News

On 13 May the European Commission published the 2015 Country-Specific Recommendations (CSRs), which form the centre-piece of the European Semester. In line with the Juncker Commission’s revised approach to the European Semester, the number of recommendations made is reduced to focus on key priority areas.

Upon taking office the new Commission initiated a reform of the European Semester process, which is now in its fifth cycle. The aim is to increase ownership of the Semester’s main output – the CSRs – by increasing interaction between the Commission, member states and stakeholders, by streamlining the reporting processes and by focusing upon a smaller range of concrete issue areas. The 2015 CSRs thus emphasise the removal of barriers to investment, improvement of the business environment, the restructuring of public finances to make them “growth-friendly” and the improvement of employment policy and social protection.

What recommendations for health?

According to the Commission’s own overview, just ten member states have received CSRs relating to health (compared to 19 in 2014, 15 in 2013, six in 2012 and four in 2011) while 14 countries received a CSR relating to pension systems and six were issued guidance relating to poverty and social inclusion. The countries receiving health-related recommendations are: Bulgaria, Czech Republic, Finland, Spain, Croatia, Ireland, Latvia, Romania, Slovenia and Slovakia. In general, the recommendations have returned to a brief, generalised format, calling for improvements to cost-effectiveness in the healthcare system and reductions in healthcare spending. Particular areas targeted include pharmaceutical spending, administrative structures, quality and accessibility of care and the balance between primary and hospital care. Notable recommendations relating to health include that issued to Ireland, which encourages the implementation of adequate prescription practices and the recommendation issued to Slovenia, which suggests the adoption of health and long-term care reform by the end of 2015.

What does the new approach mean for health?

Across the full spectrum of CSRs, more extensive and detailed recommendations have been issued for those countries with excessive imbalances (BG, HR, FR, IT and PT) or imbalances that are considered to be serious (HU, DE, IE, ES, SI). The broader ‘scaling down’ of the recommendations is substantial, but the Commission notes that those areas covered in previous years’ CSRs will not be forgotten:

“The Commission will continue to monitor [the broader policy areas covered in previous CSRs] in its country reports and will continue to encourage Member States to take a holistic approach in their National Reform Programmes. Many of these issues will be taken up via other policy processes (e.g. in the context of the Energy Union, the Digital Single Market, in the monitoring and enforcement mechanisms related to the Single Market and in areas such as environment and the monitoring of the European Research Area and the Innovation Union) and/or in discussions on policy implementation with sector committees of the European Parliament, with sectoral Councils and with the relevant stakeholders. Where EU law is not being correctly implemented the Commission will use infringement proceedings to ensure the necessary compliance rather than issue recommendations.” Communication page ten.

Furthermore, in its 2015 Ageing Report, released on 12 May, the Commission notes the increasing pressure put on public budgets by health and long-term care and the Council’s conclusions on the issue urge speedy implementation of related CSRs to address the threat posed. Thus, whilst there is a clear retreat from offering intrusive and prescriptive recommendations in health, it is unlikely that they will disappear altogether.

What’s next?

An EPHA analysis of the CSRs will follow in the coming weeks. Ministers and leaders will discuss and endorse the CSRs in June and the Council will formally adopt them in July.

The Commission’s Communication on the CSRs can be found here. The individual CSRs can be found here.