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Úsáidimid do shíniú suas chun ábhar a sholáthar ar bhealaí ar thoiligh tú leo agus chun ár dtuiscint ortsa a fheabhsú. Is féidir leat díliostáil ag am ar bith.

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De réir Chomhghuaillíocht Eorpach do Leigheas phearsantaithe (EAPM) Stiúrthóir Feidhmiúcháin Denis Horgan

Inequalities in access for patients to the best healthcare available in Europe is a big issue – and never more so than in smaller and/or less wealthy member states.  Challenges include, but are not exclusive to, a lack of interest by industry to place medical goods on such small markets due to high or inefficient unit costs of production, and a lack of competition between providers.

This leads to high prices for medicines and medical supplies due to the relatively small volumes of consumption.  Meanwhile, the administrative burden of regulation does little to help patient access and lower prices in these countries.  Aside from that, health inequalities across socioeconomic groups are of major concern in all countries, large or small, given that education and income – plus, as we shall see, immigration – have a substantial effect on the health of individuals.

Also, the reality that the EU has an aging population to take care of is a further burden.  Regarding immigration specifically, it has been shown many times that there are significant differences in the level of health and use of medical care between the indigenous and foreign populations in many member states.  Of course, the European Union is fighting hard to reduce these inequalities through the European Commission, the Parliament and the relatively new semester process.

In the latter case it has specific recommendations in respect of, for example, Bulgaria and Romania, where a need to ensure effective access to healthcare and the pricing of healthcare services have been highlighted, as well as the necessity to pursue health sector reforms to increase efficiency, quality and accessibility, in particular for disadvantaged people and remote and isolated communities.  In general, Europe’s patients would benefit from a strengthening of health systems, the public health capacity, emergency preparedness, surveillance and response. Meanwhile, creating resilient communities and supportive environments is a prerequisite of improving health.

Some emerging suggestions to overcome inequalities include adding value through partnerships among governments, sectors and institutions with support from the EU structural fund.  But as it stands there is an unequal development of quality strategies across the EU and a lack of clear, transparent information on quality of health care.  This is greatly down to the fact that there are different healthcare systems across the member states, making an overview difficult and best practices problematic to share.  As mentioned earlier, addressing inequalities in health has been a major part of the EU’s work in recent years. And five years ago the Union made a commitment to lift 20 million people out of poverty by 2020 via the European platform against poverty and social exclusion.

Aiseolas

This process should have a positive impact on health inequalities between and within member states.  But, aside from that and as a good start, European health policy needs to become better attuned to the specific challenges facing health systems – especially those in smaller states and regions.  Fittingly, this year, the rotating presidency of the European Union sees two of the EU’s smaller states take the helm.  Latvia currently holds the presidency and the Baltic state, which joined the Union just over a decade ago, will be succeeded in the role by Luxembourg, a founding member, on 1 July.

Since the EU enlargements of 1995 and 2004, there are now seven member states with a population of between six and 10 million and eight countries with 5 million or less (and some much less).  Prior to the 2004 ‘big bang’, when ten new states joined the EU, smaller countries had little choice but to accept an Acquis communautaire which often failed to take into account their individual aspects and characteristics.  A significant turning point was reached, however, during the pre-2004 accession negotiations when part of the formulation of the pharmaceuticals package included a provision for abridged registration – Article 126a, also known as the ‘Cyprus clause’.

Following this landmark event, smaller states have been active in shaping health policy at European level and can now act as vital policy entrepreneurs pursuing normative policy agendas. This has been demonstrated by, for example, Slovenia and its major role in promoting cancer policy development at EU level.  Meanwhile, cooperation in areas such as health technology assessments are likely to receive more support from these countries, which often rely heavily on networking and capacity building.

The Brussels-based European Alliance for Personalised Medicine (EAPM) believes that the perspective of these countries, as well as regions in larger states, is extremely important when determining whether there is a case for EU-level action on health.  Yet it is undeniable that there is a need for greater collaboration and, in the smaller states, the pooling of resources. And it may well be the case that European health policy will be driven by the needs and aspirations of these small- and medium-sized member states as well as regions in the larger ones.  This scenario would certainly present an opportunity for an innovative dimension in health policy to be developed at European level in which the added value of joint working could be realized through visible benefits attained for small administrations.  Of course, the perception of what constitutes added value will differ between member states and, thus, there is an argument to suggest that smaller states will become active proponents of the further Europeanization of health policy.

In fact, since 2004 it has become evident that health policy has already begun a process of Europeanization.  EAPM believes that topics which need to be urgently addressed are the development of a new socio-economic paradigm, how to bring about a reduction in administrative burdens, and a minimization and simplification of reporting obligations in line with the EU’s better regulation agenda.  There is no questioning the value and perspective that smaller states can bring to the health debate in Europe and EAPM will work in concert with the Latvian and Luxembourg presidencies as much as possible to push the agenda forward.  In a nutshell, EU health policies need to recognize and tackle the inherent health system vulnerabilities faced, specifically, by smaller countries and in the regions of the larger ones.

EAPM has called this a SMART approach – Smaller Member States And Regions Together; and this will be further developed at the Alliance’s third annual conference in Brussels on 2-3 June.  The forum is entitled ‘Smaller Member States And Regions Together (SMART)’: STEPs in the Right Direction to a Brave New Healthier Europe’; and among the high-level speakers will be the health commissioner, the health ministers from Latvia, Luxembourg and Malta, as well as several MEPs.

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