: European Commission. 2017. State of Health in the EU. [ONLINE] Available at: [Accessed 9 April 2018].