This article gives a brief overview of health-related developments, activities and events in the EU’s economic governance framework that have taken place over recent weeks.
Following the sovereign debt crisis and economic recession in Europe, the EU established new powers of coordination and oversight in the fiscal and macroeconomic policies of its Member States. This framework provides for both direct inclusion of measures relating to health and indirect impact upon health through other policies. EPHA tracks the inclusion of health in the economic governance framework and works towards the greater inclusion of civil society organisations and health stakeholders in the relevant processes. An overview of the issue and EPHA’s position can be found here and you can follow developments via the ‘Health in economic governance’ mini-series updates, available at www.epha.org and tagged ‘health in economic governance’.
On 28 November the European Commission presented the Autumn 2014 economic governance package. This includes five elements:
- The 2015 Annual Growth Survey (AGS)
The 2015 AGS again highlighted the need for a structural reform to health systems, but made fewer specific references to health-related measures than in previous years, instead focusing upon the planned review of the European Semester. A full analysis of the 2015 AGS can be found here.
- The Alert Mechanism Report (AMR)
The AMR is a screening process carried out by the Commission to detect early warning signs of potential risks to the European economy. It uses a scoreboard of indicators, measuring house prices, government debt, unemployment and a range of other factors, to identify any weaknesses or concerning trends within Member State economies. As a result of the 2015 AMR, 16 Member States are now subject to In-Depth Reviews, which will further examine the issues highlighted and feed recommendations into the Country Specific Recommendations (CSRs) in the spring. The 2015 AMR does not make reference to any specific health system concerns, but draws upon data on long-term care and demographic change in its evaluation of government deficits and public expenditure.
- The Joint Employment Report (JER)
The JER measures social and employment trends and contains the scoreboard of employment and social indicators. This year’s Report notes some improvement in employment rates, but warns that poverty and social exclusion remain rife, particularly affecting children and those in vulnerable situations. As EPHA noted in its open letter to ministers of health last month, however, a true assessment of the social dimension of economic policies requires a heath indicator, as well as measures of child poverty and homelessness.
- The review of the Six Pack and Two Pack legislation
The Six Pack and Two Pack legislation is made up of seven regulations which set out the EU’s framework for oversight and monitoring of Member States’ fiscal and economic policy. It includes provisions for the Macroeconomic Imbalance Procedure (MIP), Excessive Imbalance Procedure (EIP) and fiscal surveillance. Of particular interest for health, the review notes the value of the scoreboard used in the AMR but emphasises that, in order to maintain its effectiveness, this should be reviewed and revised on a regular basis, leaving scope for the potential addition of new indicators. It concludes more generally, that the system is serving its objectives relatively well, but that room for improvement in the transparency and complexity of the process remains.
- The Commission’s opinions on the draft budgets of euro area countries.
The countries of the euro area are required to participate in more stringent oversight and surveillance mechanisms and each October submit their draft budgetary plan (DBRs) to the Commission for review. EPHA’s analysis of this year’s DBRs can be found here. At the end of November the Commission published its opinions on the plans, deeming seven countries to be at risk of non-compliance with their obligations under the Stability and Growth Pact (SGP). Among these Member States, Malta is specifically urged to accelerate planned reforms to improve the financial sustainability of its healthcare system. Though none of the other six countries receive recommendations which target health directly, their precarious fiscal situation makes it likely that planned reforms and expenditure reduction measures will be pushed ahead as soon as possible. This is particularly true for France, Belgium and Italy, which face ‘corrective measures’ under the Excessive Deficit Procedure if they are not able to demonstrate sufficient progress.
The mid-term review of the Europe 2020 Strategy has continued to dominate meetings of the European institutions, with several committees and configurations exchanging views and issuing opinions on the process in recent weeks. Ahead of a meeting of the EPSCO (Employment, Social Affairs, Health and Consumer) Council on 1 December, the Italian Presidency issued a note encouraging health ministers to engage in the review and providing a set of questions for a discussion on the role of health in achieving the objectives of the Strategy. Whilst the Council embraced this opportunity and highlighted the value of investing in health for growth and employment, they failed to introduce a headline target for health, preferring to maintain a system of information and best practice exchange. Meanwhile the ECOFIN (Economic and Financial Affairs) Council met on 9 December and following a brief discussion of the Europe 2020 Review confirmed that it will submit a report to the General Affairs Council meeting on 16 December, to inform discussions with the Commission. It also noted that the European Council will assess the implementation of the 2014 CSRs ahead of a meeting in March 2015.
In the Parliament, the ECON (Economic and Monetary Affairs) and EMPL (Employment and Social Affairs) Committees held a joint exchange of views with Commissioners on the Europe 2020 Review, the Six and Two Pack legislation review and the Commission’s opinions on the draft budgetary reports. Meanwhile, the ENVI (Environment, Public Health and Food Safety) Committee discussed on 3 December a draft opinion by rapporteur MEP Giorgos Grammatikakis (S&D) on the 2015 AGS. The draft opinion suggests just six amendments to the ECON Committee text, adding reference to sustainable development, climate goals and the waste framework, as well as stating that ‘the European Semester should be a tool for safeguarding high quality and efficiency in national health systems’.
Finally, on 3 December MEPs Jean Lambert (Greens/EFA) and Marian Harkin (ALDE) hosted a hearing in the European Parliament with the Semester Alliance, a group of NGOs campaigning for a democratic, social and sustainable European Semester. The event focused upon the role of civil society in the Semester and speakers reiterated the importance of ensuring that social partners, trade unions, civil society organisations and beneficiaries are productively involved in the process.
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