European Health Union to Srtike the Balance between Free Movement of Health Workforce and Universal Health Coverage
The health and care workforce is at the centre of health policy debates. Focus on healthcare professionals was especially strong during the peak phase of the COVID-19 pandemic. The participants of the Conference on the Future of Europe (CoFoE) that ran from April 2021 to May 2022 discussed how to reinforce the resilience and quality of member states healthcare systems guaranteeing equal access to healthcare in all MS and what should be done in this area at EU level.
Vytenis Povilas Andriukaitis is the Former Commissioner of Health and Food Safety of the EU between 2014 and 2019.
Inequalities in health across the EU, that is partially caused by uneven allocation of medical personnel, are striking. The importance of European health policy strengthening (not excluding the upgrading of European Treaties) is reflected in the conclusions of CoFoE. By presenting on September 2022 a report “Health and care workforce in Europe: time to act” the WHO Regional Office for Europe acknowledges the Europe-wide importance of issues related to health personnel.
Training, recruitment and retainment of health personnel are in the domain of national policies but the issue has regional and even global components. The complex interaction of national and international actions in the development of the healthcare workforce was discussed on the 30th of November 2022 on the premises of the European Parliament. The main objective of the conference was to identify how to balance the free movement of workers as a fundamental principle of the European internal market with the assurance that equitable accessibility of health services will be provided across all European regions including those of workforce source countries and to discuss the policies, strategies and actions that most meaningfully contribute to the solution of the existing health and care workforce-related problems on national and European levels. The European Institute for Health and Sustainable Development (EIHSD) together with the Foundation of European Progressive Studies (FEPS) and the Members of the European Parliament organised the conference.
Speakers of the conference: Vytenis Andriukaitis (EIHSD), Giorgio Cometto (WHO), Corrine Hinlopen (Wemos), Maren Hopfe (ILO), Christopher Fearne (Government of Malta), Juozas Olekas (EP) Maria João Rodrigues (FEPS), Nicolas Schmit (EC), Tomas Zapata (WHO), Tiemo Wölker (EP). Moderators: Mathias Wismar (European Observatory on Health Systems and Policies), Mariam Zaidi (Euractiv)
- Shortage of health personnel especially in primary health care, long-term care, rehabilitation, rural, remote, and poor urban zones. In the EU a lot of countries are not able to assure accessibility of doctors and even nursing services in remote areas, including reach countries like Italy, France or Sweden;
- Shortage of health personnel aggravation because of the lack of protective equipment, overwork and additional stress caused by COVID-19;
- Skills mismatches, inefficient organisation of work, inadequate governance;
- Improper working conditions in health such as too long working hours, underfunding, shift work, nonregulated work of informal carers
- Striking variation in medical doctor availability between countries that ranges from 17,3 to 88,7 and in nurses from 27 to 202 by 10000 population;
- Ageing of medical professionals. In one out of three European countries, 40+ percent of doctors are over 55 years of age. Young people are lacking interest in medical professions;
- Most of the health workforce are women, thus general problems of gender equality are reflected in the health sector;
- Free movement of people is the asset of the EU but it can’t undermine equal access to health services for European citizens. The certain contradictions between the two create preconditions for a political storm. Competition between MS for the best resources do not help to reduce the problem and to assure equal access to health services across the EU;
- Non-regulated international mobility of the healthcare workforce has certain characteristics of brain drain from source countries or even waste of health resources (if investment into training by source countries is wasted by employment in destination countries below acquired qualifications). Qualified nurses from Eastern and Southern Europe working just as babysitters or carers in families of more affluent countries equals to brain waste for the European Union.
- Challenges the EU is facing because of international migration of the healthcare workforce mirror those on the global stage. WHO Global Code of Practice on the International Recruitment of Health Personnel (2010) is the key instrument of international governance of health workforce migration (HWM). For more than a decade design and execution of bilateral agreements on international HWM is contributing to achieving win-win results for the source and destination countries even if it is not common for Ministries of Health to be involved in HWM. A guidebook on HWC is one of the promising avenues for the growing role of the Code.
- The European Pillar of Social Rights (2017). The Pillar jointly proclaimed by the main EU institutions During the Gothenburg Social Summit sets out 20 key principles guiding the EU towards a strong social Europe. Four of these principals are explicitly stressing the importance of health. The 16th principle of the Pillar (health care) states that ‘Everyone has the right to timely access to affordable, preventive and curative health care of good quality’. European health policy is gradually evolving even in circumstances then the EU has no competencies to legislate on health matters related to the health workforce.
- European health systems survived COVID due to the dedication of health professionals. Doctors, nurses, and carers are central workers in European economies. The fact that during the pandemic MS and EC acted together, even in the fields with no clear competencies of the EU, was of critical importance. European health policy is gradually evolving even in circumstances then the EU has no competencies to legislate on health matters related to the health workforce. Now the understanding that the resilience of health care systems is one of long-term goals for the EU prevails in the discussions between all political groups of European Parliament.
- The pandemic exposed problems of health systems like underinvestment, extortion/burnouts of health personnel, undervalued and underpaid work of nurses. And in this situation, a European Care Strategy (2022) is an example of how the EU starts acting for better health and tackling problems in this sector.
- Challenges to sustainability of healthcare workforce should be addressed locally and also at EU level. Specific combinations of policies are needed for the training, recruitment and retaining of medical personnel. Training of medical professionals may be one of the pillars of a European Health Union;
Agreement on having decent health as one of the social rights of Europeans requires that the scoup and the quality of services should be comparable across the EU;
- Health should be an important part of the European Semester and should be strongly presented in European upskilling policies. Free movement of people should not be a way for the rich to have everything at expense of the less affluent;
- Stronger European actions are needed in medical research and development of orphan and personalised medicines as well as the management of rare diseases and rare cancers;
Working conditions and payment of health personnel have to be upgraded across the EU, mobility of health personnel should be organised in a more cooperative way, and training of health and care personnel should be as high on the priority list of MS and the EU.
- Inequalities in health across the EU are striking and the scope of those challenges require bold actions. Mapping of medical deserts indicates correlation between inequalities in health and dissatisfaction with European project. Politicians should be encouraged to act by the fact that health is high among the priorities of Europeans.
- One way is to tackle personnel imbalances by measures based on existing legal instruments. Another one is to fine-tune existing instruments in parallel to the development of secondary legislation and institutional capacities. The most radical way to reform European health policy is to strengthen the status of the European Health Union with provisions for a European Health Union incorporated into the Treaty on the European Union, giving the EU shared competencies in very concrete areas while preserving the principle of subsidiarity as a core;
- Today health is at the level of supporting competencies of the EU, but, according to the opinion of speakers that promotes radical reforms, it has to be upgraded to the level of shared competencies between the EU and MS.
European Union is evolving. Some of the developments already pre-agreed by MS (for example, the accession of Balkan states, Georgia, Moldova, and Ukraine) will require the Treaty changes. Accelerating the debates related to Treaty changes and European health policy is in the interest of the medical community, patients, the European Project.