TOWARDS AN EU HEALTH UNION: It’s time to think big!

As Europe faces a geopolitical and energy crisis, with rising inflation and a looming recession creating new challenges for Member States, we should remind ourselves that health is wealth. Our health systems are precious assets which we must nurture and protect. Instead of putting additional burdens on systems that have been strained to the limit by COVID-19, we must continue to invest in health and in the resilience of our systems. Informed by experience of the past and the problems of the present, it is time for Europe to prepare our health systems for a brighter future.

Enable the collection of standardised, high quality and relevant health data in a secure manner to improve healthcare delivery, enhance research and drive greater efficiency of healthcare systems.

In the EHDS, define common specifications and standardised requirements for data processing along with criteria for decision-making related to assessing applications for access to data across Member States. This would help to avoid fragmented implementation that would lead to fragmented rights. To truly enhance the flow and connection of data, and to minimise bureaucracy, consistency with other data-related initiatives (GDPR, AI Act, Data Governance Act, Data Act) is imperative.

Build a positive ecosystem fostering greater coordination and collaboration on Artificial Intelligence across the EU, and between different disciplines, to enhance the trustworthy and ethical use of AI in healthcare.

Invest in AI competencies and literacy as a key enabler of the European AI Strategy that aims at making the EU a world-class hub for AI and ensuring that AI is human-centric and trustworthy. Ensure that the rules on AI laid out in the AI Act are adequate, appropriate, clear, and consistent, fostering a harmonised approach across the EU.

Invest in infrastructure, digital technologies, and skills development as crucial drivers to make digital transformation a success in the health sector.

  • Ensure appropriate financial support for the EU Member States from the EU4Health programme and the Digital Europe Programme to accelerate the digital transformation. By offering tailored reskilling, lifelong learning and continuing professional development opportunities for healthcare workforce, establishing a robust data infrastructure and Electronic Health Records, and promoting the value of data and digital innovation, health outcomes can be improved for all.
  • Develop advanced digital skills for healthcare professionals to support the safe and efficient use of digital technologies, as well as the collection and recording of patient data in electronic health records. Ensure that citizens and patients have digital health literacy skills to enhance their trust in, and understanding of, digital technologies to manage their health in an age, culture, and gender-inclusive manner.

Implement effective EU health policies and programmes coordination, within and across EU countries, to achieve health system integration.

  • Strengthen and measure the implementation of the Health in all Policies approach and ensure a broad health impact assessment: all EU policies should be designed to be cross-beneficial, and their health impact should be clearly measured. Such measurement could be supported by a dedicated report of ‘EU Health systems integration’ in the ‘State of Health in the EU’ process and linked to the implementation of the Horizon Europe Partnership on Transforming Health and Care.
  • Foster coordination through multi-stakeholder partnerships built on the quadruple helix model (science, policy, industry, society) and with proper engagement with regions and cities. In concrete terms, this could happen through the establishment of a European Health Union multi-stakeholder and multi-level (European, national, regional, local) advisory group, providing data and inputs on health systems and health policies integration challenges to EU institutions and Member States.
  • Elevate health workforce as a core pillar of the European Health Union, building on existing and upcoming European-wide initiatives focused on future-proofing the European health workforce (e.g., BeWell project, HEROES Joint Action).
  • Move towards further improved cross-border cooperation, building on the results of the evaluation of the Directive 2011/24/EU to ensure patients’ rights in the EU in cross-border healthcare, tackling identified shortcomings (e.g., obstacles to reimbursement), further developing positive achievements (e.g., ERNs), recognising and supporting the central role of regional and local health authorities.

Incentivise integrated care across Europe through dedicated resources, competences development and assessment.

  • Support health systems in adopting incentives supporting concrete integration of care and the development of integrated care patient pathways. This could be made possible, for instance, by
    • Researching and implementing innovative financing models, linked to value and outcomes, ensuring affordability, bridging of budget silos and delivery of better care.
    • Linking payments to outcome metrics to incentivise focus on high-quality service delivery, positive patient outcomes and quality of life.
    • Developing a European framework to assess implementation and progress on integrated care (through dedicated EU project) and the inclusion of an integration of care measure in EU projects proposals.
  • Boosting health professionals’ integration and interdisciplinary skills. Health systems integration elements should be better included in education and on-the-job training, by working with professional institutions to provide educational materials and opportunities on integrated care.

Invest in Europe as a true research and innovation hub, making sure that excellence in basic research and early discovery is translated into innovative solutions, products, and services through a strong public-private ecosystem.

