PHSSR European Union Investing in Health 2025

20 Investing in Health for a Competitive, Secure, and Resilient Europe: A Strategic Call to Action The Partnership for Health System Sustainability and ResilienceThe annual European Semester provides an established framework for continuous objective setting that aligns EU-level and Member State priorities. This includes Commission guidance to all Member States, with country-specific recommendations on how to respond to challenges and deliver on key policy objectives.68 For example, under the 2024 European Semester, the country-specific recommendations in Germany acknowledged the labour shortages the country has faced in the healthcare sector and recommended investment in upskilling of people with lower-level qualifications and people with a migrant background to overcome this situation.69 Robust health indicators addressing EU strategic priorities in health, such as prevention and access to care, can drive progress towards shared objectives within the existing European Semester framework. A context-specific approach to objective setting for health system sustainability and resilience is particularly important given the heterogeneity both between and within European health systems. In 2011, the EU Expert Group on Health System Performance Assessment (HSPA) was established to support the development of tools and methodologies for HSPA, including identifying priority areas for EU-wide assessment of health system performance.70 The HSPA group has produced reports to support evidence-based policymaking on several topics, including prevention, reduction of low-value care, and health system resilience.71 The latter report proposed several indicators to measure health system resilience, including health system capacity, the ability to quickly mobilise resources, and the adequacy of supply chains.72 Lessons on the assessment of system-level performance can also be drawn from other sectors. EU- wide stress tests are now a cornerstone of assessing the resilience of the banking sector, having been mandated by the Council in the aftermath of the 2008 financial crisis.73,74 As set out in the EU Regulation on Serious Cross-Border Threats to Health (2022/2371), stress tests of the resilience of health systems could identify critical health system weaknesses and enhance crisis preparedness, at both the national and EU levels (ECDC and HERA).75,76 The Council Recommendation on the Critical Entities Resilience Directive reinforced that national stress tests based on common principles could enhance the resilience of critical infrastructure, including the health sector.77 A handbook with a pioneering methodology for resilience testing, developed by the OECD and the European Observatory on Health Systems and Policies, was published in 2024 and is now available to health authorities.75 The 2008 financial crisis also sparked a broader debate around the role of non-legislative EU instruments such as the Open Method of Communication (OMC), a mechanism for spreading best practices and achieving convergence towards EU goals in policy areas which fall under the partial or full competence of Member States.78 In the years since the financial crisis, the OMC has been extensively reviewed and improved, and applied in different policy areas including health. A key achievement has been the development of EU indicators for social protection and social inclusion, which includes health and long-term care.79 These provide a benchmark for assessing trends across EU countries and supporting Member States in developing policies. Recommendations � Leverage programme-level key performance indicators (KPIs) and benchmarks to monitor implementation, adapt to evolving policy priorities, and minimise inefficiencies in the allocation and use of EU health funding. � Utilise EU-level targets to track Member State progress towards shared strategic objectives, integrating these with broad governance mechanisms such as the European Semester and taking lessons from existing targets in health, such as in Europe’s Beating Cancer Plan.