Congress report - European Health Forum Gastein

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European Health Forum Gastein 2001
The basic ethical question – just how valuable health is to a society has to be put into
perspective, when faced with data from Western states: Within EU – countries the amount of
health expenditure in relation to the GDP varies below 7% in GB and Ireland, to 10% in
Germany and France. Relatively low health expenditure in GB, hardly more for example than
in Hungary, and even lower than in the Czech Republic, have already led in GB to the
political objective of increasing expenditure to Western European average, which according to
the year moves between 8% and 9%, and henceforth put an end to recurring overlong
waiting lists.
On the other hand there is also an upper limit beyond which no further benefit in health-care
can be gained for the population, especially concerning the amount of public health
expenditure. With 8,3% – split into 6% public funding and 2,3% out of private means (the
latter figure showing a steady increase) – Austria is ranking mid-field in Europe. We might
occasionally have the odd bottlenecks in terms of waiting – times, but certainly not in cases
of emergency. But on the other hand, due to stagnation over the years, our present system
has become inflexible, so that necessary adjustments, usually with suggestions regarding
cost – calculation, are not feasible in practical terms.
The ethical question in connection with financing the health care system is also not primarily
how much is being invested, but rather, if all groups of the population have access to each
and individual care, which of course should also be highly comprehensive, as well as of
utmost quality.
In principle we are therefore determining reforms in the health care system on the structural
level. To my knowledge no initiatives are being taken in any countries where social welfare
has a high standard, which are aiming from the start to restrict care, introduce rationing or
plan expenditure-cuts. On the contrary, structural changes and adjustments, as well as
efficiency and better performance of efficiency will have to stem the increase in expenditure.
In highly developed health care systems there will always be a potential for that.
What I want to state is that regardless in which area of the health care system they are
implemented, they must never have any detrimental effects on the patients.
Now lets move to Central-and Eastern Europe, where new challenges are waiting. With the
accession of the applicant countries the present member states of the EU will almost double,
which will have far-reaching consequences not only for medical systems from candidate
states, but also for medical doctors in the present member states. European health
organisations will have to face the fact that the economic situation as well as the health
status of the population in the candidate countries is considerably worse than in the EU.
The share of health care expenditure in the GDP will have to be increased in most of the
candidate countries in order to provide the population with health care systems which
comply with present EU-standards. Medical studies and postgraduate training have to
guarantee quality which meets the requirements of EU standards.
The unfavourable economic situation of medical doctors, together with a low social status in
many candidate countries might cause a migration problem to the prejudice of the EU
member states as well as of the applicant countries.
General and particular solutions on a broad consent have to be found with regard to the
economic and structural conditions to be established in order to provide high quality of
medical care in all of Europe.
I would like to stress the point that Austria will immediately be confronted with the applicant
countries, and not as other EU-countries, after their entry. These countries are already our
neighbours and, regardless of Eastern expansion they have to be accepted as full partners.
International Forum Gastein, Tauernplatz 1, A-5630 Bad Hofgastein
Tel.: +43 (6432) 7110-70, Fax: Ext. 71, e-mail: info@ehfg.org, website: www.ehfg.org