Holistic healthcare: More not less

A truly holistic approach to healthcare demands prioritising, not marginalising, future investment in health, writes Kateřina Konečná.

Katerina Konecná | Photo credit: European Parliament audiovisual

By Katerina Konecná

27 Sep 2018

Much is happening in EU public health legislation; but not all of it is positive. I am increasingly sceptical about future developments in this area. Although 70 per cent of Europeans want the EU to do more on health and social issues, it appears to be moving in the opposite direction. As we prepare for the multiannual financial framework post-2020, I am concerned over plans to merge the EU health programme with an enlarged European Social Fund+.

Although the desire to address the socioeconomic determinants of health is positive, the new governance structure is a concern, with rumours of no health Commissioner, perhaps even no DG SANTE in the next legislative period. Funds are under threat, with a proposed eight per cent cut compared to the 2014-2020 period. It means the European Social Fund+ instrument is being asked to do much more with less resources. In fact, health budgets should be significantly increased as part of a reinforced health programme.

Last year, I was part of the European Patients Forum campaign to raise awareness around the barriers facing patients in accessing healthcare and placing universal health coverage at the centre of the policy debate. This topic is close to my heart; I am co-Chair of the MEP interest group on Patient Access to Healthcare and a member of a wide range of patient’s organisations.


Despite much progress having been made, for example on collaboration within the healthcare system and among health care professionals, much more is needed. This is why I support the deeper cooperation between members states in healthcare, even although public health is not the exclusive competence of the European Union. We have to know and identify individual patient need if we are to tailor care appropriately, implementing access to a holistic range of health and related services.

The major issue in this area remains the poor connection not only between individual national health care systems but between health care and welfare systems. Policymakers and civil society must be encouraged to implement intersectoral action for health or risk huge economic damage.

In my own country, the Czech Republic, our health care system frequently resists paying high prices for medicines for patients with rare diseases or injuries, simply because of the cost.

At the same time, public insurance companies fail to realise that without treatment, this patient could become an invalid, disabled or excluded from work. Their costs are not saved; they simply pass from health care to the welfare system, where they could stay for decades at cost much higher than treatment. This is a huge miscalculation that wastes limited resources.

We should also promote prevention, which encourages healthy and active ageing to reduce chronic conditions prevalence and co-morbidities. Member states should promote research on how the effective coordination between systems creates more effective and efficient health provision.

For example, I see a huge potential for cooperation in financing and research of Rare diseases. Around 30 million European citizens are affected at some point by one of the 6000 or more rare diseases. Yet only five per cent of rare diseases have effective treatments. 

Small patient populations and expertise, as well as geographical scattering, deepens inequalities between countries and regions in accessing appropriate medical and social care and treatments.

We should ensure that patient groups, including these vulnerable groups, are able to collaborate systematically on health issues. 

We also need to promote a patient-centred approach to reforming healthcare systems towards integrated care delivery, designed to best serve the needs of patients throughout the care pathway.

This year, the European Commission presented a proposal for boosting cooperation among member states for assessing health technology. The legislative proposal, on which I am a shadow rapporteur, intends to centralise the clinical assessment of new medicines and new medical devices Europe-wide. Although an excellent first step, it is not enough.

All other areas of HTA, which are highly connected to the access to holistic range of health and social services, will remain - according to the proposal - the subject of voluntary cooperation, something that won’t change for at least a decade. The Parliament’s negotiations on this file are almost over, and I remain sceptical.

Member states clearly don’t want it and even in the ENVI committee, the proposal has been weakened. While I was partially successful in promoting patient organisation participation in the HTA, meaningful, mandatory patient involvement in the process is essential in ensuring HTAs are conducted in the interest of patients.

The EU and its member states need act to close unacceptable gaps, overcome barriers and reduce unmet access in healthcare; they must also take the issue of an integrated care approach to health and social services seriously. After all, health is a fundamental part of Europe’s wealth. I hope that this question will play a prominent role in next year’s European Parliament elections.


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