Europe is now in its fifth year of a grinding economic crisis that has affected the daily lives of Europeans in many ways. One of the most profound effects has been on the provision of healthcare.

In Greece, austerity imposed by the government at the request of international lenders, including the European Central Bank and the EU, has forced cuts to the spending of hospitals and other healthcare providers. Doctors and other medical professionals have been laid off. What was already a poorly functioning health service is plagued with long waiting times and poor care.

It is not only in Greece that the economic crisis has affected citizens’ access to healthcare. In Spain and Bulgaria, the healthcare systems have creaked badly. As the need for care increases, the financial resources to pay – whether on the part of the state or the individual – have decreased. Citizens are asked to contribute more for their care, which puts care out of the reach of some. The principle implied in EU law that treatment should be accessible to every patient who needs it is under strain (see page 14).

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The crisis has had other significant effects on healthcare in the EU. It has given the EU institutions an unprecedented level of control over national healthcare decisions.

Officially, the EU still has only a limited competence to make policy in the field of health – it is for member states to make decisions about their own healthcare systems. But the introduction of greater surveillance of national budgets – through the European Semester – has involved the European Commission in national healthcare decisions. Under the European Semester, the Commission makes recommendations about healthcare, social security and pensions.

Although the semester programme was started in 2010, as the eurozone felt the need to ratchet up powers to enforce more disciplined economic governance, examination of national healthcare spending did not start until last year. Now, the Commission has a degree of scrutiny over national healthcare decisions, and has been tasked with making sure healthcare funding is not only being spent wisely, but also maintains a fair degree of access.

Campaigners for vulnerable groups such as the poor, the disabled and those with rare diseases increasingly see an opportunity, even a need, to turn to the Commission as the guarantor of patients’ rights.

The semester is not, however, the principal way that the EU looks to improve and guarantee access to healthcare. More directly, the EU has passed legislation that looks to set some common standards about the provision of healthcare.

A law on cross-border healthcare is supposed to codify patients’ rights to get access to healthcare in countries other than their own. Patients can go to another EU member state if the operation or treatment they need is not available in their own country in a timely manner. The legislation also imposes obligations on national healthcare systems to be transparent about pricing, which will force some member states for the first time to put prices on their medical procedures. The EU hopes this will reduce wasteful spending and improve access to healthcare for patients. EU measures to encourage e-health are also seeking to increase information and access (see page 16). The technological possibilities are growing all the time, though so also are the possibilities of a digital divide in which the technologically savvy patient has greater access to more, better and cheaper care than the technologically illiterate.

Increasingly the EU is also getting involved in the quality of care. The health scare about faulty breast implants from PIP fed fears about the safety of medical technology and procedures. Calls for changes in approval processes are growing, even while the possibilities for patients to buy procedures or medicines outside the traditional channels proliferate. Last week the European Parliament approved EU-wide rules for conducting clinical trials on medicines and agreed a first-reading position on EU approval of medical devices.

The landscape of healthcare is changing rapidly on many fronts. The challenge for the EU is to ensure that access to healthcare keeps pace with technological changes to care and its delivery.