Health care under pressure throughout Europe

Date: 15/07/1999

By Tim Jones

TO THE many Europeans who admire Americans for their dynamism, entrepreneurship and job-creation performance, the US still provides one object lesson in how not to run an economy: health care.

EU citizens have grown up on scare stories about inadequately insured accident victims being driven from hospital to hospital as fee-conscious administrators refuse to let them in.

Nothing like that should ever happen here, they say. Yet as their countries' populations grey, their public spending is cut and they all demand tax cuts, Europeans are having to accept until-now unthinkable private sector encroachments into largely state-run health-care provision.

The baby boomer generation is approaching its mid-60s, with all the demand for health services and long-term care that this implies. The life expectancy of people with Down's Syndrome has increased from less than ten to 40 years since 1960, while survival after the detection of breast cancer has gone up by six years and multiple sclerosis by 11 years.

Every policy-maker in the EU knows that there is a price to be paid for this success.

Ironically, the Union member state which is consistently the readiest to bring market mechanisms into all industrial sectors has been the most resistant to allowing the private sector into health care.

Yet even in the UK, where a Conservative finance minister once described the National Health Service as the country's "only true religion", 31 hospital-building projects are under way using private sector firms.

Health-care markets remain largely national in character and cross-border provision of services is still mostly a matter of compensating one national system for treating another system's client.

Throughout the Union, health-care professionals - from hospitals to drugs companies - are being asked to slash their costs, and the state is increasingly refusing to pick up the slack with full subsidies for prescription drugs, long-term care or 'hotel' stay-overs in hospitals.

In most member states, health spending has been cut as a proportion of gross domestic product over the last five years: in France, from 9.8% to 9.5%, and in Germany from 8.4% to 7.5%.

At the same time, the EU is calling on the applicant states to spend more on their health-care systems. In a recent report on public health in eastern Europe, the European Commission found that the level of communicable diseases was increasing while vaccination coverage was declining and illegal drug-use growing. More worryingly for the future, health professionals have a low social and economic status. "There could be a danger in the future of a growing exodus," said outgoing Health Commissioner Pádraig Flynn.

He warned the candidate countries that they needed to increase their health-care spending to come close to EU requirements. Poland, he said, spends 250 euro per capita on health care, lagging well behind other EU candidates' 500-600 euro, and member states' 1,600 euro.