The Communication recommends to Member States, which have primary responsibility for their health systems, that they:

• Strengthen effectiveness, keeping in mind that the first objective of a health system is to improve the health of the population. This can be done through applying performance assessment results, ensuring safety and quality of care for patients, and developing an integrated approach to care so as to avoid over reliance on hospitals.

• Increase accessibility, so that health systems provide healthcare services to the whole population. This result can be achieved through better planning of the health workforce and a more effective use of medicines. Furthermore, the Directive on cross-border care will provide increased transparency, and better affordability and availability of care.

• Improve resilience, so health systems are capable of adapting to changing environments and identifying innovative solutions. This capacity can be strengthened by choosing more effective and efficient treatments which respond to patients’ needs. Of equal importance is building efficient information flows and innovative Information and Communication Technologies in health.

Why now? : Timeline of the Communication

Some milestones that have paved the way for the Communication are:

• 2006: Member States agree on common values and principles of the health systems of the European Union.

• 2011: Adoption of Directive 2011/24 on patients’ rights in cross-border healthcare.

• 2011: The Council of Health Ministers establishes an EU-level reflection process to help Member States provide modern, responsive and sustainable health systems.

• 2013: In December, the Council of Health Ministers endorses the progress made and calls for further work in this area in its conclusions on the ’reflection process on modern, responsive and sustainable health systems’.

• 2014: The Annual Growth Survey emphasizes the need to improve the efficiency, financial sustainability and effectiveness of healthcare systems, to reach the objective of building competitiveness and growth. It also acknowledges the importance of the healthcare sector in tackling the social consequences of the economic crisis, stressing that healthcare services are an area that will generate significant job opportunities in years to come.

The evidence-base

The Commission’s Communication is backed by several studies, in particular on access to healthcare, effectiveness of health systems, and reforms of the hospital sector. Some findings are:

• In general, assessing the effectiveness of health systems is a complex process: healthcare measures may only show their effects after a long period, and reliability of data is a challenge.

• Early diagnosis of colorectal, cervical and breast cancer through organised population-based screening programmes is a useful means for the healthcare system to improve results.

• Healthcare access is directly affected by the organisation and management models used in healthcare systems, with patients having more difficulty in accessing healthcare if health systems are complex and lack transparency.