Semester CSRs must be geared towards a healthier Europe

Opinion by European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan

The current European Semester process is in full swing, yet many questions remain unanswered in respect of this relatively new initiative.

The Semester gives Europe’s institutions a detailed overview of member states’ economies and forward planning on an annual basis with the goal of allowing the European Commission to give advice and guidance based on fiscal and structural objectives for the upcoming 12-18 months.

The process runs from October to May-June, by which point each country has received individual advice and guidance prior to the finalizing of budgets for the next year.

While still new, the Semester has already been criticized for a lack of transparency, due to the relatively small involvement of the European Parliament, while only 10-15% of the recommendations were acted upon across member states in 2013.

MEPs debating last month were generally of the view that recommendations should be better implemented and the process be more transparent. motr pm

A report was written by Belgian MEP Philippe De Backer, who believes that the coordination of economic policies should be subject to more democratic control by Parliament. De Backer previously addressed the European Alliance for Personalised Medicine (EAPM) conference in September and will be present at the Alliance’s Regulatory Affairs meeting in the Parliament on 10 December.

Meanwhile, other critics have called for a long-term vision and  "courageous reforms” alongside a more disciplined process.

EAPM is committed to helping to bring about personalised healthcare to all of the EU’s 500 million citizens, using advances in technology, bigger and better data streams, improved education among patients and health professionals, greater use of research and more collaboration.

EAPM’s interest in the European Semester is essentially to evaluate what impact this new initiative will have on healthcare systems across the member states and, of course, the knock-on effects in personalised medicine.

The afore-mentioned Commission policy guidance is designed to be reflected in the National Reform Programmes and Stability and Convergence Programmes of the EU’s 28 countries. The Commission draws up a number of Country Specific Recommendations (CSRs) which are later adopted by the European Council.

Due to the financial crisis and subsequent bail-outs, healthcare systems in the most-affected countries came under a great deal of scrutiny and, given that health is such a large part of each member state’s budget, this has continued to be the case when it comes to CSRs.

EAPM and other health stakeholders have noted that the sustainability element is dominating discussion in the CSRs and this is playing down the access and quality element - vital for all patients across the bloc in order to bring about innovative treatments and diagnostics.

It is fair to say that, post the bail-out processes, scrutiny of health systems is now occurring in most EU countries. In fact, the Commission has so far made health recommendations to 15 member states. These are Austria, Bulgaria, Croatia, Czech Republic, Finland, France, Germany, Ireland, Latvia, Malta, Poland, Portugal, Romania, Slovakia and Spain.

EAPM has several questions regarding the European Semester in the area of facilitating personalised medicine and will be debating them - and making recommendations - in the future. Key among them are: Will the European Semester be a temporary influence on health systems or is this a permanent undertaking?; has the health sector policymaking shifted irreversibly?; what difference will the upturn in economic growth make?, and; how effective are CSRs in non-bail-out countries?

In future, the health sector is expected to come under increasing scrutiny by the EU’s processes, due to it being a fast-growing employment and economic sector. A lot of this is now occurring under the European Semester programme.

There seems little doubt that evidence-informed CSRs are necessary to ensure that reforms in member states do not have an adverse effect on health systems. Meanwhile, CSRs offer opportunities for reform in these systems but a simple focus on cutting expenditure is not the answer.

A general stakeholder view – shared by EAPM – is that CSRs must be evidence-based, appropriate to the specific member state and that health systems should not automatically be the key target of reductions in public expenditure.

Nobody wants to see a repeat of the bail-outs – which brought about even-more limited access to personalised medicine - and all want to see sustainable growth across the EU. But there are concerns that the European Semester is too top-down, and cannot take into account stakeholder views other than those of member states it is advising.

EAPM maintains that the involvement of all stakeholders is necessary to help ensure the best access to personalised medicine and offer the best healthcare possible to all of the EU’s 500 million citizens.

The Alliance supports the goals of the European Semester in principle but would expect the process to take into account patients and all other parties involved in the health and personalised medicine arena, and not merely the budgetary authorities in member states.

CSRs especially must be focused and balanced, rather than looking for sweepîng cuts in the bigger budget areas such as health. That is short-sighted and certainly will not promote growth and employment. In fact, EAPM believes that all decisions and recommendations under the Semester should promote such growth, as well as research and efficiency, especially in the areas of health and personalised medicine.

The European Semester clearly must strike a balance between short- to mid-term growth goals and the need to work towards better and more sustainable healthcare for every European – whoever and wherever they may be.

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