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Principle 16

Health care

Health care workers across Europe are working hard to treat and stop the spread of the COVID-19 virus. In many cases, their task is made harder because of staff shortages, inadequate facilities and lack of personal protective equipment and testing kits. The European governing bodies and national governments should take immediate measures to ensure that health services receive much needed emergency funding and to boost staffing levels in the short term. The European Semester is addressing sustainability and accessibility to health services. Austerity measures have drastically reduced the scope of public services and their accessibility. At the start of the 2019 Semester, ETUC stated that health care and long-term care systems were a source of huge concern and suffering for a growing proportion of the EU’s population, and require immediate action. More than 15 Member States show very poor performance in health care. Coverage and access to long-term care is insufficient in several Member States. Informal care dominates the sector, to the detriment of services and female participation in the labour market. While public structures are often lacking, private options are extremely costly, inaccessible, and often lead to a deterioration in services as well as working conditions in the health sector. No substantial investments were contemplated in the past Semester cycle. In the medium and longer term, increased public spending on health and increased investment in public health are crucial, not just to reverse years of underspending in many countries but also to ensure that health staff and facilities can cope with future demands. Europe had a shortfall of around one million health workers even before the COVID-19 outbreak. Governments need to radically change their approach to public health and public services: short-term contracts and precarious jobs in the health sector are not enough to tackle emergencies such as this.

Access to health services and to long-term care is an EU emergency. The EU Semester cycle promoted “rationalisation” and “cost-efficiency”, implying aggregation of structures, a shift in already allocated resources, de-hospitalisation of care, but almost never public investment in necessary personnel and services. Out-of-pocket expenditure for health is on the increase in many Member States. SGP rules have extended the scope of the private market supplying health services and insurance to people. This reduces access to health services, which is one of the main reasons for discontent among the population.

The care sector is crucial to ensuring a decent standard of living for elderly people. It is necessary to improve the attractiveness of the sector in order to raise the quality of the work and services supplied. There is a high incidence of migrants, undeclared and undocumented workers in the sector, especially female migrants. It is important to eliminate all areas of vulnerability for people working in this sector and give workers the opportunity to improve their skills and their working conditions for their own benefit as well as the benefit of users.

The EU should push for a rights-based approach and public investment in universal, solidarity-based and gender-responsive social protection systems at international, European and national levels. It should also pursue upward convergence goals and funding allocation in child, health, elderly, long-term, disability and dependency care in order to guarantee universal coverage and high-quality care.

In order to meet the current and future needs of an ageing population, greater expenditure on universally accessible, affordable and good-quality public services for health and long-term care must be undertaken and viewed as an investment. Preventive care must be enhanced through proper policies and funding. Professional development, training, education and career recognition are crucial in order to improve quality and coverage of care and provide quality job opportunities. Work-life balance policies should support workers with care responsibilities. The EU should introduce an EU Right2Care backed with national action plans.

Actions aimed at setting a minimum floor of rights in the EU, a level playing field in the Single Market

  1. Guarantee access to quality and affordable health and long-term care (LTC) in all MS.
  2. Free movement: Revision of Regulation 883/2004 on coordination of social security systems to strengthen the coordination of such systems including health and LTC in order to improve the rights of mobile workers.

Actions aimed at establishing upward convergence in living and working conditions

  1. EU Right2Care programme, backed with national action plans through the European Semester, based on transparent and ambitious objectives
  2. Monitoring capacity, functioning and impact of occupational welfare (in national systems, and the role of collective bargaining).
  3. EU initiatives to strengthen the resilience of publicly-funded, universal and accessible healthcare systems.