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Published on 29 April 2009

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Crisis across the Continent

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The impact of the world financial crisis on healthcare across Europe is likely to be detrimental, with limited increased investment and greater pressure to secure higher productivity

Brian Edwards

Emeritus Professor of Healthcare Development University of Sheffield UK

Former President HOPE (European Hospital and Healthcare Federation) Brussels, Belgium

The whole of Europe now seems to have been drawn into the world financial crisis. In a very gloomy economic assessment, the European Commission has forecast that the EU economy will reach a virtual standstill in 2009. Public finances are set to deteriorate as unemployment rises and tax revenues drop. Arguments continue about the wisdom of riding out the recession with increased public spending, but this will be mainly focused on capital investment.

The impact across Europe is uneven. Hungary is finding that its recent economic recovery has been stalled. GDP, which had been growing, is expected to decline to 0.7%, putting pressure on a health economy that was already struggling with demand. The UK will also see growth reduce sharply, and the health sector will almost certainly have to draw on the reserves it has accumulated in the past year. France will see its budget deficit increase to perhaps 3.8% in 2010. Very moderate wage increases in recent years may help Germany through the crisis earlier than most.

Overall, health can expect to see little by way of increased investment in the next two years and greater pressure to secure higher productivity.

Meanwhile, the conclusions of the EU Pharmaceutical Forum ran into heavy weather when they were presented to the Commission in October 2008 by Gunter Verheugen, the enterprise commissioner. The commissioners for the internal market (Charlie McCreevy) and competition (Neelie Kroes) both expressed major concerns, and even the communications (Margot Wallstrom) and health (Androulla Vassiliou) commissioners had reservations.

The proposals contained no great surprises and included:

1. Supporting Member States in undertaking relative effectiveness assessments of pharmaceutical products and building a consensus on general principles and good assessment practice.
2. A requirement that all data available at the time of marketing authorisation should be made available to agencies in Member States responsible for relative effectiveness assessments in as transparent and complete a manner as is possible. An assessment toolbox is proposed that would force into the open the need to balance access for patients and rewards for innovation and development by the industry.
3. The ban on advertising of prescription medicines to continue.
4. New collaborations between Member States on information for patients.

The package of measures presented to the Commission included draft regulations on pharmacovigilance and a directive on counterfeit medicines.

In a debate in Parliament the following day, Verheugen was frank and direct: “In our societies there is a conflict between the health bureaucracies and the needs of patients… [the bureaucracies] do not want patients to have more information because well-informed patients ask questions… make demands”.

Whilst acknowledging that parallel importing was legal, he wondered how it could be justified “not to permit the opening of a packet of noodles yet allowing anything to be done to a box of medication”.

This is a powerful debate that looks like rolling on for some time to come as the EU seeks to balance the rights of the citizen (and their need for protection), the funders of healthcare and the pharmaceutical industry. All against a backcloth of a major world economic slowdown.

1. European Commission. Economic and Financial affairs. Economic Forecast Autumn 2008.



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