Why European health systems must overcome the big challenge

Seemingly unaffected by recent financial crisis and austerity measures, European healthcare keeps improving. Performance, in key terms such as infant mortality, the survival of severe conditions, access to services, patient empowerment and the rational use of pharmaceuticals, all show improvement. The dire economic situation in a few countries hit very severely by financial turmoil, does not change this overall picture.

The Euro Health Consumer Index (EHCI), the independent monitoring of healthcare in 36 countries, published its 8th edition in January this year ( www.healthpowerhouse.com). Since 2006 this comparison of key values in healthcare, taking the patient and consumer point of view, has improved the understanding of European healthcare, empowered patients and helped to address weaknesses. EHCI, and a wide range of disease-specific studies produced by the Health Consumer Powerhouse Ltd. (HCP) set standards for what could and should be achieved by modern, well-serving healthcare.

A widening gap

The EHCI 2014 shows that these performance targets come within closer reach year by year. But it also illustrates widening gaps between countries, with a group of mainly North-Western European leaders, a mid-field of wealthy countries not quite making it for different reasons and a large group of low-performers with a significant need for radical improvement, almost all of them being less affluent Eastern European countries. We are still far from fulfilling the vision of pan-European healthcare equality.

In spite of this general improvement, it is clear that the performance of healthcare not even among the Netherlands, Switzerland, Norway, Denmark and other top competitors will be enough to meet the challenges of tomorrow. Every forecast tells us that the combination of the ageing European population, medical breakthroughs, growing expectations of care quality and slow long-term economic growth will put accelerating stress on health systems. This is why the discussion of how to increase efficiency, in terms of doing the right things in the right way, should be given priority.

Where to find the best value for money healthcare?

EHCI shows that there is a very large span between countries operating their health systems in an efficient way and others, paying a lot for poor services. Our term is “value for money healthcare” (also expressed as “bang for the buck”). EHCI ranks every country in the comparison from the relation between overall performance and per capita spend on healthcare, as shown by this graph from the 2014 EHCI report:

A few countries such as FYROM*) and Albania must be disregarded in this comparison, as their positions are explained by their extremely low healthcare spending. Looking at examples such as Estonia, Finland and Portugal etc, is of greater interest. The Netherlands, the multi-year EHCI champion, succeeds in matching high costs with excellent outcomes. In the lower end, you find countries such as high-spending Luxembourg as well as Italy, Spain and Ireland, evidently in need of repairing their health systems. This approach calls for much deeper analysis and conclusions.

(*) FYROM took a giant leap in the 2014 Index by doing away with healthcare waiting lists by opening up the booking systems for specialists and diagnostics on the Internet!

Health systems assessment a priority

The European Commission has recently declared that improving value for money in healthcare will be a priority for the next 5 years. Practically, this means the development of methods to assess the performance of member state health systems. Such tools will open for discussion on how to improve health systems, even for more fundamental or radical reform of the way health and healthcare is funded, organised and delivered. This is about re-shaping and modernising the biggest industry in Europe, accounting for one tenth of European Gross Domestic Product and aimed at delivering even greater value. There are many questions to make and lessons to learn, from the HCP studies and similar research:

  • How come that national health, contrary to large public systems such as education, and every successful private business, is reluctant to learn from the best performers of the world? “Not invented here” is still a strong, harmful culture.
  • What keeps some countries away from what should be obvious reform, such as replacing long, expensive in-hospital treatment with cost-efficient procedures out-of-hospital?
  • What will it take to make many more health systems open for active patient involvement, allowing interaction between healthcare and users to deliver improved outcomes, satisfaction and value for money?
  • What are the lessons from some health systems (crisis-struck Baltic states the best examples) that do the right things to recover while in other countries corruption and deterioration have become the pattern?

Driving the modernisation of European healthcare is a demanding task. Nevertheless, it is absolutely necessary that this huge process of replacing poor and expensive performance with modern, value-for-money health delivery will be successful. This is vital to meet the challenges of ever-increasing expectations on steadily more capable healthcare systems, resulting in an ageing population. Health Consumer Powerhouse Ltd. would be proud to contribute to this important effort.


Dr Arne Bjornberg

Chairman & COO

Tel: +46 8642 7140



Johan Hjertqvist

Founder & President

Tel: +46 70 752 1899



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