A Europe of 28 Health in an Enlarged Union Benjamin Gannon GSK Brussels

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A Europe of 28?Health in an Enlarged
Union Benjamin GannonGSK Brussels
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The Making of a Union

• European Coal and Steel Community (1951)
• Treaties of Rome (1957)
• European Economic Community (EEC)
• European Atomic Energy Community (EURATOM)
• Since 1957 four processes of enlargement
• Moving towards greater economic, monetary and
  political unity.

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Political Process

• Negotiation of accession launched 1998, 30
  chapters (hot agriculture, regional aids,
  budget, competition)
• Political agreement at Copenhagen summit Dec.
  2002 accession in May 2004 (10 candidates)
• Commission recommends enlargement
• EU Parliament agrees to enlargement April 2003
• National referenda under way
• Signature of Accession Treaty in 16th April in
  Athens
• First Election to EU Parliament 22nd June 2004
  (then 732 MEPS)
• Then New Commission in 2004 25 Commissioners

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What One Thing Would Improve the Quality of Your
Life?
A Clear Message from Europe
Pan-Europe
Better Health
Higher level of pension/ welfare benefits
Live closer to family/friends
Better healthcare Better weather Better
transportation facilities Other
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Perceptions About Health
Source OECD Health Data 2001
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Drivers for Healthcare Demand

• to healthcare
• to information
• to technology

Access

• Ageing Population
• Lower Birth Rates
• Migration

Measuring Healthcare

• Higher Life Expectancy
• Disease Prevalence
• Standardized Death Rates
• Mortality

Health Indicators
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Healthcare is increasingly expensive

• Ageing populations
• Treatment possibilities improving
• Improved diagnosis
• Better knowledge of medical treatment

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Polands Population Evolution from 2000 to 2050
Going up
Going down
Pop. (mill.)
Source US Census Bureau
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Economic Growth With Enlargement Less Than The
Netherlands
GDP/capita EU15 22,500 GDP/capita EU25
10,796
GDP CEE lt GDP NL!
380bn
368bn
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Economic Growth Rates Required
How Much To Reach 75 of EU in 20 Years?
2000 2001 2002f

• Slovenia 2.4 4.6 3.2 3.2
• Czech Republic 3.1 2.9 3.4 3.7
• Hungary 4.1 5.2 3.9 3.6
• Slovak Republic 4.4 2.2 3.1 3.4
• Estonia 5.6 6.9 4.3 3.1
• Poland 5.7 4.0 1.1 1.6
• Latvia 6.6 6.6 7.6 5.0
• Lithuania 6.6 3.9 5.7 3.5
• Romania 7.3 1.6 4.9 3.5
• Bulgaria 8.1 5.8 3.9 3.4

Source ECN, European Union Accession, July 2002
Statistical Service July 2002
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Low Health Expenditure in CEE ( of GDP)
Unequal commitment to health and new technology
Source Health for all database WHO, 2002 a
data from 2000, b data from 1999, c data from
1994
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Total Health Expenditure as of GDP
Total health expenditure as of GDP
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8
7
6
5
Alarming development
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3
2
1970
1975
1980
1985
1990
1995
2000
2005
EU average
CEE average
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Healthy Life Expectancy (HALE)
Source WHO European health for all databases,
version January 2002
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Cardiovascular Disease (CVD) in the Population
Aged 65 and Over, SDR/ 100,000 (1997)
NARROW THE GAP
Source WHO European health for all databases,
version January 2002
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Trends in Estonia
GDP
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Issues CEE Healthcare Systems

• Insufficient funding (both in total and in
  relative terms)
• Insufficient structure and coverage how to?
• Insufficient infrastructure (eg hospital beds
  gap urban/rural)
• Morbidity and mortality indicators below EU
  average (heart disease, prevention, HIV!)
• Pharmaceuticals CEE generics depths, private
  market

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Impact of Enlargement on Healthcare System

• Conflict/ Free movement of people (people)
  services, goods versus national competence to
  design social security systems
• ECJ has to strike balance!
• Patients Use of competence centres west (extra
  cost) competition on price East(plastic
  surgery, dental services, health spa)
• Workers loss of competence to West, competition
  on wages from East
• goods medicines!

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Enlargement Brings..

• Movement of People, Goods Services
• Health gaps and infectious diseases
• Public health standards
• Brain drain
• Health System implications
• Harmonization of benefits across EU
• Surveillance systems
• Financing Implications
• Payment of services across borders
• Impact on RD/ generic pharma
• Insurance industry

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Healthcare and EU enlargement

• EU realised only relatively late that differences
  between the MSs and CCs in healthcare
  infrastructure, healthcare budget, the
  availability of modern equipment and medicines
  might be a significant uncertainty factor for the
• overall health status and safety of the entire EU
  population
• welfare of its inhabitants
• overall economic success of the EU

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IMF Recommendations - Annual report, May, 2003

• For balancing the Hungarian national budget IMF
  recommended to decrease expenditure in the
  following areas
• government administration
• healthcare!!!!!
• pensions
• public welfare support

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Accession Countries - Healthcare Positives

• Medical culture and traditions similar to those
  of the EU
• Highly trained medical personnel
• Well developed and established
• Healthcare system
• Drug regulatory and control procedures

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Goal Imroved equity, quality and efficiency, but

• Large informal sector hinders collections
• Powerful interest groups resist change
• Informal payments impede access
• Social insurance lacks knowledge expertise
• Public health functions are weak
• Public health is not a political priority

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What to do?

• Harmonise quality of healthcare across EU
• reduce differences in the level of medical care
  between MSs and CCs
• Channel more EU global funds to achieve
  harmonization
• Increase the share of healthcare within the
  national budget of the CCs

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Activites

• Engage in the Healthcare reform process
• EFPIA - Health Enlargement strategy
• Demonstrate the benefits of innovative medicines
  and proper resource allocation
• Discussions with global lending bodies (World
  Bank, EIB, etc)
• PhRMA
• Projects in development (patient group support)
• Healthcare sector analyses
• e.g. study of wastage in Polish healthcare sector

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