David BYRNE

European Commissioner for Health and Consumer Protection

Prevention key to healthcare costs in an ageing society

Informal Health Council
Noordwijk, 10 September 2004

Thank you, Chairman, for bringing us together in this informal Council. The topic you have chosen of "healthcare in an ageing society" is indeed a crucial one.

Let me begin by summarising the five key points that I wish to make.

First: that the challenge for healthcare in an ageing society is a significant one, but not an overwhelming one.

Second: that in responding, we must find solutions that respect the fundamental values on which European societies are based.

Third: that our response should focus on improving the quality of healthcare and health promotion, not by reducing solidarity and access to healthcare, nor by creating financially unsustainable systems;

Fourth: that this can be done, and that European cooperation can help all Member States to achieve this in practice;

And fifth: that by investing in health, we will be making a vital contribution to the economic growth and sustainable development of our societies as a whole.

Let me set out in more detail what I mean.

1. The challenge of demographic ageing

The starting point is of course the challenge posed by demographic ageing. Your background document, Chairman, does an excellent job of setting out the projected trends, given all the uncertainties surrounding these projections.

One crucial area of uncertainty, is to what extent greater numbers of older people will generate a proportionately greater demand for healthcare. Unlike pensions, health costs are not linked in a fixed way to ageing. Good health can be extended and improved in cost-effective ways throughout life.

If we think more strategically, we can work in the decades to come to improve the health status of the population. And as we age, we should innovate to reduce health and residential care costs by working to keep people at all ages -including the elderly - active, productive and at home for as long as possible.

In this way, Healthcare will continue to be heavily concentrated around the last year of life, whenever that comes.

Until then, there is no reason why older people should not continue to be active and contributing members of society. We can do a great deal to ensure that this is the case, in fact, by paying investing in the minor, low-level early support and prevention. These measures will keep older people healthier for longer, and will help to minimise costly major interventions later in life.

And of course, the main factor driving increases in health expenditure is constant innovation in medical technologies and techniques. After all, we have already had decades of constant pressure on health budgets without greater numbers of older people being an issue.

These innovations frequently make healthcare more efficient. Look at the development of keyhole surgery, for example, which is better for the patient and which shows the potential for innovations to reduce the cost of healthcare, not increase it. Nevertheless, as we grow able to do more to improve health, the demand on healthcare budgets increases overall.

Therefore, we must also make sure that as new innovations are introduced, we properly evaluate their efficiency and effectiveness in comparison to existing practices, to ensure evidence-based medical practice.

1. Respecting fundamental European values

Looking at the massive resources invested in healthcare past and present brings me to my second point about European values. When compared with the rest of the world, there is clearly a distinctive "European social model". The commitment to accessible, high-quality and financially-sustainable healthcare is a key part of this model. For the citizens of the new Member States these values represent a central part of the Europe to which they aspire.

Many health systems have tried the approach of requiring citizens to pay for a greater proportion of their healthcare as a cost-containment measure, in particular during the 1980s. This worked up to a point, as the reductions in healthcare expenditure during that period show, but only to a limited extent.

Ultimately, people perceive healthcare to have a very high benefit to them. Therefore, reducing the public proportion of financing has only limited effect. The benefit that citizens consider healthcare provides rapidly outweighs any politically feasible cost that can be imposed. Moreover, people will seek to cover the cost to them from elsewhere, such as from supplementary insurance.

However, I do think that we can do more to get citizens to take more responsibility for their health, and to promote a more rational use of healthcare. Perhaps we should consider trying to create incentives for good health, rather than merely costs for sickness. We should also remain ready to act to minimise costs of ill-health from external determinants, such as tobacco.

Whatever approach we take, I think we must respect the basic values of accessibility, quality and sustainability which characterise European health systems.

1. Responding by improving the quality and efficiency of healthcare and health promotion

Our best response to the challenges of demographic ageing is to improve quality and efficiency in healthcare provision.

Our achievements in providing acute, high-intensity care have sometimes overshadowed the importance of preventive measures, and other low-level interventions outside hospitals. Yet this is precisely the kind of care of which we now need more.

