Vytenis Andriukaitis calls for paradigm shift in health policy thinking
European health and food safety commissioner talks to the Parliament Magazine about the right to quality healthcare, access to innovative treatment and why he’s fascinated by the potential of eHealth.
Vytenis Andriukaitis is talking about rights; the kind that are fundamental, enshrined and, at least in the eyes of the EU’s no-nonsense health chief, often pretty obvious. Kicking off his Parliament Magazine interview, he begins by stating that, “Access to healthcare is a fundamental right in the EU, as a subject to national law. The right to preventative, diagnostic and curative treatment regardless of financial means, gender or nationality is a principle enshrined both in the European Union’s treaty and its charter of fundamental rights.”
A qualified heart surgeon and, until his appointment as EU heath Commissioner last year, Lithuania’s health minister, Andriukaitis knows a thing or two about healthcare and rights. As he prepares his opening speech at this year’s European Health Forum Gastein in Austria, the right to treatment is focussing his thoughts. “It seems obvious to me that access to high-quality healthcare should be part of the debate on ‘securing health in Europe’ – the overarching theme of this year’s health forum in Gastein. Efficiency, quality and accessibility of health systems, in particular for disadvantaged people and remote rural communities, need to be addressed swiftly.
That right of accessibility is, in his view, one of the most important challenges for health systems across Europe and one that he feels needs to be safeguarded, particularly in the current economic climate when public purses are under intense pressure. “Gastein provides a great opportunity to recall the EU’s health agenda on health systems. Adopted last year, it’s a great platform to exchange views with the European health community focusing on the accessibility, effectiveness and resilience of the healthcare sector.”
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It’s also a great way, he believes, to highlight the benefits of EU healthcare initiatives, “such as how their proper use by member states can create added value, for example through European funding instruments such as the European fund for strategic investments or by the use of structural funds in implementing reforms.”
Innovation in healthcare, particularly the issue of access to innovative, safe and affordable treatment, will also feature strongly in the Commissioner’s Gastein address. “Access to medicines implies a multi-level decision-making process from research and development to the moment the patient can access the product. Access to innovative medicines is specifically highlighted, as there is an increasing interest among EU countries to reflect jointly on how to increase patient access to them.” And while he accepts that there are differences between national health systems, he believes that often the challenges are just the same and that more cross-border cooperation in the healthcare sector can only help Europe economically.
“I am certain that the Commission’s session at Gastein will enrich the discussion on the challenges for timely access to innovative and safe medicines and contribute to paving the way forward for further cooperation at EU level.”
It’s tough out there in austerity-driven member state land, and Andriukaitis is especially keen for the EU to deliver on its ‘added value’ potential and to play a significant and complimentary role in improving people’s healthcare access.“ I believe that in our effort to move Europe from the crisis towards investment and growth and towards even stronger economic governance, we need strong, well-performing health systems as a key component. The EU should play a supportive and complementary role, in particular in the context of the European semester, where the Commission issues country-specific analysis and recommendations, focusing on the effectiveness, accessibility and resilience of national health systems.
Shortly after taking office, Andriukaitis’ boss, Commission President Jean-Claude Juncker asked him to develop a range of expertise that could focus on assessing the performance of Europe’s health systems. “Last November, I launched a new expert group which started its work in this area and together with member states we shall build country-specific and cross-country knowledge while developing tools to boost policies at both national and European level.”
Andriukaitis recently called for a significant shift in health policy thinking, arguing in favour of moving away from defining health spending solely in terms of cost. “I’ve mentioned on several occasions that in health policy we need a paradigm shift in the way we finance, organise and operate our health systems.” What he’s after is a change in thinking about healthcare costs, and in the healthcare savings that can be gained from a preventative approach. “I strongly believe that real expenditure is directly linked to risk factors such as obesity, physical inactivity, alcohol abuse and smoking. These are fuelling the burden of chronic disease and need to be addressed.”
Citizens’ health, he believes, is just as much of an investment as infrastructure and new technologies are. “Member states who invest in health policy today, contribute to the economic growth of tomorrow. People’s health is not a precondition for economy – it produces economy. Effective healthcare is not some kind of mandatory burden; it’s one of the best possible investments we can do.”
And according to the Commissioner, health systems are one of the EU’s fastest growing economic sectors accounting for eight per cent of Europe’s workforce and ten per cent of the bloc’s GDP. “The real costs we should avoid paying are those caused by factors that are preventable. The burden of chronic diseases accounts for 70-80 per cent of healthcare costs in the EU, an estimated €700bn. But, on average in the EU, only three per cent of healthcare budgets are used for prevention. This has to change.”
The more health systems can invest in preventative measures now, he argues, the less they will have to pay in treatment costs further down the line. “And I am not just talking about some distant future. There are many prevention measures that could be put in place, such as enforcing bans on smoking in public places or action against drunk driving which can yield immediate returns.” During his confirmation hearing last year, Andriukaitis told MEPs that he wanted to focus on ‘prevention, promotion and protection’ during his time as health Commissioner. “I believe all member states could gain from providing more emphasis on prevention and promotion with a long-term perspective.
