November 2021  
Defiance and trust
We can only deplore the fourth Covid wave which is currently breaking over Europe, hitting hardest eastern Europe where vaccine coverage is significantly lower.
We can analyze and discuss numbers and facts, they are important, but it is time for EU27 to look for solutions and act.
At the very beginning of the crisis, we observed actions of solidarity towards supporting hospitals and seeking solutions for Intensive Care Units, with appropriate equipment and workforce. Later the EU managed to celebrate contracts with the Pharma industry providing Europeans broad and fast access to vaccination.
Stella Kyriakides, Commissioner for Health and Food Safety, said at the time “… I am happy that we have now concluded six vaccine agreements so far. This is a clear demonstration of the European Health Union in action: a European Union that delivers tangible results for its citizens and a blueprint for our cooperation in the area of health in the future. A safe and effective vaccine is more important than ever in helping to restore normality and overcome this pandemic. No one is safe until everyone is safe.”
But one and half year later, we observe a poor protection rate in some Member States.
Let me remind you of a very compelling OECD paper “Trust and its determinants: Evidence from the Trustlab experiment” published in 2018, one year before the crisis. We learn in this paper about our common weakness, our failure to communicate. The EU must remain strong and engaged in this last step, not only by providing or financing, but by convincing all European citizens that science is the answer in healthcare and that results must be trusted. Policy makers in our common space must also be supported by results and medical benefits. All forces are useful when human lives hang in the balance.
The private health providers that UEHP represents, continue to properly inform the population, to vaccinate, to treat the patients and to open new ICU beds when necessary. The private health sector is a major link in this chain providing indispensable care for all.
Dr Paul Garassus
President of UEHP
ECDC - A strong partner during the pandemic
Dr Andrea Ammon, ECDC Director
What has been the role of the European Centre for Disease Prevention and Control (ECDC) during the COVID pandemic?
Since the very first signals of the threat in China and throughout the pandemic, ECDC has constantly assessed the evolving risk posed by COVID-19. We have produced 33 COVID-19-related risk and threat assessments to support Members States and partners in their policy- and decision making.
We have standardised data collection through common case definitions and produced regular epidemiological updates and in-depth analyses by country and for the EU as a whole. Our updates and analyses include number of cases, hospitalisations, ICU admissions, deaths, figures about vaccine uptake and ongoing public health measures put in place by the EU/EEA countries. We also use our mathematical modelling expertise to deliver 30-day forecasts, taking the epidemiological situation and such measures into account.
On the basis of the data collected, analysis of scientific developments and lessons learned, we have also delivered numerous guidance documents covering most aspects of the response to COVID-19, from infection prevention and control in hospitals and in various settings to recommendations on the use of non-pharmaceutical interventions and contact tracing.
ECDC has also produced reports over the course of the pandemic guiding decision making regarding vaccination, supported the EU/EEA countries to strengthen whole genome sequencing infrastructures, and enhanced our risk communication activities, amongst other activities. 
Which tools have been implemented to help monitor the pandemic and evaluate the risk assessment?
ECDC has been able to produce an overall picture of the COVID-19 pandemic across the EU with data gathered through different surveillance systems such as The European Surveillance System (TESSy), the Epidemic Intelligence tools and the Early Warning and Response System of the European Union (EWRS), which are official databases to which the EU/EEA countries report.
ECDC has also developed tools to communicate about the data and findings. The European COVID-19 Forecast Hub was initiated by ECDC with the aim to provide evidence-based near-term forecasts of COVID-19 cases and deaths for public health decision-making. It collates short-term forecasts from modelling teams around the world on a weekly basis and predicts the number of COVID-19 cases and deaths four weeks ahead in 32 countries.
The COVID-19 Situation Dashboard show indicators regarding deaths and daily data on EU/EEA countries and the ECDC Vaccine Tracker presents detailed information on vaccination uptake as well as deep analysis per target groups and especially age groups.
