EFPIA welcomes the publication by the European Commission of the Annual Growth Survey, starting off the European Semester Cycle for 2017. EFPIA agrees with the three main objectives for EU economic policy – to boost investment, to pursue structural reforms and to ensure responsible fiscal policies – and would note that a strategic approach to investment and structural reforms is necessary to achieve long-term fiscal sustainability.

EFPIA agrees that Member States should continue to reform their health systems, and that health policies should support social safety and active inclusion through preventive, curative and rehabilitation policies. Protecting the population from ill health is, as the report states correctly, essential both from a social and an economic viewpoint. Indeed, in an era of ageing populations and declining proportion of the working age population, it is essential to strengthen efforts to keep people in the workforce healthy and to make sure that the elderly population can enjoy high-quality lives without the burden of chronic diseases such as cancer, diabetes, respiratory and cardiovascular disease. Investing in health and reforming health systems to deliver better health outcomes for each euro spent will be essential to reach these objectives.

In order to ensure that the health sector can contribute fully to the objectives laid out in the Annual Growth Survey, EFPIA would like to make the following recommendations for the European Semester 2017. 

1. Evaluate Member States health policies based on a thorough and evidence-based assessment of health system performance. The Joint Report on Healthcare and Long-term Care Systems and Fiscal Sustainability points out rightly that healthcare system reform should be evaluated both ex-ante and ex-post, using relevant indicators, in order to assess the impact of the reform on health system performance, including health outcomes. The report recommends that overall indicators of population health such as healthy life years and mortality need to be complemented by disease-specific and patient reported health outcomes measures. EFPIA would call on the Commission to follow this approach when assessing health system reform and issuing recommendations as part of the European Semester.
2. Reform healthcare systems through focusing on health outcomes. There is still high variation in health outcomes for patients from healthcare interventions, both across and within EU countries. Many of these variations are due to unwarranted differences in clinical practice, care pathways or uptake in health technology. Through standardised collection of data on health outcomes and better understanding and analysis of what kind of outcomes are produced across health systems, care pathways can be redesigned to give the most value for patients and systems for the resources invested. Full transparency of outcomes data can also facilitate a positive “race to the top” and enable patient choice.
3. Promote integrated solutions for health service delivery, and integrated budgets. Treating patients with one or several chronic diseases requires a more integrated approach to health service delivery, where different providers collaborate towards the same goal, with the patient in the centre. Integrated budgets for healthcare and social care services will facilitate resource allocation based on the needs of the patient, efficiency and value for money, rather than the organisational set-up of the different providers.
4. Use Health System Performance Assessment to compare and analyse healthcare performance. Comparing the performance of hospitals, regions and countries is key to identifying and spreading good practices, and improving the performance of those lagging behind. Many HSPA models in use today have insufficient data on actual health outcomes, including Patient Reported Outcomes, and instead rely on input or process data. The EU should continue its work to build the capacity of Member States to perform HSPA, and also develop further HSPA capacity at European level.  
5. Highlight the role of health data for improving health outcomes and reduce inefficiencies in healthcare. A key enabler for the objectives above is the comprehensive use of Health ICT. Collection of health data, including real world data on health outcomes through universal Electronic Health Records and disease registries, linked through unique patient identifiers, will enable quality improvement in healthcare, patient-centered integrated care, and innovative payment models based on results, research and big data analysis. The EU should encourage and facilitate the use of EU funds, including through the European Structural and Investment Funds and the European Fund for Strategic Investments – for strategic investments in comprehensive Health ICT infrastructure – and ensure system standardisation and interoperability.
6. Increase health spending in countries with poor health outcomes and access to health services. Several lower income EU countries, primarily in Eastern and Central Europe, still have underfunded health systems, with access problems, high levels of co-payment, insufficient health workforce capacities and overall poor health outcomes. EFPIA welcomes the Commission’s move to grant some countries permission to deviate temporarily from the budgetary targets in the Stability and Growth pact in order to enable investments that will bring long-term sustainability through a more efficient healthcare system. Indeed, investments in areas such as primary healthcare, and primary and secondary prevention programmes, can create better health for the population at lower costs in the long term. Moreover, EFPIA would like to highlight the negative effects from certain External Reference Pricing measures on the access to medicines in countries with lower than average GDP, and would call on the Commission to take this into account when evaluating healthcare spending and pharmaceutical policy.