Health policy

A case study for post-Brexit EU policy-making?

The UK vote to leave the European Union in the referendum on 23 June has cast significant uncertainty regarding both the institutional consequences of the vote and the general political direction the European Union will adopt in the run-up to and after a Brexit.

In the field of healthcare, the location of the European Medicines Agency and economic implications for the pharmaceutical industry have already been identified as key post-Brexit challenges. A broader question, however arises regarding the changing dynamics one can expect at EU level on a number of key health dossiers and the impact of Brexit on the general EU approach to health policy.

Brexit – the loss of a key partner across the health policy spectrum?

Although the institutional arrangements of the post-Brexit EU-UK relationship are unknown at this stage, it can be assumed that a Brexit would lead to the UK losing most of its ability to influence both the EU health policy agenda and negotiation process on key dossiers.

Under the European Health Technology Assessment (HTA) network, national authorities are discussing common approaches to assessing the relative efficacy, societal benefits, and the pricing and reimbursement of medicines. In this field, the UK National Institute for Health and Care Excellence (NICE) is a widely renowned institution which could have provided useful input to this process. On the other hand, the Healthcare UK programme, under which the NICE plans to sell its HTA expertise abroad, could see Europe as another market in which to do business.

Industry can also regret the loss of a pragmatic and innovative, business-friendly partner. On intellectual property rights and incentives for example, where reforms of the current system are increasingly presented as a necessity by The Netherlands and other member states, the UK would have likely offered counter-balancing views.

It is likely to become much more difficult for UK stakeholders to engage at EU level and drive the agenda. Without UK organisations, the European Data in Health Research Alliance, a coalition aiming to ensure that the specificities of health data are taken into consideration in the data protection package, may not have emerged. On Anti-Microbial Resistance (AMR), it is UK leadership that contributed to putting the issue at the top of the agenda, with the Commission now considering the possibility of EU action.

The leave vote – a real change regarding the EU’s approach to health policies?

While Brexit is likely to have significant consequences on specific dossiers, its impact on the broader EU approach to health policy is less clear.

The entry into office of the Juncker Commission in 2014 undoubtedly led to less health-related legislative and policy output. The election of a high number of Eurosceptic MEPs in 2014 was interpreted as a sign that the EU needs to do less and focus on broad priorities contributing directly to jobs and growth. The legislative framework for pharmaceuticals and tobacco had recently been revamped, and since 2014, health legislation has entered something of a ‘deep freeze’.

The jobs and growth focus has led the European Commission to deal with health dossiers where it has limited powers, such as health systems sustainability in an austerity context. The move towards subjects on which a very weak competence exists has resulted in more Joint Actions, intergovernmental approaches and Commission studies and expert groups from which member states can pick and choose.

On health technology assessment, member states and healthcare organisations are working together and exchanging best practices via a network, EUnetHTA. Discussions on pharmaceuticals pricing mechanisms remain mainly national or intergovernmental, for instance the Benelux initiative on common orphan drugs price negotiations or the similar initiative announced by Bulgaria and Romania last year.

A key question therefore, is whether Brexit will reinforce this fragmented, increasingly intergovernmental approach to health policy? Maybe the UK presence in the EU, perhaps the most stubborn member state on matters of sovereignty, is the reason for such an approach. A change in treaty might be needed to move beyond the status quo following Brexit, the 5 Presidents Report and the persistence of the European economic malaise, but this is not politically conceivable over the coming years.

However, while health policy remains largely intergovernmental, perhaps a post-Brexit UK could still participate in certain initiatives. ‘Taking back control’ was a leitmotif of the Brexit camp throughout the referendum, though it would be surprising if the UK were to completely duck out of EU health policy cooperation and dialogue.

What next?

There is no doubt that on a number of specific health policy topics, stakeholders and other member states will lose a key partner. Whether Brexit will lead to an entire institutional and political shake up, is however less certain at this stage. Although the UK referendum outcomes were a wake-up call for many capitals, radical change to the EU via treaty changes has been at the moment ruled out. Brexit may only demonstrate that a multi-speed EU cooperation, which already exists to some degree in the field of health, is a relevant way forward for Europe in the short to middle-term.

Words  Thomas Kanga-Tona, Burson-Marsteller Brussels

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