  • Focus investments through earmarked funds in the next Multiannual Financial Framework (including through the structural funds and RD&I funds) to support vibrant and sustainable life science ecosystems and clusters at scale in Europe, strengthening all components including human capital, intellectual capital, growth, and innovation capital.
  • Ensure that the next EU RD&I budget is ring-fenced from the rest of the MFF to ensure funding instruments’ stability and maintain trust in the system.
  • Ensure alignment between the EU Industrial and Pharmaceutical Strategies, facilitating the translation of early scientific discoveries into innovative products and services in Europe through a vibrant life science sector – including Small and Medium-Sized Enterprises, supported by a competitive IP protection framework and a future-proof regulatory system.
  • Ensure an inclusive and patient-centric understanding of Unmet Medical Needs, so that research and development of prevention, diagnostics, treatment, and cures aligns with patients’ needs across disease areas and does not stifle the development of treatment options that improve patients’ care and quality of life.
  • Ensure that sufficient research funds and incentives are in place to meet the needs of underserved populations and areas, such as children and rare disease populations, including through EU research funds (e.g., through the Horizon Europe strategic planning process 2025-2027) and the revision of the Orphan and Paediatric Regulations.
  • Ensure that the EHDS can enable translational research, strengthen federated data networks, and access and use of RWE. The new regulation must provide the necessary regulatory clarity and harmonisation around health data sharing, without adding additional complexity to a situation where legislation already overlaps, and national or local interpretations differ.

Monitor the development of new medical technologies and practices to allow for health system planning and early stakeholder awareness. Foster the uptake and spread of these technologies and practices in health systems to facilitate actions for health equity and improve health literacy.

The EU should establish a monitoring centre for innovative health technologies and clinical practices in collaboration with Member States and stakeholders including patients, healthcare professionals and industry. The centre should perform:

    • Horizon scanning of medical technologies in development, to facilitate early health system planning for the introduction of health innovation and early stakeholder awareness.
    • Monitor and benchmark uptake and spread of innovative clinical practices (including the timely update and uptake of clinical guidelines as well as diagnostics and programmes for screening and early detection) and access to new treatments and technologies (including for children and rare diseases), in European health systems. This would support the identification of inequities in access to healthcare, including barriers and bottlenecks for healthcare professionals and patients to avail of innovative health solutions across the union. This action would also improve health information and health literacy for all, including for healthcare professionals, patients and informal caregivers, by making this information available.

The monitoring centre could be set up as part of the Joint Research Centre, using EU4health funding.

Reframe healthcare expenditure that provides long-term value as an investment rather than cost.

The Commission and Member States should initiate a discussion on how certain healthcare expenditure could be classified as investment rather than operational expenditure for the purpose of budgeting and accounting, to enable new forms of financing and funding models. The European System of Accounts should be reviewed and adapted for this purpose.

Support the development of patient-centric and outcomes-based health systems.

  • Support Member States in adopting national plans for patient-centred health systems, which should include modalities for patient engagement in healthcare decision making at all levels of healthcare (macro, meso and micro), as well as actions to capture the voice of children, informal caregivers and underserved communities. Templates and methodologies could be developed through a dedicated EU4Health project and recommended to Member States through a Council Recommendation.
  • Set up sustainable frameworks for the collection of standardised measures on 1) patient experience on access to, and process of, care to benchmark performance and guide policy action, and 2) patient health outcomes to allow patients to have evidence-based communications with healthcare professionals and health authorities whilst also allowing evidence-based decision making for health policy. The standardisation and collection of health outcomes data should build on the progress made by the IMI Health Outcomes Observatories PPP (H2O) and other relevant projects, providing a model for outcomes measurement standardisation, integration with other data sources and the use of outcomes data for healthcare delivery and research.
  • Review the EU cross-border healthcare directive to include the disclosure of relevant indicators on access, process and health outcomes as part of information requirements, to enable informed decision-making by patients.

Previous recommendations

The COVID-19 pandemic has shown us the importance of cooperation between sectors and actors in ensuring our healthcare systems work to their optimum ability in preventing premature deaths. 40 organisations across the health community have put together concrete recommendations on how the EU could lead in areas such as healthcare systems, policies for health, research and innovation, and health data and digital health.

The Time for Action is Now.

As we head towards the European Parliament elections in 2019, healthcare systems and citizens across Europe are facing unprecedented challenges driven by an ageing population, and increased prevalence of chronic diseases.

A shared vision for the future of health in Europe