EUROPE: European healthcare systems suffering from austerity measures
Austerity measures are harming EU economies and seriously damaging public health, says influential European health group European Health Forum Gastein.
This is important for medical tourism as it confirms other evidence that millions of Europeans are struggling financially so are delaying medical treatment, dental treatment and even buying medicines.
As the public supply of health care decreases, the private health industry can step in to fill the gaps. There is evidence that those who can afford private healthcare are increasingly doing so across Europe.
Professor Martin McKee of the London School of Hygiene and Tropical Medicine told the forum “Europe’s politicians have to realise that stringent austerity policies are harming their economies as well as the health of their populations.”
There is growing evidence of the direct negative effects the crisis and austerity policies are having on people’s health and healthcare systems, said McKee, who is finalising research on the impact of the economic crisis for publication later this year.”
Professor Helmut Brand added “The subject of health is given much too little attention in the discussion of the financial and economic crisis. But it could offer a window of opportunity at European and at national level to implement reforms that would otherwise not be possible without the crisis, including a reform of the EU health mandate.”
In many European countries, austerity measures are having a dramatic effect on health budgets. The current OECD Health Data 2012 report shows that, in 2010, after years of increases in health expenditures, deep cuts were made in a number of European countries: minus 7.6% in Ireland, minus 7.3% in Estonia, minus 6.5% in Greece. Other studies show a 25% reduction in the health budget in Latvia between 2008 and 2010, and a cut of 30% for the Czech Republic.
The cuts on 2011, 2012 and beyond are much more severe than in 2010, with some counties looking to cut health expenditure by 20%.
It also effects who is entitled to local healthcare. Spain has used a royal decree to change entitlement to health care from residence to employment. Thus young people who have never been employed – as is the case with almost half of all youth – and undocumented migrants risk being excluded from healthcare.
In Portugal increases in the rate of co-payment for many services has meant the cost of attendance at an emergency department in a major hospital has doubled to 20 Euros. Initial reports indicate that the death rate began to rise at the beginning of 2012 as a result of this measure.
In Italy a reduction in the number hospital beds from 4.5 to 4 per 1,000 population has been introduced, while co-payments are now required for visits to a specialist or an emergency department.
Professor McKee concludes, “Some of the measures that have been taken to reduce health expenditures in response to the crisis can be justified, where they have streamlined a previously inefficient system. However, in many cases, such as the introduction of co-payments, where there has been a failure to discriminate between medically necessary and unnecessary utilisation, reforms are not supported by evidence. The full consequences of the various cuts in health care systems can still not be properly foreseen. But it is clear that people with chronic illnesses, such as hypertension, diabetes or cancer are being particularly affected. A breakdown in the supply of essential medicines could be fatal. The silence from health ministers on the human consequences of austerity is shocking.”
Health services in Europe need to have greater private sector involvement said Antonio Durán of Técnicas de Salud, “It is unlikely that European States will be able to fund healthcare systems – including new required capital investment – as they have in recent decades. The limits to the direct state provision of health care are marked by the limited investment capacity of governments, in particular in situations of tight budgets and fiscal crises. The public sector needs to concentrate on what it does better: financing and regulation. A majority of funding should be public in order to promote equity. The future health system function may be substantially, but never only, private. Service provision finally may be privatized extensively if socially agreed and if adequate regulation is provided.”
Dr Thomas Czypionka, of the Vienna Institute for Advanced Studies, added, “Pressure to cut costs in times of recession can create opportunities to accelerate reforms in the health sector. Demand for health services does not depend on the economy. Crises can mean that change has to be implemented which might otherwise not happen till years later. But many European countries have reacted by simply making cuts, even abandoning reforms which had already been put in train, or increasing the burden on individuals for using basic services, either by imposing extra costs or lengthening waiting-lists. The consequences will be felt for many years to come.”
Five trends will cause a complete revamping of hospitals in the near future: concentration on the patient as a whole instead of on individual organs, a multidisciplinary approach, continuous care and system integration, and the search for interventions that are highly effective despite involving minimal resources. Health care systems in many countries around the world are facing a sea change. Many changes will be evident in hospitals over the next five years.
Dr de Roodenbeke explains: “Until now we have concentrated on treating individual organs or diseases. An approach focusing on the condition of the patient as a whole is more effective and more affordable in the long run. The emphasis in the future will also be on greater continuity in health care, on many areas of specialization collaborating together, on the integration of different systems and on services involving maximum effect and minimal costs. The hospitals that make progress with such measures will fare the best in the long run whereas those whose areas of specialization continue to work on parallel tracks without cooperating will suffer from the changes.”
Understanding what is happening within Europe is vital for medical tourism agencies and hospitals to decide what they offer, to whom and where.