Context
EU health systems are facing multiple challenges: rising demand due to demographic changes, an increased chronic disease burden, workforce shortages and fiscal pressure due to the impact of the current economic environment on public spending, as well as steep cost increases for certain cost drivers (in particular technological innovation in pharmaceuticals and medical devices).
Enhancing the availability and quality of healthcare services, in particular primary care increasing value for money and reducing the pressure on the workforce is therefore imperative. Overall, the OECD estimates that “up to one-fifth of health spending could be channelled towards better use”[1], and that “actions to encourage healthier populations and policies to eliminate up to half of the ineffective and wasteful spending […] could save up to 1.2 percentage points of GDP.”[2] Measures to this end must cover all key health system functions, from revenue raising to strategic purchasing, and crucially include the budgeting process.
The flagship will build on the results of the 2022 TSI on-going multi-country project with Austria, Belgium and Slovenia on a Resource Hub for Strategic Investments in Health (the EU Health Hub). It will: (1) enhance the capacity of the ministries of health to make the case for concrete health investments vis-à-vis the ministries of finance, (2) help them to test more strategic solutions for investments, and (3) inform the design of a concept for an EU Health Hub that could serve all Member States.
The flagship responds to the expectations set by the Council Conclusions on strengthening the European Health Union of December 2021, which invited the Member States to make use of the TSI to increase the resilience of their health systems, and the Commission to explore the provision of an advisory service with a single point of access to assist Member States in making a better use of EU funds to support health reforms. It is also in line with the ambition of the Belgian EU Presidency to initiate a reflection process on the future EU funding framework for health, with the potential establishment of an EU Health Hub, building on the results of the 2022 multi-country TSI project.
[1] OECD (2017), Tackling Wasteful Spending on Health, OECD Publishing, Paris
[2] OECD (2024), Fiscal Sustainability of Health Systems: How to Finance More Resilient Health Systems When Money Is Tight?, OECD Publishing, Paris.
Objectives
The proposed flagship will support Member States to enhance the resilience and overall fiscal sustainability of their health systems by improving the quality of health spending and strategic health investments, in line with the objectives of the European Health Union and the European Care Strategy. It will also strengthen their capacity to design, implement, monitor and finance health reforms.
Two-pillar approach and examples of indicative support measures
To achieve these objectives, the flagship will make available to all Member States the EU Health Hub, a solution developed on the basis of the lessons learnt from pilot projects performed in three Member States, by offering Member States the possibility to benefit from support on health reforms and investments at national or regional level. It will pilot the operationalisation and the functioning of the concept of an EU Health Hub at larger scale.
The technical support will be organised around two complementary pillars:
Pillar 1. Quality spending for future proof health systems
The specific objective is to support Member States to:
- Enhance costing/accounting, health technology assessment and public procurement practices;
- Improve budgeting practices, including public investment management;
- Reprioritise spending and reduce low-value care;
- Prevent and detect corruption & fraud.
(Across all areas, AI methods and tools may be used)
Indicative examples of support measures across all areas mentioned above:
- Analyse current procedures, guidelines, frameworks related to health spending;
- Analyse spending and data to estimate attainable effectiveness and efficiency gains;
- Review governance and formulate recommendations for improvement across all areas mentioned above;
- Support the drafting of action plans, strategies and guidelines;
- Conduct training and capacity building activities for Member State authorities;
- Support the development of monitoring and evaluation mechanisms for the respective reforms.
Pillar 2. Strategic investments for future proof health systems
The specific objective is to strengthen the capacity of Member States’ ministries of health to:
- Make the case for evidence-based sustainable and “bankable” public investments in health systems vis-à-vis the ministries of finance;
- Pilot the EU Health Hub at national or regional level in all interested Member States with the aim of helping Member States to make more strategic and efficient use of EU funds, including blending them with national funds, and support them to design, implement and monitor health reforms in a wide range of areas.
Indicative examples of support measures:
- Pilot the EU Health Hub in the design and/or implementation of a selected health reform at the national/regional level, such as, for example primary care, hospitals, e-health, greening of hospitals, integrated care;
- Support the setup and/or strengthen the coordination of national contact points for EU funds that can be used for health;
- Conduct training and capacity building for authorities involved in health reforms;
- Evaluate the effectiveness of the EU Health Hub in supporting the specific health reforms.