To what extent will the COVID-19 crisis help you move forward on other issues of concern or will other issues of concern fall behind as a result of this health crisis?
COVID-19 has been everyone’s focus since the beginning of 2020, and rightly so. However, despite the still ongoing pandemic, we cannot afford to neglect other major global public health issues. ECDC has used its resources in the best way possible in the past two years, being able to respond to the challenges posed by the pandemic, while still keeping up with its role and responsibilities in other areas.
A good example of our continued efforts in other areas is antimicrobial resistance (AMR). ECDC marked the 14th European Antibiotic Awareness Day on 18 November with the release of the latest data on AMR and on antimicrobial consumption.
This year’s findings showed that there is a decrease in the total antibiotic consumption in humans by more than 15% between 2019 and 2020. This has been seen in most EU/EEA countries, mostly in primary care, and most likely as a result of the COVID-19 pandemic. Nevertheless, our data show that AMR, in particular combined resistance against several antibiotics, remains a serious challenge in the EU/EEA, and that we need to continue to reduce unnecessary antibiotic use.
It is important to further improve infection prevention and control practices in hospitals and other healthcare settings, and to keep enforcing some of the lessons learnt during the pandemic to prevent infections and thus antibiotic use, i.e., appropriate hand hygiene, physical distancing, respiratory etiquette and vaccination. 
Launch of the Factbook 2021
At UEHP we are thrilled to announce the official launch of our latest publication “Creating resilient and sustainable health care in Europe: the role of private hospitals” which will be held as an online event on 1st December, 11:00-12:30 am.
In our publication we address the most important challenges healthcare systems are facing with a focus on efficiency, patient satisfaction, investments in healthcare and health systems performance during the COVID-19 pandemic. In addition, there is a specific chapter on European cohesion in the fight against cancer, which we wrote in collaboration with Dr Joy Raynaud, Health Geographer. In this chapter we analyzed the main causes of disparities in cancer treatments in Europe, forming what we can sadly call a “iron curtain” between Eastern and Western Europe.
Mr Hans Martens, author of the Factbook, will present the main findings and key messages of this study during the official launch.
The event will be held with the kind support of Romanian MEP Cristian-Silviu BUŞOI, Group of the European People's Party (Christian Democrats), who will deliver a supporting speech.
Register HERE
UEHP at 44th IHF World Hospital Congress
Our President and Secretary General attended the 44th World Hospital Congress, organized as a hybrid event by the International Hospital Federation and La Unió Catalana d’Hospitals in Barcelona last 8-11 November.
The World Hospital Congress of the International Hospital Federation (IHF) dates back to 1929, when it was first held in Atlantic City, USA as a biennial event. Since 2015 it has been held annually across the globe.
The Congress is a unique global forum that brings together IHF members and leaders of hospitals, health services, and healthcare organizations to discuss key drivers of national and international policy, management, financial trends and solutions. Through this forum multidisciplinary exchange of knowledge, expertise and experiences are facilitated, together with dialogue on best practices in leadership, management and service delivery.
The event contributes to the enhancement and enrichment of the knowledge and skills of healthcare professionals.
In the context of the long-lasting partnership between IHF and UEHP, UEHP attended the session “Hospital financing in times of COVID-19”: this session was hosted by the World Health Organization. The IHF and WHO have launched an international program of work called “Hospital financing in COVID times”, in order to document the economic problems experienced by hospitals because of the COVID-19 crisis, the policy measures taken to relieve the sector, the contribution of hospital federations to the policy response and the possible broader consequences of the COVID-19 crisis for the hospital industry. UEHP and its members have been involved in this study.
The main objective of this session was to organize a triangular conversation between health financing experts, hospital federations and hospital managers. WHO presented early findings from the joint IHF-WHO program of work. Data presented were extracted from international surveys implemented by WHO, IHF and hospital associations like UEHP.
In the second part of the session the European Observatory on Health Systems and Policies presented data from their COVID-19 Health System Response Monitor, with a focus on hospital financing issues.
