In profile: cohesion policy
improving health services
in the regions

The EU's cohesion policy invests in health, a key asset for regional development and competitiveness, in order to reduce economic and social disparities. The health sector and public health policy is a very important issue across the European Union. Health spending accounts for almost 10% of the GDP in Europe with those people employed in health related fields accounting for 15% of the European workforce.    
Cohesion policy investments in health are closely linked with the EU's health policy framework, including needs assessment and cost-effectiveness. Investments may address a number of different areas such as Europe’s ageing population, healthcare infrastructure and sustainable systems, e-health, health coverage and health promotion programmes. 
The Coronavirus Response Investment Initiative (CRII) was adopted on 1 April, 2020 to mobilise cohesion policy to flexibly respond to the rapidly emerging needs in the context of the COVID-19 pandemic.  The objective is to target more support to the most exposed sectors, such as healthcare, SMEs and labour markets, and help to the most affected territories in Member States and their citizens.
In relation to health, the initiative includes provisions to accelerate and enhance support to Coronavirus related expenditure including  the financing of health equipment, medicines, testing and treatment facilities, medical equipment (including ventilators and masks) and support to vulnerable groups.  Accelerated procedures are also now in place to support the reallocation of EU cohesion policy financing.
It is expected that many national and regional programmes will come forward with reprogramming proposals in the coming weeks based on their specific needs.    
Below we examine the investments planned since 2014 under the European Regional Development Fund (ERDF) by the programmes.
As programmes report on progress the data presented below will be updated (indicator values and detailed financial progress are reported annually). 

Which types of health improvements are prioritised? 

Many types of  interventions can be financed by the ERDF.  The Commission's guidance for 2014-2020 highlighted the following priorities: 
  • Investment in health and social infrastructure to improve access to health and social services and reduce health inequalities, with special attention to marginalised groups such as the Roma and those at risk of poverty;
  • Infrastructure investments that contribute to the modernisation, structural transformation and sustainability of health systems, leading to measurable improvements in health outcomes, including e-health measures;
  • Targeted infrastructure investments to support the shift from institutional to community-based care, which enhances access to independent living in the community with high-quality services.
  • Support infrastructure investments in childcare, elderly care and long-term care;
  • Support for the physical and economic regeneration of deprived urban and rural communities including the Roma, which reduces the spatial concentration of poverty, including the promotion of integrated plans where social housing is accompanied notably by interventions in education, health, including sport facilities for local residents and employment.
Health investments in cross-border cooperation programmes respond to needs and challenges identified in the border regions. For example, projects focus on improving cross-border governance, important in emergency situations, as well as health and emergency services covering regions on both sides of the border. 
The Commission proposed broadening these priorities in the Coronavirus Response Investment Initiative as set out above.  
Project examples form the current and previous programmes are highlighted below:

Improving emergency services, BG 

Cohesion Policy funds are financing better equipped, more efficient and more accessible emergency healthcare services in Bulgaria with EUR 71 million.  All 237 emergency care facilities throughout the country will have improved infrastructure and emergency rooms with state-of-the-art medical equipment and 400 new ambulances.  Benefits should especially be felt in more remote areas and for the most vulnerable groups of patients.

Cross-border cooperation of emergency services, LT, PL

Emergency services in the cross-border areas between Lithuania's Marijampolé & Alytus regions and the Podlaskie & Warmińsko-Mazurskie regions of Poland cooperate to improve their response times and to promote the EU-wide 112 emergency number.

Da Vinci Surgical System: robots in surgery, ES

The da Vinci Surgical System project is developing techniques and providing the training for using robots in minimally invasive surgeries. 
It is improving the quality of surgical interventions and reducing patient recovery times.

New diagnostic centre for cancer patients in Vilnius, LT

new centre for positron emission tomography was built at the Vilnius University Hospital Santaros Klinikos. This advanced imaging technology has improved early diagnosis of cancer and the effectiveness of treatment. The modern centre provides better access to health specialists and state-of-the-art equipment for Lithuanian citizens.

