The European Union has 27 different health systems, but they all face a common problem: reconciling limited resources with growing demands for healthcare.
In 2006, rich countries spent around 8.9% of national income on healthcare, according to the most recent data from the Organisation for Economic Co-operation and Development (OECD).
But the rate of growth has slowed in recent years, a process that began even before the economic crisis hit. In 2006, health spending in OECD countries grew by less than 3%, compared to an average annual rate of growth of 6.2% between 2000 and 2003.
Assessment
Against this tough economic background, health technology assessment (HTA) is entering the spotlight. This is the process of scientific, social, ethical and economic evaluation of new drugs, surgical procedures and other medical treatments (in health management jargon, even pills are known as “technologies”).
HTA is increasingly seen as a way to make “ethical and effective use” of innovations, according to the Tallinn Charter, a declaration signed by 53 health ministers at a World Health Organization conference in 2008.
In 2006, the EU set up a pan-European network on health technology known as the EUnetHTA.
This brought together 63 health technology institutes with the aim of sharing information, avoiding duplication of research and helping countries adapt information to specific regions.
Finn Børlum Kristensen, leader of the network and also director of the Danish Centre for Health Technology Assessment, said that the exercise has created “a number of useful tools and structures for helping the production of HTA in European countries”.
He added: “There is an exchange of knowledge and experience not only between east and west, but also north and south.”
In his view, even some old member states do not have a strong tradition of HTA.
The European Commission wants to make this network a permanent fixture through the draft directive on cross-border healthcare. But the role of the network will remain modest. It will not become a fully-fledged EU agency and neither will it harmonise the availability of drugs and treatments across EU countries.
The Commission thinks this would be impossible, as it believes that definitions of cost-effectiveness would vary too much between rich and poor countries. The focus of any new body would be on the softer work of collaboration and information sharing, with priority-setting remaining at a national level.
Some European countries have set up organisations to make decisions on what drugs and treatments should be publicly funded, such as the National Institute for Health and Clinical Excellence in the UK and the Institute for Quality and Efficiency in Healthcare in Germany.
These organisations make the final decision on what treatments their healthcare systems should provide. But the harsh truth remains that even the most careful decision-making can only allocate funds more efficiently. It does not create any additional resources for healthcare.
