Bridging the Healthcare Gap: Solidarity and Investment for East-West Equality

We live in an era of big challenges, and major crises. One of them, the COVID-19 pandemics, has taught us a brutal lesson about the many weaknesses of health systems in Central and Eastern Europe (CEE) and once again exacerbated the disparities in health spending and outcomes between East and West.

Today I’ve had the pleasure of discussing Europe’s health challenges at the GLOBSEC Forum in Bratislava with a range of international health experts. The issue I wished to highlight is the urgent need to close the healthcare gap between the nations of the European Union. We must prioritise healthcare and investment in health in CEE now to build the crisis preparedness we need for our societies’ resilience. We are aligned that only all-stakeholders collaboration linked with long-term planning can lead to closing the health gap between East and West and make for a more resilient Europe fit to face future challenges.

Going to the roots of the problem

The COVID-19 pandemic showcased the weaknesses of CEE health systems and exacerbated the disparities in health outcomes in Europe. Excess mortality during the pandemic has been considerably higher in CEE countries. According to a study in The Lancet, Central Europe had an excess mortality rate in 2020 and 2021 over twice as high as that for Western Europe (316 and 140 per 100,000 people, respectively.)

The greatest excess mortality happened in CEE despite the exceptional budget increases across the CEE region in 2020 and 2021, implemented to enable health systems to fight the COVID-19 pandemic. Further, these were largely meant as emergency measures and were not fully translated into a structural increase of investments leading to a modernisation of the overall system. Something must be done about it.

It’s a matter of fact that despite generally stronger economic growth over the past decade in Central and Eastern Europe, these countries still spend low proportions of their national resources on healthcare. Whereas on average EU countries commit 10.9% of their GDP to healthcare Poland and Romania, the two largest CEE countries, each spend less than 6.5%. The figures for spending per person are even more stark: whereas, on average 3,269 euros were spent on healthcare per person in the EU in 2020, in Poland the figure – adjusted for the lower cost of goods and services – was just 1,591 euros (~50% of the EU average) and in Romania 1,428 euros. The economic hardships caused by the pandemic and Russian invasion on Ukraine have also increased the pressure on governments to reduce healthcare spending. 

These funding disparities have serious consequences. CEE countries have the highest rates of mortality from treatable and preventable diseases, with Bulgaria and Romania having rates twice as higher as the EU average. 

The disparities for access to new medicines are also particularly shocking. Whereas in Germany, it takes 128 days on average for a new medicine to reach patients, it takes 590 days in Slovakia, 827 in Poland and 918 days in Romania. We can only tackle these disparities by looking at the root causes.

In Western Europe, value assessment processes and evidence requirements slow market access to medicines in some countries, while in Eastern Europe the main factor is health systems’ resource constraints. One-size-fits-all solutions will not work in a world where health systems differ wildly: we need actions carefully adapted to local conditions in each country.

The turning point is now

Solutions exists. As European Commissioner for Health Stella Kyriakides recently stressed at an American Chamber of Commerce to the EU (AmChamEU) event on East-West health disparities in Europe: “Health system resilience is central to a strong Health Union. Working together with Member States, we can build stronger healthcare systems that deliver for citizens and patients across Europe, no matter where they live.”

This event was the occasion for the launch of a study by The Economist Impact, entitled At a Turning Point: Healthcare in Central and Eastern Europe. The study puts forth several recommendations for action in areas such as alternative financing models, focus on primary and community care, improved access to innovative treatment, diagnostics, and digital infrastructure. The challenges posed by both underinvestment and demographic shift in the CEE region can’t be overlooked any longer.

The EU has been taking numerous actions to make solidarity in health a reality in our continent. In response to the pandemic, the EU has shown impressive solidarity in the form of the 807-billion euro NextGenerationEU post-COVID recovery plan financing action in areas such as research and innovation, the climate and digital transitions, and health.

Europe´s Beating Cancer Plan makes a priority of improving access to early diagnosis and screening, treatment and care. Four billion euros have been earmarked for actions tackling cancer, notably to enable knowledge and resource sharing between EU countries.

Just last month, the European Commission presented a once-in-a-generation reform of the bloc’s two-decades-old pharmaceutical legislation. The new rules aim to streamline the approval process for new medicines, boost R&D in Europe and improve availability and access to medicines across the EU.

These EU actions can provide great foundations and support for effective national and local action on healthcare. Policymakers at all levels should make the most of them! In this respect, having a solid performance indicator to track progress is essential.

That’s why MSD is proudly supporting GLOBSEC’s own CEE Health Readiness Index. The latest version of this Index, with updated 2022 data, was introduced at this Forum yesterday, providing a composite indicator that compares and evaluates CEE countries’ healthcare systems. I hope this Index will be actively used by policymakers in the region to help make decisions to improve local healthcare systems, based on sound data and best practices.

There are signs of hope too. In February, two-thirds of EU countries recorded no excess deaths, according to data from Eurostat, compared with the average over the same period in 2016-2019. However, several countries did see excess mortality, including Greece, Cyprus, Portugal, the Netherlands, and France. At its worst levels in November 2020, the EU saw excess deaths at 40 percent above its baseline.

So, let’s take heart. Progress can be made. The pandemic provided a painful lesson: Europe was unprepared, health systems disparities were significant, and the resulting loss of life was huge. However, tremendous work has been done to strengthen the resilience of Europe’s healthcare systems since then. One thing is certain however: we can only make progress on closing care gaps if EU policies embody solidarity and healthcare investment is prioritised over the long term in Central and Eastern Europe. In this way, we can make sure that all of Europe is ready to tackle future health crises and that all Europeans have access to quality healthcare, regardless of where they live.

* Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or EACEA. Neither the European Union nor the granting authority can be held responsible for them.