This means enshrining promotion and prevention objectives into all relevant policies into a long-term, comprehensive approach. The EU has a number of instruments to help EU countries, and I will continue to raise member states’ attention to the opportunities for EU support.” He’s also keen to urge national governments to follow the Commission’s ‘health in all policies’ approach, which aims to consider the impact on health or health systems of new non-health policy initiatives. “It is important that this same approach is followed at national, regional and local levels.
Andriukaitis’ name hit the headlines recently when a number of MEPs and health NGOs accused him of abandoning plans for a shiny new EU alcohol strategy in favour of including alcohol within a broader focus on tackling chronic diseases.
The row led to the walkout of several NGOs from the Commission’s flagship expert forum on alcohol and health. The Commissioner says he is keen to “stress that I fully share their concern about the devastating consequences of alcohol misuse and that I believe there is much to be gained from EU cooperation to address this important issue.” He adds that he is committed to shaping solutions on reducing alcohol abuse and on the harm it causes and in addressing the reasons that lead to alcohol abuse.
“In fact, my colleagues and I are currently discussing with those NGOs that left the forum, on the best way to continue cooperation. We need to look at the reasons which lead to alcohol abuse. Sometimes it’s desperate conditions that lead some people into abusing alcohol; sometimes it’s easy access to the bottle, which slowly grows into alcohol dependency.” The Commission is also supporting national authorities in many areas and encouraging member states to take a comprehensive look at the issue, he adds.
“In the meantime, I intend to continue our ongoing initiatives, such as supporting the joint action to reduce alcohol-related harm and the action plan on binge drinking, all within the context of the 2006-2012 strategy to support member states in reducing alcohol related harm. I have also secured €1.7m for alcohol related projects in the 2015 health programme work plan, to strengthen EU action and cooperation in this area.”
Andriukaitis is also part of the commission project team that earlier this year adopted a digital single market strategy which included a focus on eHealth. The Commissioner says he is “fascinated” by the innovative solutions and tangible benefits that eHealth can bring. “As a medical doctor, I am fascinated by the innovative solutions that are part of today’s medical toolbox. The more familiar I become with eHealth, the more convinced I am that it can enable better health, better and safer care for citizens and boost the performance and sustainability of healthcare systems across the EU.”
Both eHealth and mobile (mHealth) can, he believes, also “deliver more tailor-made, ‘citizen-centric’ care and help reduce medical errors. Technologies such as telemedicine can empower patients and help healthcare professionals make better use of their time. New solutions such as mobile health apps enable for example, diabetic patients to monitor their own blood glucose, transmitting the information electronically to their healthcare specialist.”
Digital technology also has the potential to generate high quality jobs and innovative growth, and to reduce costs. This is particularly important in times of common challenges affecting all health systems in Europe: an increasingly ageing population, the rise of chronic diseases, patient expectations and the constantly increasing cross-border dimension of healthcare in the Union. Therefore, I very much welcome that eHealth is one of the 10 domains identified by the Commission as key priorities for standardisation, under the digital single market project.”
This, he argues, is a major step forward in promoting the better use of digital health technologies. “In addition to addressing standardisation, we also need to tackle the legal and institutional obstacles preventing the wider use of telemedicine services across borders. I want to seize the opportunities offered by the emerging European digital market and ensure that we create an environment where practical, innovative, and cost-effective eHealth solutions can thrive. I will make it a priority to continue this work with my colleagues in the Commission, our stakeholders and member states, in order to maximise the potential of eHealth.
Vaccine hesitancy and the continuing threat of anti-microbial resistance (AMR) have also hit Europe’s headlines recently and Andriukaitis is keen to address these so-called emerging public health threats. “The fight against AMR is one of my key priorities. I am from the generation of doctors who remember how antibiotics transformed the medical landscape, and I am alarmed at the thought of these essential tools of modern medicine losing their effectiveness because of over-use and misuse.
Around 25,000 people die each year as a result of infections caused by resistant bacteria. The annual economic cost of the problem is estimated at €1.5bn, mainly in healthcare expenditure and productivity losses. “The Commission has a holistic, ‘one health’ approach to AMR and pursues a 10-point action plan to address resistance both in people and in animals. The current European action plan against AMR expires at the end of next year. The Commission is reflecting carefully on what further action needs to be taken beyond 2016.”
Turning to vaccination, he’s of the opinion that vaccines are one of the most cost-effective public health measures available. “I believe EU-wide cooperation can benefit all and increase the cost-effectiveness of vaccination programmes – and this is why member states have agreed to cooperate further on vaccination.
I have written to all health ministers recently to encourage them to consider any appropriate measures to ensure that all children in their countries are vaccinated against preventable diseases. As far as Andriukaitis is concerned vaccines are a key preventive healthcare treatment, or in other words, the right stuff.
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