Understanding challenges as opportunities

The health systems across Europe are facing similar challenges owing to demographic change and increasing expenditure. Solutions to these challenges can be found relatively easily using suitable strategies, according to European experts.

The health systems in Europe may have very different structures, but they face similar challenges: the rising proportion of elderly people among the total population, the growing demand for health services, staff shortages and increasing costs. What can be done to cope with these challenges and develop sustainable health systems?

Portrait of Jennifer Dixon, Chief Executive of The Health Foundation
Jennifer Dixon, Photo: The Health Foundation

“Healthcare costs are increasing more rapidly than the gross domestic product in all European countries. There’s huge room to improve efficiency in the National Health Service of the United Kingdom, as well as prevention of ill health and promotion of wellbeing. The biggest impact on our health are from factors unrelated to health care”, remarks Jennifer Dixon, Chief Executive of The Health Foundation. This independent British institution contributes to better healthcare, more effective policy strategies and ultimately a healthier population in the United Kingdom (UK) using research, strategic analyses and grant giving.

Healthcare costs are increasing more rapidly than the gross domestic product in all European countries.


Worthwhile investments

According to the experts interviewed by “Healthy Europe”, greater cost efficiency should be achieved above all by an improved allocation of resources. This means that the existing resources should be utilised particularly in those areas of the health system where the best effects are anticipated. These can be expected especially in primary care and also through increased health promotion and prevention. “The return on investment due to health-promoting or preventative measures amounts to 1:18. In other words, every euro that is invested can produce a productivity gain of 18 euros,” states Josep Figueras, Director of the European Observatory on Health Systems and Policies with headquarters in Brussels, which is celebrating its 20th anniversary this year (see also box: “Celebrating 20 years”).

Portrait of Josep Figueras, Director of European Observatory on Health Systems and Policies
Josep Figueras, Photo: Eureopean Observatory on Health Systems and Policies

He also points out that currently around 20 per cent of the resources in the health systems is wasted, for example due to unnecessary treatments. Nevertheless, it is not just the expenditure that should be at the forefront of considerations when it comes to the health systems, emphasises Josep Figueras: “Investment in health is investment in the future. It ultimately enables better health among the population and economies that are more productive. We need to communicate this even better to the decision-makers in Europe.”

The return on investment due to health-promoting or preventative measures amounts to 1:18.


A greater number of years in good health

Portrait of Pamela Rendi-Wagner,
Member of the Austrian Parliament
Pamela Rendi-Wagner, Photo: Parlamentsdirektion/Simonis

“A sustainable health system must be able to do more than just deal economically with the existing resources,” emphasises Member of the Austrian Parliament Pamela Rendi-Wagner. She adds: “It should be measured by its results, and the most important aspect is to increase the number of years that we enjoy in good health.” In accordance with the concept “Health in All Policies”, this is a challenge that concerns not just the health system, but all social areas: “Here too, it is a matter of whether people live in conditions that enable them to enjoy fairer health opportunities. This begins with how we develop childcare facilities and schools, through to working conditions and the living situation of older and very old people.”

A sustainable health system should be measured by its results.


With respect to the health system itself, “integrated care” aims to increase quality. The sub-areas – from the surgery of an individual doctor through to a large rehabilitation centre – should be better coordinated and geared to one another. The “case managers” could have a key function here, accompanying patients on their journey through the health system and thus generating greater efficiency. This would also prevent diagnoses and therapies occurring several times.

Increased cooperation between health professionals is also desirable. Multi-disciplinary teams consisting of doctors, nurses, patients, administration staff and other health professionals can often solve problems rapidly and easily in everyday working lives. “Models for quality management could be adopted from industry, such as the ‘big room’,” remarks Jennifer Dixon. This format for regular multi-disciplinary meetings originates from the automobile industry. It was adopted by a Sheffield Trust hospital in England and proved such a success there that it is now practised by several other hospitals in the UK as well.

Patient-focused health systems

Taking the experiences of patients into better consideration is also regarded as an important step towards greater sustainability. This should make the health systems simpler to use and make them more transparent, and better designed to meet the needs of users overall. “It is a matter of empowering the patients, not just seeing them as observers of their own healing process, but as experts for their own health,” says Pamela Rendi-Wagner. This in turn can act as a basis for “shared decision-making”. Using well-founded information, patients should discuss with health professionals to decide which therapy is probably the best for them personally.

Inclusion is a criterion

Josep Figueras describes “inclusion” as a further criterion of a sustainable health system. It must be accessible and useable by all people to the same extent. “Equality is a core value of European countries, and inclusive societies are ultimately more efficient, too,” says the health systems expert: “If we do not take this into account, we will pay a high price in the form of poverty, disease, unemployment and other negative consequences.”

Inclusion is an ambitious goal, and a high degree of dedication is necessary to deal with the challenges that now face the health systems in the European countries as a whole. “However, we must see the challenges in healthcare for the population as opportunities. Then we will succeed in achieving sustainable health systems and secure the best possible treatment for all patients,” summarises Josep Figueras.


The European Observatory on Health Systems and Policies was founded in 1998 on the initiative of the World Health Organization (WHO). Its purpose is to collect and analyse existing data on health systems and make this comparable, and also to enable this to serve as the basis for developing them further. “We prepare the information where there is an actual need, in a manner which makes it easily useable for decision-makers,” explains Josep Figueras, who has been Director of the European Observatory on Health Systems and Policies since the outset. Initially with a team consisting of four colleagues, 30 experts are now employed at the Observatory, which is headquartered in Brussels. A network structure enables cooperation with around 650 further experts. The European Observatory on Health Systems and Policies is based on a strong partnership of international agencies, national governments, decentralised authorities and research institutes. Today it is regarded as one of the leading international knowledge brokers in this field.