On 29 May 2013, the European Commission published its proposals for the 2013 Country Specific Recommendations (CSRs) for the third annual cycle. In 2013 there are an increased number of CSRs on poverty, employment, education and care and health services, as well as the new positive individual proposals for some countries regarding key target groups such as youth, children, migrants and Roma.
For the first time, in 2012 the Annual Growth Survey (AGS) included a recommendation to reform pension systems that should be “coupled with a reform of health systems aiming at cost-efficiency and sustainability.” The 2013 AGS had a subtle, but significant change: "reforms of healthcare systems should be undertaken to ensure cost-effectiveness and sustainability, assessing the performance of these systems against the twin aim of a more efficient use of public resources and access to high quality healthcare”. In addition to the goals of health system reform, health is also mentioned in relation to "tap[ping] the job potential of expanding sectors, such as the green economy, healthcare and ICT [....] ensuring transparent pricing in healthcare services," and “high-quality services, such as social and health services, childcare, housing and energy supply."
The staff working document (SWD), which accompanies each Country Specific Recommendations (CSR), provides some countries with further recommendations on how to improve efficiency. Member States have received recommendations to improve cost-effectiveness of healthcare systems, shift from institutional to home care, improve access to primary care, provide coverage to disadvantaged groups, and place greater emphasis on prevention and independent living.
Some consistency between the different CSRs is evident. The emphasis is mainly placed on reducing public deficits and debt, primarily through reducing public expenditure instead of providing guidance on reaching the Europe 2020 Strategy (the European Semester is the main implementation tool for this). This raises two questions. Firstly, will the focus on economic objectives undermine the coherence of the social CSRs? Secondly, can the CSRs be implemented in an effective way to deliver on objectives of the National Reform Programmes?
The analysis also reveals that countries receiving financial assistance from the International Monetary Fund, the European Central Bank, and DG ECOFIN received no proposals to deliver on Europe 2020. Some countries, such as Sweden and Italy, received no health specific CSRs. In other cases, the SWD and background information unveiled inefficiencies in health systems and public administration without any proposals or suggestions to address them – this was the case for Slovakia, Austria, Estonia, Hungary and the UK, among others.
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