MEP Pietikainen: ‘Only A Long-Term Vision Can Ensure Sustainable Investment in Health’

MEP Sirpa Pietikainen (EPP, Finland) is one of the 5 champion MEPs of the EPF Campaign on Access to Healthcare. A member of the Committee on Economic and Monetary Affairs at the European Parliament, Mrs Pietikainen supports our work on sustainable investment in healthcare across the EU. 

Why have you decided to become a champion of the EPF campaign? 

The right to the “highest attainable standard of health” is enshrined in international agreements.

At the same time, the World Health Organisation estimates that about 86% of deaths in the European Region are due to non-communicable diseases, such as diabetes, cardiovascular diseases, cancer, chronic respiratory diseases and mental disorders.

As access to timely, acceptable, and affordable health care is a fundamental human right, it must be ensured for all our citizens. Making sure that fundamental human rights are fulfilled can never be an issue of subsidiarity. Therefore, it is something that the European Union has the responsibility to guarantee. 

Are you aware of specific gaps or barriers that patients are facing in accessing healthcare in your home country Finland?

Due to insufficient resources, not enough investment is made into preventive care and progressive health.

As per their original objective, our health centres should be counselling places, where healthy lifestyles would be promoted and advanced systematically. Currently, there are gaps in active health monitoring through a life-cycle approach from birth to death, and active health promotion does not systematically take place. When resources are stretched thinly, this objective cannot be fulfilled. 

Particularly for elderly people, accessing health services in scarcely populated areas is challenging. Also, the smaller the country is, the less resources there are for rare diseases. 

This gap in resources with the consequences described above does not exist only in Finland but in all EU Member States.

Within the campaign, you champion the action area on committing to sustainable investment in health. Why does this topic matter to you? Why is it important that health programmes and public health receive adequate and sustainable investment and resources from Member States?  

I would note three reasons here:

Firstly, because access to health is a fundamental human right, which must be guaranteed to everyone.

Secondly, investing in health prevention and early diagnosis is always cheaper than treating diseases.

Thirdly, it is important to make upfront investments to improve health, both prevention and care, with emerging innovations and opportunities provided, such as eHealth. Ultimately this allows for better quality, patient-oriented health care which is more cost-effective. 

Do you see a role for prevention measures in saving and releasing resources to provide healthcare to patients? 

Several research studies have shown that prevention and improved control of noncommunicable diseases would have a positive economic impact on society.

Prevention should and is becoming a global trend. It is also an issue of equality. Population-level health promotion and disease prevention as well as effective treatment and care have been identified as effective prevention strategies to reduce the disease burden of noncommunicable diseases.

From a point of cost-effectiveness, we should substantially increase our focus on prevention.

It has been demonstrated that effective health spending helps increase the economy’s productivity, for instance by enabling people to remain active and working longer. However, decision-makers sometimes only see the initial cost (investment), and possibly the short-term impact of measures. How do we change the focus of decision-makers from short-sighted focus on costs to a real commitment to a long-term vision of health as a sustainable investment where equity of access is a priority?  

I agree. Several global studies and discussions on European Member States health economics have emphasised this point. This has been understood within the framework of active health promotion, not just responding to disease. 

We need to identify ways to effectively communicate this to decision-makers.

We need a change in policy which would initially require a double-investment. This makes it difficult for policy-makers to implement. While we cannot cut the budget for emergency health and long-term care for patients, we need to make a significant investment into prevention. However, a large number of patients will continue to exist over some time. So, at the same time as we continue to care for these persons, we would need to simultaneously invest in prevention. We would only see the results of the investment into prevention after several years, even decades, when the number of patients needing care for example for noncommunicable diseases would decrease. 

On the longer-term, this would be more resource-efficient. However, politicians are under acute pressure not to cut from immediate needs in order to invest into longer-term results. In the meantime, without preventive measures, the total number of patients and cases of diseases will continue to rise.