Even once people reach old age, it is not too late to improve health through preventative measures. Preventive strategies then can still bring benefits for major conditions such obesity, cardiovascular diseases, diabetes, stroke and osteoporosis.

And when older people do require care, a proper integrated assessment and package of care provided locally while they still live in their own homes will be both cheaper and more effective than leaving people to deteriorate until they require a costly referral for hospital care.

Finding a way to balance the books through improvements in the quality of health services would be better, both politically and economically. The question is, can it be done?

1. Scope for quality improvements and European cooperation

On the basis of the available evidence, the answer is yes, it can be done.

Current variations in practices suggest that the potential benefits of achieving best practice throughout Europe are enormous.

For example, five-year survival rates for breast cancer range from 81% in Swedish women to 58% in Slovakia and Poland.

Or take skin cancer - for malignant melanoma (the most serious kind), five-year survival rates vary from 89% in Sweden and 86% in the Netherlands, to 62% in Estonia, 64% in Poland and 68% in Italy.

This potential to learn from each other does not just apply to acute care. For long-term care, Denmark reduced nursing home use by the elderly by over a quarter from 1982 to 1996 through provision of publicly-financed care at local level.

And note the size of these variations - not two or three percent difference, but a whole order of magnitude larger. An order of magnitude, in fact, comparable to the projected size of demand increase due to demographic ageing.

So the potential for improved quality and efficiency in healthcare to provide a response to the impact of demographic ageing is there.

This, of course, is far easier said than done. However, Chairman, European cooperation can help by facilitating comparisons and thus helping all systems to attain the standards of the best.

This is why I consider that the developing cooperation on healthcare issues at European level is so important. We can provide direct support for projects and developing best practice through the public health programme and the research and technological development framework programmes.

European funds can help to upgrade health infrastructure and skills through the structural funds. Policy convergence and cooperation can be supported with the open method of coordination proposed for healthcare and long-term care, using common indicators and sharing best practice. And the High Level Group on health services and medical care provides a mechanism for practical cooperation on making health systems work together better in practice.

These tools provide a solid basis for developing cooperation at European level.

1. Investing in health as a contribution to economic growth and sustainable development

This leads me to my final point. We have real strengths in Europe in our healthcare industry and research base. The resources we invest in healthcare underpin a world-class industrial sector.

Similarly, active, healthy older people are a valuable resource for society. We can project the possible costs of increased healthcare. But we do not project the additional contribution that these people will make to their families, to society and to the economy at large.

This involves issues somewhat beyond the scope of our discussion today, such as how to ensure that labour market regulation is flexible enough to allow people to remain active past current retirement ages if they wish to.

But these issues and the other key elements of our welfare state policies are also being discussed in other forums and through the open method of coordination. The tools are there for a coherent European response to all aspects of ageing.

Or let me take the example of the shortage of health professionals. This is certainly a serious issue - but it is a problem that we can solve, if we work together. And the greater need for healthcare professionals is also an opportunity. The healthcare sector provides a source of employment, with a wide range of opportunities from relatively simple jobs to the very high-skilled, in work that by its nature must be provided where the patients are and cannot be `outsourced' outside the Union.

Money spent on healthcare is an investment in jobs, in technology, in a service that citizens consistently rate as one of their primary concerns, and in providing the healthy and active population on which our overall development depends.

Conclusions

Chairman, let me end by addressing your five questions.

On your first question, I do think that the challenges for health systems over the coming years are significant, from ageing but more importantly from medical innovation. But I do not think that these challenges need overwhelm our systems.

On your second question, I agree entirely that policies should be developed to ensure that people have more healthy years, but these policies must reflect the fundamental values which characterise European societies.

On your third question, I think that we should focus on meeting these challenges through improving the quality of healthcare and health promotion.

On your fourth question, I agree that European cooperation can help all Member States to achieve this in practice, through financial tools, through policy cooperation in the open method of coordination proposed for healthcare and long-term care, and through practical cooperation in the High Level Group on health services and medical care.

And on your fifth question, I consider that the High Level Group on health services and medical care provides the right mechanism to begin this cooperation, alongside the other relevant bodies such as the Social Protection Committee.

Thank you.