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Does WHO actually understand Europe’s health systems?

The World Health Organization (WHO) released its European Health Report 2024 this month. It should be a good document for consultation and political guidance and has many positive aspects, but it fails on one essential issue.

WHO continues to have an incomprehensible and unacceptable bias: private providers are simply not considered or are even cited as a cause of the problems. WHO says that “Several factors are contributing to the reduction in the supply of health workers, such as the ageing of health workers; increased internal mobility from rural to urban areas and from the public to the private sector (pages xiii, 168, 171)”. You read it and it is hard to believe what is being said.

Private providers are now an essential component of many health systems and they are not a source of the problem – they are part of the solution. Today, private hospitals and clinics – both for-profit and non-profit- account for 40% of Europe’s hospital capacity. Private sector professionals are not operating outside the system, they belong to the system, contributing to meet the healthcare needs of Europeans. Regarding access, we have said it many times and I will say it again: access is a matter of financing – essentially a political choice and not of the ownership structure of providers. The key to improving access lies in the proper alignment of providers and effective contracting.

It is the World Health Organization itself that argues in its report (page 167) that financial protection involves “supporting coverage policy through the allocation of an adequate level of public spending on health and spending better by allocating health-care resources efficiently and equitably” but then fails to distinguish between public financing and public provision.

This report seems to have overlooked the lessons it had identified in a previous study: Engaging the private sector in delivering health care and goods: governance lessons from the COVID-19 pandemic. Private individuals can play an important role in healthcare provision.

I firmly reject the notion that there should be a conflict between public and private sectors, and even more so that the growth of private providers is a problem. This is not a battle, we are all on the same side, working toward the same goal. The fight for the sustainability of healthcare systems requires the correct articulation between public and private providers.

The problem of health worker shortages affects all countries, all systems and all providers. We are all in the same boat. The problem must be solved with an objective diagnosis and appropriate policies. This is exactly what we heard from Francesca Colombo, OECD Director for Health, who at the UEHP General Assembly clearly identified the “strategies to address health workforce shortages:

• Training more health workers, but need to increase attractiveness of health sector jobs
• Improving job quality to increase retention, but it will cost money
• Innovating to make more effective use of health workers and new technology”.

Private hospitals and clinics in Europe are very active and have the potential to contribute even more, not only by increasing direct care but also by promoting prevention and collaborating in public health issues. We are willing and highly committed to this. We hope that prejudices will not hinder the search for the best solutions for the health of Europeans.

Oscar GASPAR
President of UEHP