The event was a success, attracting more than 1500 participants from more than 70 countries and territories.
All the session recordings are available on the event platform until 3rd of December.
UEHP speaks at COCIR event “The Promise Of Data In Healthcare”
Last 2nd November, our Secretary General, Ms Giannico, was invited as speaker to the event “The Promise Of Data In Healthcare”, organized by COCIR, the European Trade Association representing the medical imaging, radiotherapy, health ICT and electromedical industries.
The European Commission and member states are currently developing the framework and infrastructure for the European Health Data Space. This is the right time to remind everybody of the great promise that the use of health data holds for healthcare.
The event was structured around two main sessions:
  1. VALUE OF HEALTH DATA FOR HEALTHCARE SYSTEMS - focusing on experiences in using data analytics to improve the performance and processes in healthcare systems and support the move towards value-based healthcare.
  2. USING DATA FOR PERSONALISED HEALTHCARE - discussing case studies at the level of the individual patient or disease, focusing on how data analytics can contribute to the improvement of diagnosis, treatment or aftercare.
Ms Giannico attended session n.1 and presented the private hospitals perspective on the use of data in healthcare. The higher the quality of the data the better the outcome. Healthcare stakeholders must join forces to enable the change!
The event offers an opportunity to discuss the opportunities and challenges with experts in healthcare systems and industry.
Europe’s Beating Cancer Plan: the European Commission publishes an implementation roadmap
The European Commission just published an implementation roadmap and progress indicators for Europe’s Beating Cancer Plan to monitor developments on the ten flagship initiatives as well as its other actions. The roadmap will undergo regular review by the Implementation Group.
Less than a year after its publication, Europe’s Beating Cancer Plan is already bearing fruit. In June, the Commission launched the Knowledge Centre on Cancer followed by the launch of the HealthyLifestyle4All initiative in September. Work is also progressing in a number of areas including the revision of the Council Recommendation on cancer screening and a new Cancer Inequalities Register. Under the EU4Health programme’s 2021 Work Programme, 12 action grants and 4 joint actions have already been launched covering many aspects of cancer prevention and care.
A Stakeholder Contact Group, which supports the implementation of the Cancer Plan, will hold its second meeting in November to discuss the Horizon Europe Mission on Cancer and continue its work in the six thematic groups dedicated to prevention; early detection, diagnosis and treatment; quality of life; research, innovation and digitalisation; reducing inequalities and childhood cancer.
Through this multi-stakeholder approach, the EU aims to improve the lives of more than 3 million people.
More information HERE.
OECD released its annual publication Health at a Glance.
OECD Health at a Glance 2021 says that the mental health impact of the pandemic has been huge, with prevalence of anxiety and depression more than double levels observed pre-crisis in most countries with available data, most notably in Mexico, the United Kingdom and the United States.
COVID‑19 has also had a major indirect impact on people not infected with the virus. For example, breast cancer screening fell by an average of 5 percentage points in 2020 compared to 2019, across OECD countries with available data. The median number of days on a waiting list increased on average by 58 days for hip replacement, and 88 days for knee replacement in 2020, as compared to 2019.
The COVID-19 pandemic has led to a sharp increase in health spending across the OECD. Coupled with reductions in economic activity, the average health spending to GDP ratio jumped from 8.8% in 2019 to 9.7% in 2020, across OECD countries with available data. Countries severely affected by the pandemic reported unprecedented increases. The United Kingdom estimated an increase from 10.2% in 2019 to 12.8% in 2020, while Slovenia anticipated its share of spending on health rising from 8.5% to more than 10%.
The pandemic highlights the persistent shortage of health workers stressing the importance of investing more in the years ahead on improving primary care and disease prevention and strengthen the resilience and preparedness of health systems. Indeed, the report says that health spending continues to focus mainly on curative care rather than disease prevention and health promotion, and much more is spent on hospitals than on primary health care. Prior to the pandemic, spending on health amounted to over USD 4 000 per person on average across OECD countries, reaching almost USD 11 000 in the United States. Inpatient and outpatient services make up the bulk of health spending, typically accounting for 60% of all health spending.
