BRUSSELS, April 14 (APM) - The European drug industry's strategists are leveraging general budget guidance from the European Union to reinforce their arguments that healthcare should be evaluated in terms of its outcomes rather than just its inputs.
"More granular and disease-specific health outcomes data, linked to particular interventions within the healthcare system, are needed in order to identify potential inefficiencies and analyse which interventions bring the most value to patients," says EFPIA.
The industry federation has volunteered its own health-focused view of the EU's annual provision of advice to member states on how they fix their public spending budgets - the so-called European semester (APMMA 50789).
EFPIA gives a lengthy welcome to the most recent step in the 2017 semester process: the recent publication of individual country reports on the member states' spending programmes.
But it pounces on the fact that these reports draw attention to under-funded healthcare systems, poor healthcare coverage and limited access to healthcare services and pharmaceuticals.
These findings, says EFPIA in its comments dated April 10, "should lead to important discussions around healthcare reform in the EU member states that improves health outcomes of patients."
Since last year, EFPIA has been advocating a shift towards outcomes measurement in evaluating the effectiveness of healthcare systems, claiming that expensive innovations in therapy can lead to overall savings when the criteria include outcomes for the healthcare system as a whole, rather than just the cost of a drug.
Because the country reports relate principally to fiscal sustainability and cost containment, EFPIA brings its own emphasis to the discussion, by urging the EU to give clearer advice on increasing the efficiency of healthcare.
"The country reports still to a large extent build on various fiscal, structural and process indicators (such as access to healthcare), whereas data on health outcomes are limited to a few macro-level indicators (such as overall life expectancy and preventable mortality)," says EFPIA.
It criticises the EU reports for consistently referring to expenditure on pharmaceuticals "as a cost only, without any reflection on the value they bring to patients, healthcare systems and societies."
This approach, EFPIA goes on, means that "in many countries the full benefit of innovative pharmaceuticals for patients and the larger system is difficult to realise because of short-term cost-containment measures and silo budgeting."
Instead, the EU should recognise the limitations of a focus just on costs when assessing the financial sustainability of healthcare systems. "A health system can, in theory, provide low and unequal access to healthcare, with poor health outcomes as a result, and still be financially sustainable," EFPIA points out sardonically.
The solution "cannot be cost-containment, but to increase health expenditure on interventions that bring the most value for money, and implement more effective and comprehensive resource allocation," it adds.
The drug analysis of the EU reports cites an "illustrative example" in Romania, where the EU says that "continuous overspending of the budget on pharmaceuticals constrains the introduction of innovative medicines."
For EFPIA, the analysis is flawed. "The problem here is clearly not that Romania spends too much on pharmaceuticals, but that the pharmaceutical budget is underfunded, which impedes the introduction of innovative medicines which could bring substantial value for patients and the broader health system."
It says the EU should recommend that all member states should implement systems for assessing the performance of health systems, "with a strong focus on health outcomes measurements".
The country reports show that Bulgaria, the Czech Republic, Croatia, Hungary, Latvia, Malta, Romania, Slovenia and Slovakia have healthcare expenditure below or much below the EU average.
They also reveal that most of these countries - as well as Estonia, Lithuania and Poland - have poor health outcomes.
High out-of-pocket expenditure can be a barrier to access to healthcare and medicines and lead to inequalities, including in Lithuania, Latvia and Bulgaria, note the reports.
They point to over-use of hospital and specialist care, and to the need for strengthened primary care, increased care coordination and alignment of financial incentives to health outcomes rather than to procedures.
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