According to the OECD report ‘Tackling Wasteful Spending on Health’, a considerable part of health spending makes little to no contribution to improving people’s health. The report identifies many sources of waste (e.g.: avoidable patient safety incidents, low levels of generic medicines use, unnecessary antimicrobial prescriptions, etc.). What should Member States do to reduce this waste? Could innovative measures, including the use of technology help? 

Indeed, eHealth can be a way to increase efficiency. I believe up to 75% of health services could be brought home such as diagnosis or follow-up, or alteration of medication. However, this will not happen automatically. eHealth services must be designed together with those who use them, including those for whom adopting new technology may be the hardest. There shouldn’t be separate design processes for eHealth technology for mainstream and for more vulnerable people such as potentially elderly or disabled. All technology should be designed to be accessible to all, with lots of choices for its personalisation according to real patient needs. This requires big investments. 

However, using resources at the European level could reduce the total amount of resource-demand. For example, cooperation and sharing of best practices on rare diseases should be advanced so there would be one joint knowledge pool accessible throughout Europe. 

A broad strategy should also be adopted to address challenges such as antibiotic resistance, which is not just linked to treatment of humans but also to animal health, and the status of our water and food. 

Non-communicable diseases (NCDs) are a huge cost for society. This has been recognised in the multiple UN resolutions to address this challenge in the last over 15 years, including the UN General Assembly declaration on prevention & control of non-communicable diseases in 2011. The Sustainable Development Goals include several targets on NDCs including reducing by one third premature mortality from NCDs, achieving universal health coverage and providing affordable essential medicines and vaccines for NDCs. EU Member States and the Commission work together to respond to the challenge posed by NDCs focusing on targeted health promotion, prevention and early diagnosis. 

The Commission should develop a Work Programme and EU-level legislative framework for advancing this work, as not all Member States have the willingness or capacity to develop it individually. Addressing non-communicable diseases should be approached with common EU action, just like good economic policy, with relevant monitoring, assessments and follow-up, as this is an issue with major economic significance. 

One way to guarantee sustainable investment in health is to stop undue cuts in the healthcare budget and ensure that resources are employed effectively and efficiently. Would you agree? How can we ensure that the scarce resources are employed and allocated adequately? And what does sustainable investment look like to you? 

We need to maintain the level of emergency and long-term care and treatment, while at the same time investing into prevention and health promotion. This is an efficient ways of spending resources.

I also think the level of investment into health care should be monitored as part of the European semester, to assess whether they are on made a sustainable basis, with a long-term approach.

In our recent reports on access to healthcare and on patients’ perceptions of quality in healthcare, many patients highlighted the importance of a sufficient (in quality and quantity), well-trained and motivated health workforce to improve access to and the quality of care. Shortages of professionals pose significant challenges to EU member states. How would you recommend we ensure sustainable investment in the health workforce?

Training of health care workers should be promoted. European standards should be developed for the training.

eHealth offers possibilities for cost-efficient sharing of knowledge and expertise within the EU amongst health care professionals. A European-wide network of health care professionals could be developed for consultation on complex issues, turning to countries where understanding and policy on specific diseases has been furthest developed. European centres for exchange of best practice could also operate virtually.

Any final message for our readers?

Currently health care and treatment is still managed in a manner that is too top-down. The rights of patients in this context still need to be developed further, including a right to second-opinion and right to quality of care.

Another thing that requires further investment at the European level is the development of efficacy of care and patient outcome assessments. The current method is to always initiate treatment with the cheapest form of medication and to minimise the initial number of laboratory examinations. However, in certain cases, such as for patients whose underlying condition is poor, by the time they are prescribed more developed, effective, and also more expensive treatment the patient’s overall condition may be so weak that the treatment will not be efficient. In other cases, patients showing uncertain symptoms are required to visit a health centre numerous times before the underlying condition of shown symptoms is revealed. This means that the diagnosis is delayed and health care centre appointments are booked. More thoughts should be put into the overall assessment of efficacy of care for best patient outcome at the EU level with respect to early, rapid diagnosis and care, in order to look at such health care challenges in a more holistic way.