Although the number of doctors and nurses have increased over the past decade in nearly all OECD countries, shortages persist. The lack of health and long-term care staff is proving to be more of a binding constraint than hospital beds and equipment, says the report.
You can read the main highlights HERE
Optimise regulatory timelines to improve patient access to oncology therapies in Europe
The journey of new medicines from the laboratory to patients is long and winding. After years of clinical research and development, new medicines must receive marketing authorisation followed by reimbursement discussions before patients can benefit from them.
The 2020 Every Day Counts report focused on understanding the causes of delays in patient access to new oncology treatments. This follow-up report “Every Day Counts: Improving Regulatory Timelines to Optimise Patient Access to Innovative Oncology Therapies in Europe” concentrates on the final stage of marketing authorisation: the administrative process between the final opinion of the Committee for Medicinal Products for Human Use (CHMP) and the final decision of the European Commission. The publication was commissioned to Vintura by the EFPIA Oncology Platform and developed with 35 organisations, including regulators, HTA bodies, healthcare professional associations, patient organisations, policy makers, academics, payers, and pharmaceutical companies.
With a maximum official duration of 67 days (and a range of 33-198 days in practice), this administrative process represents only a small part of a medicine’s journey, but nevertheless an important opportunity for improvement. During the COVID-19 pandemic, it was expedited to less than one day for COVID-19-related vaccines. This suggests it is possible to shorten timelines for other approvals significantly, without affecting the quality and rigor of scientific review.
The current timelines come at a cost. An illustrative analysis of 11 recently authorised oncology treatments shows that the regulatory steps between CHMP opinion and EC decision together accounted for 18,600 years of potential life lost, although the full extent of life years lost is far greater when considering all oncology indications. In addition, optimisation is necessary to increase efficiency and future-proof the system, which is currently overburdened as a result of challenges such as Brexit, COVID-19, and the rising number of new medicine assessments.
There is also momentum for change, as the EC is currently considering changes to pharmaceutical legislation as part of the EU pharmaceutical strategy. Even if only small improvements are made, they could have a significant impact on patients.
Three potential solutions to optimise regulatory timelines Several strategic options and concrete solutions were considered to improve the process between CHMP opinion and EC decision. When considering the impact and feasibility of solutions, the following potential solutions were prioritised, noting that these could be used in combination:
  1. Conduct the decision-making phase in parallel to the linguistic phase, thereby allowing Marketing Authorisation to be granted 12 days earlier
  2. Increase the use of digital tools during the linguistic phase, which could shorten this phase by 10 days
  3. Provide an opportunity to shorten the written procedure in cases where Member States foresee no objections, thereby shortening the decision-making phase by 15 days
Greater digitalisation and an increase in the number of human resources should be considered to reduce the workload pressure associated with today’s process, and may further reduce timelines.
Lastly, important gains can be made by applying a holistic approach to the overall journey to patient access. Improving the transparency and predictability of the status of individual medicines in the process between the final CHMP opinion and the EC decision would allow for better planning of the subsequent pricing and reimbursement discussions. Further optimisation could be achieved by starting national HTA processes directly following a positive CHMP opinion. This is possible as EC decisions have completely aligned with CHMP opinions in the last 10 years. Starting the HTA process earlier would therefore be a pragmatic way to avoid more than 60 days of delay to patient access.
Combining these solutions has the potential to save thousands of years of potential life across the EU, especially since these solutions are not limited to oncology therapies. Together, let’s make use of the once-in-a-generation opportunity of the review of Pharmaceutical Legislation. Because for patients, Every Day Counts.
