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EPF calls for a strong EU health agenda in response to this year’s CSRs

On 5 June 2019 the European Commission published its proposals for Country Specific Recommendations (CSRs) as part of the European Union’s yearly European Semester cycle, which monitors the EU Member States’ economic and fiscal progress.

The European Semester can help facilitate the path towards universal access to healthcare for all, if the recommendations are correctly targeted to ensure equitable access to high-quality care, investing sustainably in healthcare and ensuring healthcare that is affordable to all.

The Commission reports that since 2011, progress has been slow in implementing health and long-term care reforms.[1] The Commission also notes that while the social situation is improving, gaps in social protection systems and access must be addressed in a number of Member States.

Health system reforms should improve access

Concerning health, the overarching message of this year’s CSRs is that Member States must continue reforming their health systems. The Commission proposes health-specific recommendations to 16 out of 28 Member States, compared to 12 in 2018[2] and 10 in 2017. This year recommendations were proposed to Bulgaria, Czech Republic, Ireland, Greece, Cyprus, Latvia, Lithuania, Hungary, Malta, Austria, Poland, Portugal, Romania, Slovenia, Slovakia and Finland.

The Commission says that Bulgaria, Latvia, Romania, Slovenia and Finland need to improve access to their healthcare systems, while Czech Republic, Cyprus, Malta, Slovakia, Austria should increase their efforts in making their healthcare systems more sustainable. Bulgaria, Lithuania and Hungary need to reduce out-of pocket payments. The Polish and Greek governments should invest more on their healthcare systems. Furthermore, Ireland should enhance the cost-effectiveness of its healthcare system, and Portugal ought to improve its overall health expenditure control and specifically reduce late payments made to hospitals.

Making health a political priority at national and European level

EPF is pleased to note that the Commission’s recommendations recognise the need to ensure accessibility and affordability of healthcare for all as part of efforts to enhance health systems’ cost-effectiveness and sustainability. In accordance with the objective of ensuring universal health coverage for all, EPF and its members raise the following issues in response to recommendations:

  • Many patients still cannot access high-quality healthcare in a timely manner, and not only in those Member States that have received access-specific recommendations. According to our members, long waiting times and out-of-pocket payments which many cannot afford are still a reality for too many patients.
  • EPF calls for effectiveness and efficiency in spending. As our members observe, in some Member States, lack of access to healthcare is not only a result of insufficient funding but also shortages of qualified health professionals (the “brain drain”), with local structures not well equipped to offer stimulating and well-remunerated working conditions. Structural Funds have the potential to address some of these gaps and regional challenges. Lack of a qualified health workforce is a systemic issue that requires a comprehensive approach in the form of co-operation between national governments, patient organisations, health professionals’ organisations, and other stakeholders.
  • In order to improve access to healthcare, health must be made a political priority at national level and aligned with political ambitions.  Additionally, and also in light of the slow progress in national healthcare reforms, EPF believes that a robust European health policy, with countries pledging themselves to commonly agreed goals, is needed.
  • EPF thus calls for continued health collaboration at EU level and a strong EU health agenda. The Union has a solid economic and fiscal co-ordination system in place; health is a priority for EU citizens and should be given the same weight in terms of monitoring that recommendations are implemented correctly.

Next steps

The Council will discuss the Country-Specific Recommendations on 14 June 2019, and EPF calls on the Member States to fully implement the CSRs. EPF’s Executive Director Usman Khan said, “In line with the EPF “Roadmap to achieving universal health coverage for all by 2030”, we call on Member States and the European Commission to commit to a long-term vision where equity of access and universal health coverage is a reality for all patients in the EU”.

EPF further calls on Member States to consider these points in view of the Multiannual Financial Framework for 2021-2027, set to be finalised in the autumn of 2019. Finally, the programming of the next Cohesion Policy Funds for the period of 2021-2027 will be based on the CSRs, and to this end, EPF calls on the negotiators to keep health-specific investments as an important priority.


[2] Cyprus, Finland, Lithuania, Slovenia, Malta, Austria, Ireland, Latvia, Romania, Bulgaria, Portugal and Slovakia.