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Smaller member states can shape the future of EU health policy

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Latvia-Flag-By Professor Angela Brand, Maastricht University, and European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan

In 2015, the rotating presidency of the European Union will see two of the EU’s smaller states take the helm. On 1 January, Latvia will assume the presidency as Italy steps down. This Baltic state, which joined the Union almost a decade ago, will be succeeded in the role by Luxembourg, a founding member, on 1 July.

Since the EU enlargements of 1995 and 2004, the are now seven member states with a population of between six and 10 million and eight countries with 5 million or less (and some much less).

Prior to the 2004 ‘big bang’, when ten new states joined the EU, smaller countries had little choice but to accept an Acquis communautaire which often failed to take into account their individual aspects and characteristics.

A significant turning point was reached, however, during the pre-2004 accession negotiations when part of the formulation of the pharmaceuticals package included a provision for abridged registration - Article 126a, also known as the ‘Cyprus clause’.

Following this landmark event, smaller states have been active in shaping health policy at European level and can now act as vital policy entrepreneurs pursuing normative policy agendas. This has been demonstrated by, for example, Slovenia and its major role in promoting cancer policy development at EU level.

Meanwhile, co-operation in areas such as health technology assessments are likely to receive more support from these countries, which often rely heavily on networking and capacity building.

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Of course, many challenges remain for the EU’s smaller states, especially in the health arena, and these include - but are not exclusive to - a lack of interest by industry to place medical goods on such small markets due to high or inefficient unit costs of production, a lack of competition between providers which means high prices for medicines and medical supplies due to small volumes of consumption and, meanwhile, the administrative burden of regulation does little to help patient access and lower prices in these countries.

In essence, European health policy needs to become better attuned to the specific challenges facing the health systems in smaller states and regions.

The European Alliance for Personalised Medicine (EAPM) is convinced that the perspective of these countries, as well as regions in larger states, is extremely important when determining whether there is a case for EU-level action on health.

In the EU health arena there is clearly a need for greater collaboration and, in the smaller states, the pooling of resources, which will certainly need to occur more often. And it may well be the case that European health policy will be driven by the needs and aspirations of these small- and medium-sized member states as well as regions in the larger ones.

This scenario would certainly present an opportunity for an innovative dimension in health policy to be developed at European level in which the added value of joint working is easily realised through the visible benefits attained for small administrations.

Of course, the perception of what constitutes added value will differ between member states and, thus, there is an argument to suggest that smaller states will become active proponents of the further Europeanisation of health policy.

In fact, since 2004 it has become evident that health policy has already begun a process of Europeanization – although EAPM believes not by nearly enough.

On a practical level, a vital area in relation to personalised medicine and Europeanisation could arrive in terms of access to diagnostic and innovative therapies, as well as investment in ICT systems. This is because the costs of developing separate systems for each Member State could be prohibitive for the smaller ones.

EAPM believes that topics which need to be urgently addressed in 2015 are the development of a new socio-economic paradigm, how to bring about a reduction in the above-mentioned administrative burdens, and a minimization and simplification of reporting obligations in line with the EU’s better regulation agenda.

The Alliance is fully aware of the value and perspective that smaller states can bring to the health debate in Europe and will work in concert with the Latvian and Luxembourg presidencies as much as possible to push the agenda forward.

When it comes to smaller member states, sometimes less really is more.

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