European Health Systems Reform

This is the lastest edition of the Stockholm Network’s Health and Welfare newsletter, Gesungheit!

It is a great publication that I strongly recommend that you read. It is also worth having a look at the first edition, in which I wrote on “Should Government’s have a role to play in patient care?”


Leading pan-European think tank, the Stockholm Network, welcomes the European Commission’s draft directive on patient mobility.

The Network’s CEO and healthcare specialist, Helen Disney said:

“This plan from Brussels will help to save the NHS from itself. It is only when British patients are empowered to choose from the widest possible range of healthcare providers that value for money and patient satisfaction will be met. All too often our state hospitals are filthy, our patients neglected and our waiting lists dangerously slow. However sceptical of Brussels voters may be, British people will sign up to this opportunity in their millions.”


Stockholm Network research, based on public attitudes to healthcare reform published in Impatient for Change and Poles Apart, argues strongly in favour of an integrated health service market. Such a development will benefit patients by revealing weaknesses in national systems, as health consumers begin travelling abroad to get the treatment their home country denies them or can only offer them after long waiting times and at an inferior standard.

Research carried out by Populus for the Stockholm Network, asked Europeans whether they would be willing to travel abroad for treatment if their healthcare system paid for it. The poll was carried out in eight different European countries, including the UK, and from a variety of different age ranges.

The findings showed unequivocally that waiting for treatment is now a key political concern in Europe with 83% of Europeans regarding waiting times as important to good quality healthcare, but only 26% rating their respective health services as good in this regard.

Younger generations displayed a markedly higher willingness to travel abroad for treatment, as long as treatment was paid for by their health system. In Spain 80% of people from the 15 – 24 age group, would be prepared to travel, versus 35% from the 55 – 64 year age range.

Only older people and citizens in France and Germany are hesitant about the concept of going abroad for treatment, perhaps because their systems have previously not suffered the long waiting lists common to other countries such as the UK.

I have been away on holiday which is why I have been late in highlighting this article.

It features a report from the Health Consumer PowerHouse, an excellent group run by Johan Hjertqvist.

Johan and his team do a fantasitc job in comparing European health systems.  They are the leading organisation providing consumer information on health care, aiming to turn european patients in to powerful consumers of healthcare services.

As you can see from the article, the NHS was placed 17th out of 29 countries, lagging behind not only it’s northern european neighbours but also some former soviet block countries.  Not bad I supposed if you remember that William Beveridge, the architect of the NHS,  claimed that he would take us “…half way to Moscow…” !

In recent days I have spent some time in Central and Eastern Europe. Across the region private healthcare is growing on the back of an ever expanding middle class. After decades of huge Socialist-era failure the whole region is beginning to see a burgeoning range of private health options and brands emerge.

Indeed, I was fascinated to learn that following the manifest failings of the Slovak Republic’s state healthcare system, a system that had all the historic failures of the UK’s NHS, citizens have now been given the opportunity to insure and self fund for key elements of their healthcare.

A law passed in early 2003 means that healthcare providers can now charge Sk 20 per doctor visit, Sk 20 per drug prescription, Sk 20 per kilometre travelled in an ambulance, and Sk 50 per day spent in hospital. While patients continue to receive some medications ‘free of charge’ – many can now be purchased privately.

While Slovakia has more than a hundred hospitals and mental health centres I found it nevertheless unfortunate that private companies are still precluded from obtaining a majority stake in larger hospitals. As a consequence the private sector in provision is unnecessarily limited – for the time being at least – to primary care and the smaller hospitals.


The great thing about Slovakia is that having introduced a range of radical market reforms across several areas of activity – of which healthcare is simply one – the economy is now set to grow at more than 8 per cent a year. Having introduced a highly competitive flat tax regime of just 19 per cent, the country looks to be well on the road to prosperity.

Unlike many state health systems in Western Europe (the UK, Spain and Italy), Slovakia looks as if it is well on the road to developing a sustainable health market that is rooted in the principles of consumer led quality.