Healthcare
and EU enlargement Sept03 |
The founders of the EU dreamt of a single market for goods,
services and labour based on competition and diversity that can offer the
European consumer choice, quality, prompt delivery and low, stable prices.
Today, 50 years after the birth of the EU, European Citizens
do not have a: 1) Choice of doctor, hospital or treatment; 2) Quality of treatment that is the same throughout the EU; 3) Prompt delivery as patients have to wait long for consultation
and even longer for operations 4) Low stable prices as health costs vary substantially from one
member state to another A universal EU health care system, offering almost 500 million EU
citizens in 25 countries, is a challenge for all stakeholders. How should
such a pan-EU health system be funded based on state, private and
individual contributions? How can we reform supply and modernise delivery
of health care? Consumerism and the increasing expectations of patients, fuelled by
the internet, media, pharmaceutical companies and health promoting
agencies, increase the pressure for all countries to deliver similar
services. The challenge is compounded by the demographic changes with an
increase in people living with chronic diseases together with the poorer
health status of people in some of the accession countries. How will Member states with well funded health systems cope with
increased demand as patients waiting for treatment in their own countries,
especially the elderly, seek treatment across national frontiers? How will
accession countries be affected if health professionals seek better
prospects elsewhere? Is there an opportunity for accession countries to
utilise its health professionals to offer health delivery for patients
from the more affluent EU Member States? Can this be done through both
public and private hospitals and clinics? Will private health insurers
seize such opportunity to invest in the accession countries? Spending on national health delivery, as a % of GDP, is different
amongst the 15 EU Member States and the difference is significant if we
include the accession countries. Health expenditure is financed by direct
taxation, national social insurance contributions and employer/employee
contributions to private insurance schemes. Differences in charge systems
for visits to doctors, ownership of pharmacies and financial incentives
for co-existence of private and public provision of health delivery
highlight significant differences in the quality of healthcare systems
found in the existing EU states. Prices for prescription medicines in each EU country are negotiated
by industry with governments based on the level of national health
budgets, estimated sales volume and consequent government expenditure, per
capita income and the cost of living. On such calculations, the prices of
prescription medicines are much lower in Spain, Greece, Portugal than in
the UK and Nordic countries. Such huge price differences have led to
“parallel” trade that has generated instant and substantial profits
for numerous newly established traders. Profits from parallel trade,
secured by such traders, diminish profits for pharmaceutical manufacturers
who invest in research and development. Furthermore, such parallel trade
has forced manufacturers to apply supply quotas for full-line wholesalers
that undermine an uninterrupted supply of essential medicines right down
to the patients. How will the healthcare systems in the 10 accession countries
respond to the high expectations of today’s patients? Is it possible for
the enlarged EU to establish a liberal free-market oriented system of
ownership of the distribution and dispensing of medicaments that will
encourage competition and greater choice for patients? Should the EU adopt
a common ex-industry price for prescription medicines with differential
re-imbursement schemes for each Member State to eliminate the parallel
traders? Pharmaceutical manufacturers should be encouraged to register their
prescription medicines through the European Medical Evaluation Agency (EMEA).
Such registered products, with multilingual insert leaflets in the
packaging, could be marketed throughout the EU at a common ex-industry
price to wholesalers. The wholesalers, using this cost price, would then
be free to price and distribute to hospitals, pharmacists, doctors and
others. Each national government, based on their negotiated re-imbursement
scheme with the manufacturer, would determine how to charge the patient
and reimburse the retail pharmacist, the hospital or the doctor. Such a
scheme was successfully used when East Germany’s healthcare programme
was integrated into its Federal health system. EU Commissioners Likanen and Byrne have set up a small group of
decision makers, called the “G 10” to discuss innovation and provision
of medicines in the EU. Their Recommendation VI is that “Price
regulation applies only to medicines purchased and reimbursed by Member
States, allowing full competition for all other medicines, including OTC
products.” This is an acceptable proposition as it enables manufacturers to
launch any new medicine, irrespective of re-imbursement status,
immediately after the grant of marketing authorisation. It encourages
price competition for non-reimbursed medicines that may be covered by
national or private insurance schemes thereby meeting the EU internal
market and competition policies. The enlarged EU faces the challenge of helping the accession
countries to upgrade and connect their health systems with those in the
existing Member States. This requires investment in manpower,
infrastructure and training of medical personnel from surgeons to
technicians. EU citizens dream of an EU Health Card that will give them
ready access to equivalent health services in every Member State. This
requires trans-national compatibility of computer systems and the
willingness on the part of each Member State to harmonise both cost and
delivery time of treatment. How long will the enlarged EU take to achieve
this? It is a question that cannot be answered today! |