What health investments were planned? How is it changing? 

"Intervention fields" are used to track direct EU investments in health improving services. Two make up the bulk of ERDF support: 
  • Code 053 : Health infrastructure (including systems and equipment)
  • Code 081 : ICT solutions addressing the healthy active ageing challenge and e-health services and applications (including e-Care and ambient assisted living)
Allocations can change over time with changing needs.  The changes in allocations since 2016 and particularly since early 2020 (linked to the COVID-19 pandemic) can be seen by comparing the two charts below.   
  • The chart on the left shows the progression in the EU amounts planned year on year 2016-2019;
  • The chart on the right show the changes to the total planned amount during 2020; 
  • Use the filters in the top right of each chart to filter by fund and country allocations. 
With the legal changes adopted in the CRII in early April 2020 it is expected that health actions will be increased.  

Explore progress with EU investment financing under ERDF

Using the chart below you can track the annual progress with the two ERDF intervention fields and, clicking on the bars, see the national investment efforts and programme effort.
Not all countries planned ERDF investment in these health objectives initially. Indeed, only a small number of Member States have allocated significantly in health categories: Poland is the clearest example of this, being at the top in all categories. In general, ERDF health investments tend to be concentrated in the less developed countries and regions.
There are also variations in the rate of implementation, both in deciding on the projects to finance and in the rate of investment spending by those projects. 
At a first glance, the data above raises question on how EU investment on health services is allocated and mobilised.
  • Why are only some of the countries focusing on improving health infrastructure? 
    It tends to be less developed regions and countries that mobilise EU funding for health service modernisation.  The richer countries have significant national budgets and, in any event, lower per capita EU funding, which is prioritised in areas such as research and SME competitiveness. The  two intervention fields do not capture research and innovation investments linked to human health and medical equipment made under the research and small and medium enterprise's high level themes.
  • Why are some of the decided amounts higher than the planned?
    This question has a simple explanation: overbooking of projects in the programme portfolios. In order to ensure that they will be able to spend as much as possible of the EU funding available, Member States often select more projects than strictly required under the plans. If some projects later fail, they programmes can still use the funding for other projects. In case all projects are completed, the national budget covers the overbooked costs that are not covered by the programme.

Explore progress with delivering investment outputs

One common indicator was defined for the period 2014-2020 to measure the "population covered by improved health services":  
Common Indicator CO36 is defined as: "Population of a certain area expected to benefit from the health services supported by the project. It includes new or improved buildings, or new equipment for various type of health service (prevention, outpatient or inpatient care, aftercare)."
This indicator was designed to track in an aggregate way the population benefiting from EU funded health service improvements.  The graph below compares the progress in tracking the European  combined improvement in health services measured by the common indicator.
  • By clicking on one of the bars a new graph appears showing the specific year across member states.
  • By further clicking, the information becomes even more specific by looking at within country information of the different programmes that use this indicator.
Comparing the common indicator targets and progress under the planned investments it appears that not all programmes investing in health are reporting on the common indicator. Indeed the common indicator does not capture all eligible actions, which have many other outputs captured by programme-specific indicators, which cannot be aggregated.
The common indicator has thrown up challenges.  It was challenging for the programmes to set accurate targets initially without knowing the projects that would be selected (that is why the programmes targets have been increasing year on year).  The values of the population benefiting are collected from each project. Where there are multiple projects there can be overlapping of the population covered, which can lead to over counting at programme level. This is being treated by some programmes by setting limits on the population covered. The robust of the values reported are alos likely to be addressed in impact evaluation).

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We are DG REGIO's Inclusive team. Contact us at:
(European Commission, Directorate-General for Regional and Urban Policy)

Date of text:  March 2020 - Authors: Petra Goran / Giulia Rossi Hernandez