Update on the European Health Data Space
Isabelle Zablit-Schmitz, project director, Europe and international expert, at the Digital Health Delegation (DNS), French Ministry of Solidarity and Health
Has the Covid crisis been an accelerator for digital health issues at European level?
First of all, the Covid crisis highlighted a number of shortcomings: patients were transferred from one country to another, but not their health data, an absurd situation in our time! This health crisis also revealed Europe's capacity to mobilise. Health pass, tracing..., the 27 were able to act quickly and efficiently. If someone had told us two years ago that we would produce open-source technical guidelines, publish a regulation, implement it in a few weeks and reach the level of an international standard, nobody would have believed it. Already more than 40 countries have joined the interoperability of the European health pass and about the same number are in the process of implementing it! This has been done while embracing European values, respect for ethics, security, etc.
This trial run allows us to be very positive about the way we are going to move forward on the European health data area project, for which the French Presidency of the European Union from 1 January 2022 will present a first version of the text. This area has become a major European issue and it is necessary to speed up the work.
What can we expect from this European Health Data Space?
This ambitious project aims to facilitate the sharing of health data in the context of the care pathway, as well as to create a space for access to health data for manufacturers and scientists, in order to increase our industrial sovereignty and research capacities for all health ecosystems in Europe. A distinction is made between the "primary use of data", which corresponds to the use of an individual's data as part of his or her care, and the "secondary use of data", which corresponds to their subsequent use for research purposes (public or private) or public policies.
Digital health is a highly complex issue at national level, for each State, as the fluidity of the care pathway is itself complicated to put in place. In Europe, the 2011 directive on cross-border care commits countries to ensuring access to care for all European citizens. In reality, today, the treatment of a patient in a third European country often poses difficulties such as access to the medical file by the health professional, as well as an obvious problem of language barriers. Europe has put in place a certain number of tools to deal with this, and each European country is working at national level. France, for example, is investing two billion euros as part of the Ségur programme for the development of digital health, in particular to improve the fluidity of the care process. The Ségur digital programme benefits from European funding and will enable France to move forward more quickly. This funding will also be used by other countries and the acceleration of e-health will therefore take place at European level. These efforts will quickly be reflected in the daily lives of citizens. Indeed, from January 2022, every French citizen will have a digital health space, which will allow citizens to benefit from easier access to their data and also to applications selected according to criteria of compatibility, security, ethics, etc.
What health data transmission system is Europe setting up?
At the European level, the MyHealth@EU initiative is a huge step forward in making the healthcare pathway in the European Union more fluid. It allows healthcare professionals, with the patient's consent, to access elements of the patient's care pathway in the language of the provider, through a transcoding mechanism. Eight countries have already implemented MyHealth@EU and since the end of July 2021 - this is very recent - any French healthcare professional can access the "patient summary" in French of citizens of four European countries already connected, including Portugal. Eventually, hospital discharge letters, imaging reports, medical biology reports, original clinical elements, etc. will also be available for consultation. By 2050, all EU countries will be connected and will provide much better, faster and more efficient access to care.
Europe has the capacity to put in place a secure data processing and transmission system, which will run through a secure and private Commission network, thus guaranteeing a high level of security. The process is underway, and each country is incorporating this perspective into its national roadmap - the technical specifications of the documents in the care pathway need to evolve in order to make them compatible with the needs of transcoding and translation.
This is a first pillar of the European Health Data Space that Europe wants to build. It will certainly take time, as we need to take a step back, given the complexity of the issues. The first version of the regulatory text that will frame the modalities and operation is expected in 2022; each country must also be able to take ownership of this regulation, make comments, recommendations, etc.
It is therefore important to realise that this European health data space is already partially implemented with MyHealth@EU. We need these concrete results because as you know when nothing happens, it is disappointing for everyone. But here, these are tangible, concrete results that must be put into practice. The good news is that they respond to the daily needs of health professionals and citizens. Of course, we are not ready for all the services, but it is important for us to trigger these promising new uses and to appropriate these new perspectives.
