Context and background
The health systems of the European Union are a "fundamental part of Europe's social infrastructure"1. The challenges that lie ahead are in reconciling individual needs with the available finances, as the population of Europe ages, as expectations rise, and as medical science advances.
Healthcare expenditure is expected to continue to rise, yet the scope for increases that meet all future demands is limited. In 2000, the health and social services sector was the dominant employment sector of the European Union with more than 15 million people employed – more than 9% of European employment. Its gross value added amounted to almost 500 billion euro – more than 6% of European Union GDP –, topped only by business services with over 513 billion euro.2 The importance of the sector has been growing since the millennium. Looking only at the human health sub-sector, total health expenditure accounted for nearly 9% of GDP in 2004, across the then EU 253 , and is estimated to continue to grow at about 1 percentage point per year faster than GDP4. The scope for increase in demand for more, better, safer, and more timely healthcare, on the other hand, is unlimited.
As a consequence, a key challenge that healthcare systems are facing is optimising the use of resources in order to meet this increasing demand within the budget constraints. Investing in eHealth is often a ‘smart move’ towards meeting this challenge5. An associated challenge is to utilise existing and emerging ICT more effectively, and this also means changing established and valued working and clinical practices.
The EU has for more than 15 years now supported technology-focused research in this field. Examples of results are integrated regional health information networks, standardised electronic health records, reliable and effective telemedicine services, including teleconsultation and home telemonitoring, as well as personal systems for citizens to support and manage their health status. The focus is currently switching to encouraging the transition of research and pilot projects into routine eHealth solutions – a prerequisite for realising the potential of eHealth.
Members States that have moved the new investment in healthcare ICT infrastructure systems from planning stages to implementation are moving their ICT spend from 1% - 1,5% of healthcare expenditure to 2% and above. Countries currently implementing or considering increases in spending on eHealth that may exceed 3% of healthcare expenditure for at least a short period this decade are Denmark, Ireland, and the UK6.
The European eHealth action plan indicates that by 2010, the European Union will be well placed to measure the impact of eHealth in terms of better access, and better, more efficient services as well as on the overall productivity of the healthcare sector; that eHealth will have become commonplace for health professionals, patients and citizens but also that "eHealth will be adequately resourced within healthcare budgets, and contribute to boosting wider objectives, such as competitiveness, jobs and cohesion"7. As part of the action plan itself, there is a commitment for Member States to undertake a collaborative approach to "supporting and boosting investment in eHealth" 8.
The Financing eHealth study focuses on providing insights and specific recommendations aiding the achievement of that goal. This involves analysis of the current financing models and proposals for future financing opportunities that need to be available for eHealth investments to expand. It will also assess their relevance of financing arrangements with respect to the specific needs and optimal allocation of resources. The study results will point out to Member States and the European Commission ways of improving the effectiveness of their strategies and specific financial support arrangements, including the terms, conditions and impacts of funding programmes.
1. "Council Conclusions on Common values and principles in European Union Health Systems", Document (2006/C 146/01), published in the Official Journal of the European Union on 22 June 2006, pp. 1 - 5
2. These are only rough figures due to considerable differences in national statistics on which these data are based.
3. Source: WHO, quoted in: Council of the European Union, MEMO/07/66: Joint Report on Social Protection and Social Inclusion 2007, Brussels, 19th February 2007
4. R. Busse, in The European Journal of Health Economics, Vol. 2, Nr. 4, Dec. 2001, "Expenditure on health care in the EU: making projections for the future based on the past"
5. Results from the European eHealth IMPACT study (www.ehealth-impact.org) show that eHealth has the potential to support the supply side at non-exploding costs.
6. For the UK, the Wanless Report (2002) to HM Treasury “Securing Our Future Health: Taking a Long-Term View” indicates the need for an increase in spending levels from 1.5% to over 3% of total healthcare spending. The report is available at: http://www.hm-treasury.gov.uk/Consultations_and_Legislation/wanless/consult_wanless_final.cfm; The annual NHS Information Management and Technology (IM&T) Investment Survey 2006 (http://www.connectingforhealth.nhs.uk/resources/funding) indicates large increases in capital spending in particular.
7. Commission of the European Communities - COM (2004) 356: Communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions: e-Health - making health care better for European citizens: An action plan for a European e-Health Area, Brussels, 2004-04-30, p.23
8. ibid., p.24
