Reform EU Healthcare Mar05

The EU has an average of 7.89% of GDP for health expenditure. Croatia, Czech Republic and Slovenia can match this but other new members spend far less. Poland's figure is 3.8%. The EU of 25, with almost double the population of the USA, spends about $100bn on pharmaceuticals whilst the USA spends $200bn.

Healthcare is highly regulated in almost every European country to this day. Each EU Member State has its own system of regulating research and development of new drugs, manufacture, product safety, national registration of the product, advertising, wholesale and retail distribution. The Food and Drugs Authority (FDA) in the USA is a single agency that offers approval of new drugs for sale in the large US market. The European Medical Evaluation Agency (EMEA) is the EU equivalent and is aiming to do the same for the EU. EMEA needs to respond more quickly and liberalise its requirements on product advertising as well as the time period for data and patent protection.

How can the EU reform its healthcare system to offer a minimum level of quality and service for its citizens?

Information

a) Authentic information based on science is essential and it must be at the centre of a European Healthcare. Information about research and development of new drugs should be in the public domain. The public needs to know the range of diseases for which drug cures are sought and the level of public investment that is offered to EU research institutions.

b) EMEA’s period for data and patent protection of new drugs must match the conditions of the FDA in the USA to ensure that pharmaceutical companies do not divert their investment in R&D to the USA.

c) Patients need access to information on diseases, doctors, hospitals and the range of facilities available to them. The family doctor is the first point of contact for all patients and these doctors need internet databank access to identify the availability of consultants and hospital beds. The patient cannot continue to rely on publications that are available at doctors' surgeries and the enclosed leaflet in the product package. There should be adequate information on the internet that is authenticated by EMEA.

Skill Utilisation

a) Most family doctors are unable to perform diagnostic tests and hospital references cost time and money. .

b) The pharmacist can perform diagnostic tests and treat minor ailments thereby saving substantial costs for national health budgets.

c) Doctors, surgeons and nurses, supported by qualified administrators should determine the running of each hospital.

Uninterrupted supply of medicines

The current system of pricing for medication is based on each Member State negotiating directly with the major pharmaceutical manufacturers. The chargeable price is determined by the size of the nation’s health budget and value of sales to the manufacturer. This results in substantial price differences whereby Greece, Spain and Portugal pay far less than UK, Germany and Scandinavian countries. This leads to parallel trade i.e. imports from Greece and Spain into UK and Germany. Such trade erodes the margins of pharmaceutical manufacturers forcing them to impose supply quotas to minimise parallel trade!

The EU should have a fixed “EU nominal price” for essential pharmaceutical products i.e the price payable by the full-line wholesaler in every EU Member State to the pharmaceutical manufacturer. With such a scheme in place, each Member State can negotiate directly with the manufacturer the reimbursement to suit its national requirements. This scheme eliminates parallel trade and results in direct savings to national health budgets. Also, it prevents erosion of the profits of the pharmaceutical manufacturers allowing them to offer lower prices and continue their investment in Research & Development of new drugs.

EU health insurance

With increasing expectations of higher healthcare and mobility of European citizens across the EU for work or leisure, it is essential that EU Member States begin a programme of shifting the burden of risk of healthcare to private insurers. The hospitals, doctors, nurses and health infrastructure can continue to be state owned but through tax relief the population can be offered the opportunity to secure private medical cover. This can be done over time for different age groups. This transition will allow patients to choose hospitals, doctors and treatment forcing private sector discipline on state owned hospitals as they compete with private hospitals. This will improve the quality of healthcare and facilitate the use of a EU HEALTHCARD that will permit any EU citizen to receive medical care in any part of the EU.