The Capital Asset Investment Dimension

EU Structural Funds are primarily aimed at promoting and facilitating social cohesion across EU states, through reducing regional variations in current and future economic potential; which in turn may contribute to disparity in social and health equality. Funds are therefore targeted primarily at investments that lead to growth in social and human capital, as a driver of economic growth, and as a way of helping reduce (health) inequality.

Since 2007/13, ‘Health’ – through the agency of DG Sanco – has received specific ring-fenced funds as part of this process in recognition of the ‘health is wealth’ principles embedded in EU policy frameworks. However, targeting funds in this way also recognized that social trends across Europe illustrate a widening of the health-gap (inequality) within and between countries. Furthermore it acknowledged that one of the major fault-lines between the 15 and the ‘new’ 12 is the poor condition of health infrastructure. This is in part a legacy of the former Semashko healthcare system (reliant on a hospital-centric care model and centrist planning regimes) compounded by decades of underinvestment across almost all ‘new’ member states.

It is clear that a significant proportion of funds has, and will in the future, be directed to investment in replacing and renewing capital assets (including large scale information and clinical technologies). This reflects the fact that in many parts of Europe, in particular those qualifying for structural funds have seen decades of underinvestment in healthcare facilities. Bearing in mind the absorption comments above and the need to achieve meaningful and measurable health benefit, experience from across all EU member states will be important to help understand what works and what does not in the context of capital investment.

This domain of heathcare has recently been the subject of a three year cross sectional study (in partnership) by the European Centre for Health Assets and Architecture and the European Observatory on Health Systems and Policies. It has been found that, despite considerable expenditure on hospitals in European health systems, there was little evidence to inform those seeking to ensure that capital investment in the health sector will maximize health gains, meet the expectations of patients and staff, and facilitate the efficient and effective delivery of health services. It was apparent that many investments in health facilities placed an undue emphasis on short-term tactical considerations, such as keeping projects “on cost and on time”.

The much more important goals of creating sustainable structures that can optimize population health and support the development of organizations delivering health care, while remaining relevant to the changing needs of patients and staff throughout the lifespan of the facility are often neglected. We sought to identify factors that would increase the chances that a capital project would be successful. Some of those we studied included taking a whole systems and lifecycle perspective, systematizing care pathways, ensuring quality-at-entry, understanding the relationship between capacity and the services to be delivered, engaging with patients and staff, and ensuring future flexibility.

Helping countries and regions access SF and invest effectively in modernisation of facilities and services

As part of this process Euregio III was established to answer four general questions in relation to the manner in which the SF process operates:

• Have public authorities invested in option appraisal to clearly inform investment planning and decisions? 
• Do public servants and hospital managers know how to use Structural Funds efficiently?
• Do they have enough data and evidence of the benefits of investments in health? 
• What are the main difficulties in applying for funding and managing structural funds in the health sector?

The results of the review will be used to address perceived SF process needs.

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