The Covid situation is tight
Austria is currently suffering from a massive corona wave and is experiencing its fourth lockdown. How does this situation affect the work of hospitals?
The tense situation in the hospitals not only affects the intensive care units, where bottlenecks in medical equipment and highly specialised staff are threatening, but also the other wards. For patients in their own covid wards with severe courses of disease, beds have to be freed up elsewhere, which leads to the outsourcing of patients or to postponements of operations and treatments.
How is the private health sector involved in the response to this epidemic wave?
Private hospitals in Austria have concluded agreements with the provinces in which beds are freed up and patients are taken over by public hospitals. As in previous "waves", private hospitals are thus relieving the system by taking over patients.
All efforts are being made to increase the vaccination rate among the population, and there is even talk of making vaccination compulsory.
Responses from the Austrian Federation of Private Hospitals - www.privatkrankenanstalten.at
A health system pushed to its limits
Since this autumn, the country has been experiencing its worst wave of coronavirus since the start of the pandemic. Today, 65% of the population in Romania has not yet been vaccinated against COVID-19 and the country currently has one of the highest coronavirus mortality rates in the world. Hospital intensive care units have reached the limit of their capacity and Poland, Hungary and other countries have received seriously ill Romanian patients.
According to Cristian Hotoboc, president of the Association of Private Medical Service Providers (PALMED), the situation is similar to that in Italy during the first wave. The anti-vaccination movement is very strong, despite the fact that restrictive measures have been decided for non-vaccinated people (covid pass, curfew for non-vaccinated people after 8pm for example). Health professionals have received the third dose of vaccine and people can also have booster if their second dose of vaccine is more than 6 months old.
Until July 2021, private hospitals had helped the public health service to take care of Covid patients in intensive care units. Then the government suspended these cooperation measures. Now (data from mid-October 2021), the private health sector is relieving the public sector by taking care of non-Covid patients, chronically ill patients and patients who cannot be accommodated in a public hospital due to lack of capacity.
Independent study concludes
Private hospitals get a higher global rating than public hospitals
The population survey "Saúde em Dia 2.0" (see link below) concluded that 9 out of 10 Portuguese citizens are in favour of the creation of partnerships between the Portuguese National Health Service (SNS) and Private Hospitals "to redirect patients when the SNS cannot ensure a fair and timely response". It also concluded that private hospitals (59% consider them good or very good) "get a higher rating than public hospitals, even by users of public hospitals".
"This independent survey shows, once again, that as far as citizens are concerned the nature of ownership or management of the hospital is not relevant for their access to care and that they increasingly value the mixed nature of the Portuguese Health system and the complementarity between public and private health services," comments Oscar Gaspar, president of the Portuguese Association of Private Hospitals (APHP).
When asked about the quality of public hospitals and private hospitals, the Portuguese give better scores to private hospitals (with a score of 8 against the 6.7 they attribute to public hospitals).
Across 10 comparison parameters, such as waiting times, quality of facilities or access to innovative treatments, private hospitals are also "seen as better than public hospitals, in all aspects". The discrepancy is more accentuated in the assessment of waiting times (42% of people surveyed consider this to be the main problem of the SNS) and more attenuated regarding the competence of health professionals.
The study also concludes that 35% of people surveyed consider that the COVID-19 pandemic will still have an impact on Health services in 2022 and that 71% of the Portuguese people (almost 6 million) consider that the amount allocated to Health is insufficient.
These are the conclusions of a study conducted by GFK Metris for Movimento saúde em Dia, comprising the Portuguese Medical Association, the Portuguese Association of Hospital Managers and Roche. For this survey 1000 interviews were conducted between September 20 and October 6, 2021, to citizens over 18 years old, residents in mainland Portugal. The results were pondered for the total population (8,251,000).
Read the full version in Portuguese
1 December 2021
UEHP Factbook 2021 launch (online)

4 February 2022 - Paris
UEHP General assembly