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By Sylvain Giraud, Head of Unit “Performance of national health systems”, Directorate-General for Health and Food Safety, European Commission

To date, investments in health have predominantly focused on infrastructure (mainly hospitals) and medical technologies (such as medicines, imaging technologies and medical devices). However, on their own, this type of investments cannot fully meet the overall needs of health systems.

Today’s health systems are in need of reforms and modernisation to adapt to the main challenges they face: on one hand, an increasing demand for healthcare due to the population ageing and the rising burden of chronic diseases, and on the other hand, health workforce shortages and constrained public resources for health. New healthcare models, such as those supporting a shift from a hospital-centred system to more community-based and integrated care structures, are part of reforms aiming at increasing the effectiveness and sustainability of health systems.

On 27 February 2017, the European Commission, in cooperation with the European Investment Bank (EIB), organised a seminar to discuss new forms of investment for innovative forms of healthcare.

The event promoted the Investment Plan for Europe and the European Fund for Strategic Investments (EFSI) as an effective financial instrument to support reforms in European health systems.

Over 100 delegates participated in the event representing Member States and regional authorities, healthcare managers and service providers, as well as investors active or interested in the health sector.

One of the main messages from the seminar is that long-term thinking together with a reform plan and an investment strategy are required to deliver transformed health services. This calls for smart investments in several areas, such as: adapted facilities, service re-organisation, new governance models, workforce skills, IT systems, eHealth and new technologies. However, due to specialisation of most funds, few financing schemes, if any at all, are investing in all these elements together.

An integrated investment approach should therefore be pursued. Firstly, it should consider the overall needs for (a) infrastructure, (b) technologies and (c) service models together - essentially, an “investment triangle in health“. Secondly, it should aim at accessing and blending financing components from different sources in a strategic way.

The investment strategy needs also to ensure sustained financing, both in up-front investments as well as during a transitional period until the reformed care models achieve beneficial outcomes and realise cost efficiencies.

In this context, it is important for healthcare authorities to raise their capacities to manage new financial instruments.

Investing in health system reforms and new care models is complex and high-risk. This is where the Investment Plan for Europe and EFSI can play an important facilitating role. With EFSI acting as a guarantee against first losses and absorbing part of the risk, the Investment Plan for Europe offers an opportunity for the public and private sectors to invest together in health areas that are challenging, high-risk, or facing a sub-optimal market situation.

A broad range of public and private partners and investors need to engage and work together. Several communities have to talk to each other - investors, health providers, policy makers, regulators, universities, SMEs, industry etc. - and create ecosystems with common goals. Such ventures are to be underpinned by new contracting models and new business models that can encourage all partners to co-design, co-invest and co-deliver new care models and transformed health services.

In particular, partnerships among purchasers and providers of care services form a fundamental element. Various models are possible with differing approaches to contractual and governance aspects and the degree of sharing risks, assets and rewards among partners. The presence of a lead provider or service integrator can be instrumental; nevertheless, there is no “one size fits all”. It is crucial to consider the local context and the partnerships should, therefore, be preferably driven by local communities. The basic principles of trust and of sharing responsibility, risks and benefits constitute essential foundations, on top of which incentives shall be configured so that everybody becomes a “shareholder”. Once again, long-term thinking, i.e. long-term contracts, will be particularly helpful in providing certainty until the benefits from new care models appear and bring the anticipated return-on-investment.

There is a need and an opportunity for smart investments to transform health systems in Europe for the better. We should not be discouraged by the tight financial constraints within which health systems have to operate today. We can look beyond the usual funding streams and harness the opportunities offered by the Investment Plan for Europe to make our healthcare systems effective, accessible, sustainable and resilient so they can face future challenges too.


The report and presentations from the seminar are available on the European Commission’s website.

More information about EFSI is available on the webpage of the EIB and of the EIF as well as in the EFSI Fact sheet on mobilising funds for the health sector

december, 2022

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