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Better financing models for health systems


In 2017, spending on health care in the EU stood at 9.6% of gross domestic product, ranging from over 11% in France and Germany to less than 6% in Romania. In most countries, in-patient care services made up the bulk of health spending, while spending on pharmaceuticals also accounted for a large share of health expenditure in some countries.[[Health at a Glance: Europe 2018.]]

Due to demographic changes in the EU with a population projected to continue ageing and higher expectations regarding provision of health care services, public health threats with relevant repercussions for society and the introduction of innovative and digital solutions to improve health care systems’ functioning, the demand for health care services as well as the budgetary pressures on health care systems are and will keep increasing.

Future models of care delivery will have to take into account both the systemic and multi-dimensional performance perspective and to look at relevant outcome and quality indicators, structure of care delivery, and knowledge base regarding optimal care delivery systems,

Therefore, research and innovation should tackle the challenges of financing health care services in the EU by addressing one or more of the following:

  • Financing of health care – development of new cost-effective models for financing and reimbursement, including incentive mechanisms and outcome-based financing in order to promote good performance of the health care systems.
  • Financing of preventive health care – novel models and appropriate structure of financial incentives for effective health promotion and disease prevention, financial incentives for stronger co-operation between primary care and public health services, long-term sustainable financing mechanism for local- and municipality-run promotion programmes and the assessment of personal health risk behaviour and its potential impact on health costs.
  • Innovative purchasing and contract methods – new strategies for contracting provision of health care services (public sector hired services) as well as solutions to better assess provision capacity and quality, to assess markets, and cost-effectiveness as well as equal access of contracting-out services. This can help align the incentives of providers with those of patients and the public good.
  • New and improved tools for better design of incentives for health care professionals – incentives that minimise differentiation between services and “cream-skimming” by patients, fostering better health care planning, optimized use of health care services and avoidance of resources’ overconsumption and -waste.

Value-based pricing- and payment models for health technologies are not in the scope of this topic; such models are covered by topic “New pricing and payment models for cost-effective and affordable health innovation” (HORIZON-HLTH-2022-IND-13-03) under destination 6.

Research and innovation in these areas should take into account the potential impact of public health emergencies and threats on the sustainability, financing, as well as the effective and efficient functioning of EU health care systems.

To ensure wide uptake by user communities and scalability of the models and methods across health systems, actions should promote the highest standards of transparency and openness, going well beyond documentation and extending to aspects such as assumptions, architecture, code and any underlying data.

Applicants are highly encouraged to actively involve public authorities (i.e. ministries of finances and health, procurement agencies/procurers and agencies responsible for the management of health services contracts, public health and health-policy institutes, health administrations, among other) in the proposals.

Projects funded under this topic are strongly encouraged to participate in networking and joint activities, as appropriate, and in particular they are expected to liaise with successful applicants under topic “New pricing and payment models for cost-effective and affordable health innovation” (HORIZON-HLTH-2022-IND-13-03) and the consortium to be created under the planned “European Partnership on Transforming Health and Care Systems” (HORIZON-HLTH-CARE-2022-IND-10-01). These networking and joint activities could, for example, involve the participation in joint workshops, the exchange of knowledge, the development and adoption of best practices, or joint communication activities. This could also involve networking and joint activities with projects funded under other clusters and pillars of Horizon Europe, or other EU programmes, as appropriate. Therefore, proposals are expected to include a budget for the attendance to regular joint meetings and may consider to cover the costs of any other potential joint activity without the prerequisite to detail concrete joint activities at this stage. The details of these joint activities will be defined during the grant agreement preparation phase. In this regard, the Commission may take the role of facilitator for networking and exchanges, including with relevant stakeholders, if appropriate.