EU Country Specific Recommendations for health systems in the European Semester process: Trends, discourse and predictors

Abstract

In the framework of "Europe 2020", European Union Member States are subject to a new system of economic monitoring and governance known as the European Semester. This paper seeks to analyse the way in which national health systems are being influenced by EU institutions through the European Semester. A content analysis of the Country Specific Recommendations (CSRs) for the years 2011, 2012, 2013 and 2014 was carried out. This confirmed an increasing trend for health systems to feature in CSRs which tend to be framed in the discourse on sustainability of public finances rather than that of social inclusion with a predominant focus on the policy objective of sustainability. The likelihood of obtaining a health CSRs was tested against a series of financial health system performance indicators and general government finance indicators. The odds ratio of obtaining a health CSR increased slightly with the increase in level of general Government debt, with an OR 1.02 (CI: 1.01, 1.03; p=0.007) and decreased with an increased public health expenditure/total health expenditure ratio, with an OR 0.89 (CI: 0.84, 0.96; p=0.001). The European Semester process is a relatively new process that is influencing health systems in the European Union. The effect of this process on health systems merits further attention. Health stakeholders should seek to engage more closely with this process which if steered appropriately could also present opportunities for health system reform.

Towards Stronger EU Governance of Health Threats after the COVID-19 Pandemic

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“…With regard to the task of establishing monitoring and evaluation structures, some respondents perceived the status of the EU health information system rather as a failure. This corresponds to observations in the literature indicating that although ground work such as the development of a common EU health indicator set is acknowledged [50,51] further efforts are needed to implement and maintain health indicators [51] and to develop a permanent and sustainable EU public health monitoring and reporting infrastructure that supports decision making in public health on EU level [50,51]. Respondents agreed that cooperation in the area of public health between member state representatives and experts as well as with other stakeholder groups has increased and has been facilitated by the EU through various projects, networks, forums, and platforms.…”

“…• 51,52 For the development of effective, accessible and resilient health systems and the formulation of respective recommendations factual knowledge on the status of population health and health system performance should be the basis. …”

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