European Commission's health recommendations to 12 EU countries once again broad and vague but a step in the right direction

On May 23, the European Commission has adopted proposals for country-specific recommendations. The Commission recommends that the governments of 12 Member States make improvements to their national health systems.

The adoption each May of proposals for country specific recommendations is a key step in the European Semester process, the EU’s yearly cycle of economic and social policy coordination.

EPF welcomes the Commission’s proposal for health and long-term care recommendations and improvements made to the European Semester process. There has been a clear shift towards more social and less financial oriented recommendations, which is a significant step forward. However, EPF regrets the once again broad and vague nature of this year’s recommendations, leaving many of EPF’s members questioning the actual steps that should be taken to fully implement the recommendations given.

Health systems - related recommendations have been attributed to the same 10 countries having received health recommendations in 2017, with the addition of Ireland and Malta. The recommendations are similar to the 2017 health recommendations. Following the 2017 health recommendations, EPF collected the opinions of national patient coalitions in a Statement on the 2017 Country-specific recommendations on health and long-term care and the European Semester Process.

Some trends in the health recommendations

Many Member States have recently undertaken a number of reforms of their healthcare systems in order to increase cost-effectiveness, financial sustainability, resilience, affordability and accessibility and improve the health status of their populations. Recommendations thus encourage Member States to implement recently adopted or soon-to-be-agreed reforms.

Trends in the recommendations include shifts to outpatient care, ensuring sustainability of health systems, improving access to health services and increasing cost-effectiveness of healthcare systems. In addition, this year, the recommendations dedicate special attention to social challenges such as inclusiveness and effectiveness of social protection schemes, guided by the European Pillar of Social Rights proclaimed in November 2017. There is a particular focus on ensuring the provision of adequate skills, the effectiveness and adequacy of social safety nets and improving social dialogue.

Towards better implementation

On the same day, the European Commission also published a Communication on the 2018 European Semester - Country-specific recommendations. The communication gives an overview of the key objectives of the 2018 recommendations as well as an overview of the implementation progress of past recommendations, indicating that health and long-term care are areas where implementation progress has been limited.

Since the start of the European Semester in 2011, Member States have made most headway, implementing recommendations related to financial services and job creation, reflecting the priority given to the stabilisation of the financial sector in response to the economic and financial crisis. On the other hand, recommendations in the area of health and long-term care have sadly not yet been addressed to the same extent. More efforts are needed in this respect.

In a leaked draft document, made available by Politico, we could read the European Commission's plans for the next seven-year European Social Fund Plus (ESF+), which will also include the health programme. Member States under this new proposal are required to use parts of the funding that is available to them under ESF+ for implementing the Country Specific Recommendations. There is, therefore, a strong alignment of availability of funding and the European Semester. To further support Member States in the implementation of recommendations and reforms, in 2017, EPF called on the Commission to link existing funding mechanisms to the country-specific recommendations and allocate existing funding to support the implementation of health-related recommendations. That is exactly what the draft ESF+ proposal does, and EPF warmly welcomes this development. The official proposal is expected to be announced on 29 May.

What's next

The Commission’s proposal for country-specific recommendations will now be discussed in the Council, where EU countries have until early July to vote on their final adoption.

In line with our Roadmap to achieving universal health coverage for all by 2030, we call on Member States and the EU to commit to a long-term vision where equity of access and universal health coverage is a reality for all patients in the EU – a target of the third UN Sustainable Development Goal on ensuring healthy lives. Many unmet needs and unequal experiences in access to healthcare still exist in all EU Member States and not only in those that have received health-specific recommendations.

The European Semester has the potential to contribute to this objective and support the implementation of the European Pillar for Social Rights and UN Sustainable Development Goals. To this end, together with our members and in particular our working group on Universal Access to Healthcare, monitor the implementation of the recommendations and continue to engage in the European Semester process, advocating for more inclusive stakeholder involvement, improved consultative processes and more significant and meaningful future health and long-term care related recommendations.