EXPH (EXpert Panel on effective ways of investing in Health). Opinion on Benchmarking Access to Healthcare in the EU.

Faced with growing evidence that some groups within European Union Member States have been unable to achieve access to necessary healthcare, the European Union has committed to action to reduce levels of unmet need, most recently as an element of the European Pillar of Social Rights. In response, the Expert Panel on Effective Ways of Investing in Health has been requested to propose a series of quantitative and qualitative benchmarks for assessing progress in reducing unmet need for healthcare and to discuss means by which EU funds or other mechanisms might be used to improve access to healthcare. A first step is to define need for healthcare. This is the ability to benefit from it, meaning that the individual in question has a condition that causes him or her to be in less than good health but also that there is a treatment available that can improve their health, whether curative, life-sustaining or enhancing, or merely palliative. While recognising that there may be clinical reasons, such as low levels of cost effectiveness, for denying treatment in the face of limited resources, treatment should never be withheld on moral grounds. In practice, however, there are many challenges involved in measuring unmet need for particular interventions, precluding its routine use. Consequently, a pragmatic solution involves the use of survey data in which individuals are asked whether they have experienced a need for healthcare but were unable to obtain that care. These data are collected throughout the European Union annually in the Survey of Income and Living Conditions (EU-SILC), with subsidiary questions that ask about the reasons for unmet need. The report of the Panel recognises that this approach has a number of limitations, and also that there are other sources of data that provide insights into the extent to which you need for healthcare is being met, including comparative data on outcomes related to healthcare, but for the present, the EU-SILC data are the only timely and comparable source of information available across all Member States. Using this measure, the Panel draws attention to persisting evidence of relatively high rates of unmet need in some Member States, and some groups within them. The Panel notes that, consistent with the political objective of achieving convergence within the European Union, there is a strong argument for setting a target for unmet need that is close to that already achieved by the most privileged group within the best performing Member State. However, given the very differing starting positions, the Panel considers that this is, for the present time, unrealistic. It is beyond the scope of the Panel to propose a precise target for reduction in unmet need, given that this will require the commitment of financial and other resources. Instead, the Panel has proposed a mechanism for setting such a target. This involves setting a benchmark of the median value achieved by the best performing Member States, with the expectation that those Member States not yet achieving it should narrow the gap by a given percentage, which might be around 50%, over a defined period of time, which might be three years. Such a target would be ambitious, requiring a significantly faster rate of reduction and has been achieved in recent years in many Member States but, in our view, would be achievable. The Panel was also asked to identify second level indicators. Taking a pragmatic approach, based on the availability of data, it proposes that this should follow the questions that are included in the EU-SILC data. These provide information on affordability, availability, and acceptability of health services. The Panel did, however, note the importance of developing additional sources of data that can be collected regularly to provide more detailed insights into the levels, patterns, and determinants of unmet need for healthcare across the European Union. The Panel was requested to identify qualitative measures of unmet need. This is particularly challenging, given the many and diverse reasons for unmet need for healthcare, both among and within Member States. The Panel was not convinced that a standard reporting system was appropriate. Rather, it was recommended that each Member State identify those groups that are most likely to be disadvantaged, according to factors such as age, gender, education, ethnicity, or employment status, analyse the appropriate data, and prepare a report on the level and pattern of unmet need among disadvantaged groups, accompanied by recommendations for action. The Panel also note the value of shadow reports produced by civil society organisations in other areas and encourages the production of such reports. Finally, the Panel reviews the scope for using European Union funds to improve access to healthcare. It notes that, as the problems facing each Member State differ, as well as the extent to which each of them is eligible for different forms of support. However, it notes that there are many opportunities for using vehicles such as Structural Funds, research funds, and European Reference Networks.