Publication

Health systems are under pressure throughout Europe as the ongoing financial crisis leads to reductions in health spending and threatens the quality of care delivered to citizens. Austerity measures and fiscal constraints have reversed the trend of increasing resources devoted to healthcare. Between 2000 and 2009, Europe’s health expenditure rose steadily at an average per capita rate of 4.6% per year in real terms. This rate of increase allowed health systems to keep pace with the increasing needs of an ageing population and take up innovations in healthcare technologies. In the first years of the financial crisis, many countries protected public healthcare budgets. However, health spending per capita fell by 0.6% in real terms across the EU in 2010, with nearly all European countries reducing growth in expenditures or making outright cuts.

This contraction is unlikely to be reversed in the foreseeable future. The European Commission (EC) expects further reductions in overall government expenditure in 2013. Even by 2014, estimated GDP growth rates of 1.5% will remain well below historic averages.iv In response to the challenging economic climate, countries such as Ireland, Italy, Greece, Portugal, Spain and Hungary, have reduced their healthcare budgets over the last five years.v The prevalence of debt-based financing of pre-crisis public expenditures makes the return of budget largesse unlikely.

Such fiscal policies place additional pressure on health systems to derive greater value for citizens from existing or diminishing resources. A number of health system leaders have commented on the impact of “downward pressure on health budgets,” citing “dropping benefits, increasing out of pocket payments and rapidly dwindling support for innovation.”

Is the European model of universal, accessible and high-quality healthcare under threat? Or does the crisis present an opportunity to implement game-changing new approaches to financing and delivering care? What is the path to improving patient outcomes and health system performance when resources are limited and patient demand is increasing? How can health system stakeholders work together to chart this course?

Tapestry Networks convened a select group of European healthcare leaders to address these questions at the Health System Sustainability Forum in Barcelona on 14–15 January 2013. The Forum sought to accelerate the transition to sustainable healthcare systems by bringing health ministers, policy-makers, budget setters, clinicians, patient advocates and senior executives from leading private sector companies together with innovators who have led specific initiatives that make this type of transition possible. Forum participants shared their experiences with driving sustained health system transformation and agreed that future health systems must learn to do more with less in order to deliver high-quality care to patients in an era of ageing populations and fiscal austerity.

Participants acknowledged the complexity of transitioning to a sustainable future. Public- and private-sector roles will shift as care delivery is reorganised, more extensive use of information technology becomes a necessity and patient outcomes dictate how resources are distributed. One health system leader said, “Now begins the hard work.” Progress depends on the ability of key decision-makers to clearly set priorities, plan strategically and lead large-scale change efforts.