Exploring the pillars of flexible health systems
The EU-funded FLASH(opens in new window) project is exploring solutions to tackle the rigidity of healthcare financing models and their inability to adequately handle sudden, large-scale disruptions. A stark reminder is the COVID-19 pandemic. While European nations responded by injecting emergency funds and reallocating resources, these measures highlighted the need for flexibility. To help improve the preparedness, efficiency and equity of EU health systems, FLASH analyses three critical dimensions of flexibility.
Sudden shocks, care and health needs
One dimension focuses on the flexibility to absorb sudden shocks. The pandemic revealed that even well-performing health systems struggled with surges in demand, often resulting in postponed care for non-COVID-19 conditions. FLASH developed a resilience measure to assess how quickly hospital systems return to pre-crisis activity levels. Their analysis identifies three pillars of resilience: a robust workforce with effective interdisciplinary coordination; digital integration, including electronic health records and real-time monitoring; and the ability to learn from experience. The researchers conclude that hospital resilience cannot be achieved through isolated interventions but requires an integrated approach strengthening human, technological and organisational capacities simultaneously. Another examines flexibility regarding where care is received. Ideally, patients should access high-quality care regardless of EU residence, yet barriers to cross-border mobility persist. FLASH investigates legal and economic obstacles, demonstrating that economic barriers can often be overcome with existing legislative frameworks. By proposing methods to harmonise cross-country payment systems and tariffs, the project suggests that facilitating patient mobility can actually increase social welfare, particularly in terms of border mobility and facilities’ capacity management. A third addresses flexibility with respect to health needs, specifically tackling inequities in funding allocation. While co-payments reduce financial burdens on public payers, they often lead to unmet needs among disadvantaged populations. FLASH extends this analysis to the inter-regional level, investigating whether increased health needs in specific regions are matched by increased financial resources. The findings reveal significant heterogeneity across the EU. While Belgium and Spain see funding increase in line with needs, this association is weak in Czechia and Italy. By cataloguing resource allocation rules in nine countries, the project provides policymakers with a reference to reform existing rules governing the allocation of funding from the central to the local level.
The case of Catalonia
However, the push for flexibility and digitalisation carries its own risks, as highlighted in a recent FLASH (Flexible Approaches to Support Health through financing) study(opens in new window) in Catalonia. It evaluated the adoption and long-term use of the Catalan National Health System’s digital platform ‘MyHealth’, covering over 9.4 million individuals and 727 million health interactions between 2015 and 2023. The results showed that despite rapid expansion accelerated by the pandemic, access to digital health services remains deeply unequal. Engagement was significantly higher among women, Spanish nationals and higher-income individuals, while older adults, migrants and rural residents remained consistently underrepresented. The conclusion reached is that digitalisation alone does not guarantee greater equity in healthcare access. As they strive for greater flexibility, EU health systems need to simultaneously address structural barriers such as digital literacy, linguistic and cultural accessibility, and infrastructure in disadvantaged areas. Ultimately, a truly flexible healthcare system is one that adapts not only to financial and logistical shocks, but also to the diverse needs of its entire population. For more information, please see: FLASH project website(opens in new window)
