PHSSR European Union Investing in Health 2025

27 Investing in Health for a Competitive, Secure, and Resilient Europe: A Strategic Call to Action The Partnership for Health System Sustainability and ResilienceCurrently, national, regional, or local authorities may submit a request for support under the TSI, which is managed by a national Coordinating Authority, represented by a range of ministries and departments across Member States, including ministries of finance and foreign affairs and offices for EU affairs.128 This reinforces the need for greater links between health and other sectors, as well as collaboration between national and subnational authorities, to ensure that actors across levels of the health system can access necessary support. Recommendations � Provide technical support to stakeholders at all levels of the health system in accessing and utilising EU financing mechanisms, by: � Expanding the scope and implementation of an EU Health Investment Hub to guide the strategic and efficient use of EU funds, in collaboration with the Reform and Investment Task Force and building on the TSI’s pilot EU Health Hub. � Leveraging the work of the THCS to support the co-design and implementation of health system transformation initiatives across Member States. � Coordinating closely with DG REGIO to facilitate the involvement of local and regional stakeholders in the planning and execution of EU-funded health investments. 2.B.3 Standardise and improve project and programme evaluation processes across EU health-related funds to promote efficiency, transparency, and evidence-informed decision-making It is challenging to evaluate how much and how effectively EU funds have been used in health under the existing and previous MFFs. In the case of the existing MFF, the challenge is compounded by the lack of clear performance metrics and fragmented reporting of progress to various Commission departments. As a result, neither the Commission nor Member States have a comprehensive picture of how EU funds are used, which hinders the measurement of the return on investment in health.129 Evaluation of the impact of EU investments in health is currently lacking, across both funds and countries, although available evidence supports that EU funding has strengthened healthcare services. Between 2010 and 2015, €237 million from the European Structural and Investment (ESI) funds was invested in Slovak hospitals, leading to statistically significant improvements in 30-day readmission rates but not in mortality rates.130 In Lithuania, ESI funds accounted for a quarter of the annual public expenditure on health in 2007-2013, and a report commissioned by the Ministry of Finance identified that EU support for health infrastructure investments mitigated the impact of a severe economic crisis on population health.131 However, the lack of coherent and reliable monitoring indicators remains a barrier to assessing the impact of investments in health. Key performance indicators can facilitate the evaluation of investments in health but must be focused and results-orientated to be impactful and in line with EU strategic priorities. Striking a balance between the effective measurement of impact and the burden on the administrative capacity of national, regional, and local authorities is critical to ensure continued engagement with funding programmes.122 The European Committee of the Regions emphasised that administrative capacity must be seen as more than just an enabling factor for the delivery of EU funds, recommending that capacity-building support for local and regional authorities be embedded in the programming and delivery of EU funds in the post-2027 MFF.132 Both the Draghi report and Heitor report by the Commission Expert Group on the Interim Evaluation of Horizon Europe highlight that administrative burden and over-regulation of Horizon Europe, including difficulties in measuring outputs and excessively complex rules for submitting proposals and managing projects, undermine the efficiency and effectiveness of the programme.133,134