National Competences in the EU
The principle of subsidiarity in public health in the EU stipulating that every Member State organises health care of its citizens by itself and common action via EU institutions are no contradiction. Moreover, they complement each other in a reasonable way with the aim to ensure comprehensive, sustainable and at the same time economic health care in Europe.
Because of the diverging national health systems in Europe, the EU has with good reason agreed on the principle of subsidiarity in the Treaty of Amsterdam. According to this principle, the EU ensures a high level of health protection and combats cross-border threats to health, whereas the Member States are responsible for the organisation of their national health systems and the delivery of medical care for their populations.
The EU ensures comprehensive protection of health
One example of the importance of the EU for the promotion of public health is the establishment of the ‘European Medicines Agency’ (EMA). It is justly considered a big landmark in the development of public health in Europe. The European ‘Health Technology Assessment’ (HTA) process could emerge as a further landmark for the assessment of the effectiveness of new medicinal products.
In addition, the EU may further contribute to the sustainable and economical supply of medicines. It can and should create an innovation and competition friendly climate in which the manufacturers of innovative products, biotechnological medicines (so-called biologics or biosimilars), generics and herbal medicines strive for individually tailored and comprehensive care for patients. The greater the variety of medicinal products, the more intense competition for best care will be.
Member States must take national particularities into account
The Member States of the EU pursue divergent approaches to pricing, models for rebates and discounts and for the reimbursement of health services. Average net incomes as well as purchasing power parities also differ to a great extent. Furthermore, the supply structures as well as financing and assessment of health services have historically developed in different directions. With this background, a sound comparison of the prices of medicinal products in Europe is neither possible nor deemed politically desirable. Attempts to create comparability of the prices of medicinal products via European price data bases, as for example EURIPID, are not promising and negate economic reality in Europe.
The value of medicinal products is multidimensional. For the constitution of reimbursement prices, different costs of hospitalisations, chronifications and work losses should be taken into account. This can however only be achieved close to market and tailored to the individual patient. It further requires adequate consideration of the surroundings in terms of social security systems and economic framework conditions in the respective country.
Future-oriented health care in Europe will not work without robust pharmaceutical manufacturers committed to innovation and investment. Only those manufacturers which are economically successful can achieve improvements of therapy for the benefit of patients.
Bringing this to success requires reasonable work sharing of the Member States and the EU with its respective competences.