Politicians know that health prevention pays off economically and that it is a crucial factor in the competitiveness of European economies. In the political cycles of incoming and outgoing governments, however, there is no room for it. In the state budgets, prevention is over-looked, because its positive effect usually shows only after the term of office of the politicians who decide on the finances for it ends. Shadow Prime Minister Karel Havlíček (ANO) and Slovak Minister for Investments, Digitization and Regional Development Richard Raši (HLAS) both acknowledged this during the Economics of Prevention conference. The solution, they emphasized, is to look at budgets from an economic point of view, not from an accounting one. The discussion panel also touched on a number of other topics such as risk reduction policy, health prevention within companies, financial incentives, the role of insurance companies or the Draghi’s report on the competitiveness of the European Union.
„Nobody disputes the role of prevention. Everyone knows that only a healthy country is a strong country, and that only a strong country can be competitive. And yet I am convinced that not only Slovakia, but most states in the European Union and perhaps in the world still have problems with creating budgets that invest in prevention as much as everyone is convinced is necessary to make it effective,“ Slovak Minister of Investments, Digitization and Regional Development Richard Raši said at the beginning of one of the panel discussions.
He immediately explained why. „Investing in prevention is something you do today, but that will have a political result only when you are no longer in office,“ he said. Therefore, when drafting a budget, it’s always the urgent problems that are at the center of attention. And although all politicians know that investment in prevention will bring a strong and indisputable effect, it is extremely difficult to allocate an adequate amount of funds to it.
Karel Havlíček, the Czech shadow Prime Minister from the ANO party agrees. He pointed out that a third of global GDP growth in the 20th century was due to a healthier population and that every crown that is spent on prevention will be returned sevenfold. „I think everyone intuitively realizes that if we put financial resources into prevention today, it will always turn out to be cheaper than the possible costs of future health care,“ said Havlíček, according to whom it is indisputable that if we as a state have a healthier population, we will also have a higher GDP and more balanced budgets. He also considers investment in sports – not only top-level, but especially in school and amateur sports – and short waiting times for medical examinations to be key.
Prevention – a topic worthy of the prime minister
According to Raši, it is a positive thing that public policy is shifting from the previously common practice of bans more towards harm reduction. „Today, we live in a time when bans do not solve anything. That is proven by the experience of Great Britain and many other countries. It is clear that we will not achieve our goals by banning stuff, so let’s try to achieve them by offering alternatives or holding campaigns to switch from the most harmful alternatives to the less harmful ones,“ says the Slovak minister.
Havlíček thinks that companies and employers should for their own benefit focus on prevention as well. „The state can obviously play an important role in that. It can for example provide tax exemptions if they motivate their employees to focus on prevention,” he said and added that according to him said approach worked wonders in the area of innovations which he introduced as a minister. The shadow Prime Minister also revealed that his party will include incentives in healthcare as a part of its election program.
Karel Havlíček thinks that prevention is a key political topic which should be coordinated at the top political level, especially given how many ministries it falls under. “It is definitely a topic for the prime minister, which is not something I’m saying only from the political point of view. I would say it is a topic of utmost importance for us all. That is because we all tend to underestimate prevention and rely on treatment which obviously has two negative outcomes – it can be too late for the patients to heal and it is also incredibly expensive,” says Havlíček.
The statement that health prevention is outside the bounds of a single portfolio is something that Raši also agrees with. According to him, politicians realize how important prevention is, but it is also necessary to transform ideas into action. „It is up to us, politicians, to start doing what we are convinced is right. To be able to overcome the tendency to only do what is connected to a single term in office. To be able to change our mindsets that if we can’t solve an issue by introducing bans, we should focus on harm reduction. And to make our political decisions based on facts, not feelings. If we can succeed in that, investing into prevention will become something that comes naturally,” Raši says.
To see budgets from an economic point of view
The European population is getting older and European countries need to invest more and more into its citizens being in a good shape. Early prevention is therefore definitely economically viable, said Andrew Bounds, a reporter for the Financial Times. He pointed out that according to OECD, people in their 50s now work less because they suffer from critical medical issues, whether it’s diabetes or cancer. “And when it comes to the health of young people, it turns out that in the UK – and it also applies to Europe – there is a number of young people who aren’t healthy. And that number has been getting higher since the financial crises of 2008, whether it’s because of covid or the financial crises,” Bound warns. He also says it’s a shame that the report on the competitiveness of Europe prepared by Mario Draghi, Italian ex-prime minister and an ex-president of the European Central Bank, doesn’t focus much on prevention.
Francesco Moscone from the Brunel University in London and Ca’Foscari University in Venice also mentioned the report. “I think that we all need to read the report and digest it. It includes concrete evidence but in short the document says that if the European Union wants to remain competitive both on a global and regional scale, it needs to make a lot of changes, from innovations to radical reforms. And there is no doubt that Europe is falling behind in productivity, for example when compared to China or the US,” Moscone says. The solution, according to him, is boosting Europe’s productivity, economic growth and getting rid of disparities between the national states.
When it comes to prevention, Moscone says, it’s good that the European Commission focused on directives related to tobacco and alcohol consumption. “Now it’s time for a revision on a European scale. And I think that one of the ways to move forward is to lower the amount of all types of cancer or cardiovascular diseases which are connected to an unhealthy lifestyle and which we are talking about here,” Moscone says. He added that he also considers himself an advocate for harm reduction.
Both top-level politicians who attended the panel spoke about the Draghi report. Richard Raši hopes that it won’t only end up being a “report just to do a report” but something that is acceptable for the member states, from which they will choose what works and will lead to real changes. Karel Havlíček is however less optimistic. “I am sceptical, I don’t think that the EU will get much inspiration from it. The report is devastating and, to be frank, doesn’t really say anything new,” he says. “I encourage politicians to do one thing and that is hinted at in the report: Let’s not approach our budgets from an accounting point of view but from an economic one. Everyone, who has ever been a part of an organization that focused on the long-term knows that we can’t only focus on the next two years but also on the next ten or fifteen years.”
Zdeněk Kabátek, director of the General Health Insurance Company of the Czech Republic, agrees. “Health insurance companies need to think economically. If we didn’t consider a ten-year or fifteen-year term, we wouldn’t be able to fulfill our role – that is to ensure a stable availability of health services for our clients. And the role of prevention is undisputable. In addition to the fact that we undoubtedly have certain reserves when it comes to the structure of health care providers and the effectivity of the whole system, prevention is one of the fields that we can actively economically focus on, that is with a certain investment into the future. It can be a key factor to keep the health care system stable,” Kabátek said.
MEP Ondřej Krutílek (ODS) pointed out that healthcare is a shared competency between national states and the European Union, with the EU getting the short end of the stick. Despite that, EU policies can help significantly. “The positive role that the EU and the European Parliament can play lies mostly in making it possible for services or products to spread across the EU,” he said, providing the pharmaceutical package and the European Health Data Space as examples.
Prevention can save money in health care but also in other fields, Matej Fekete, vice-chairman of the bureau of the General Health Insurance Company of Slovakia, says. “The average time spent on a sick leave in Slovakia is 46 days. That translates into billion euros that we can save if we as health insurance companies approach prevention proactively.” People won’t be on a sick leave as much and therefore won’t cost the system more money as a part of the social security scheme, he thinks.
Jakub Němec
Thanks for the support of the conference go to the General Health Insurance Company of the Czech Republic, Health Insurance Company of the Ministry of Interior of the Czech Republic, General Health Insurance Company of the Slovak Republic and the companies Tiscali Media, ALK, Ewing, EUC, AKESO, Sprinx, National Sports Agency and Dukla Sports Club.
