This was the analogy put to delegates by Hungarian Minister of State for Health, Miklos Szocska, during the first session of the European Health Forum panel on “Investing for health. From health to wealth.” But can all European countries make sure they stay in the saddle?

DG SANCO director general Paola Testori Coggi focused her talk around the commission staff working document, “Investing in Health,” and detailed the upcoming priorities at EU level, including the implementation of the cross border healthcare directive. She reiterated the need to view health spending as an opportunity for investment—fewer sick days mean increased productivity among the workforce. After all, how can Europe get back on its feet financially if we’re all unwell?

Nevertheless, she also highlighted that, in an age where health spending has not increased in Europe in real terms since 2008, there was definitely also a need to work “smarter.” Some countries are working hard simply trying to keep their health systems operational. There were four (Portugal, Ireland, Greece, and Cyprus) who faced recommendations after the European Semester process that were primarily based on the priority of national debt reduction rather than the preservation of the health system.

Szocska and Raed Arafat, the Romanian Secretary of State for Health, gave an overview of the practical difficulties they have faced in sustaining their health systems through austere times. Incidentally both health ministers either hold, or are approaching, the record for being the longest serving health ministers in their countries, and their contributions were particularly insightful. Hungary increased state ownership of hospitals, and made efficiency improvements by reimbursing daycase and outpatient procedures more effectively, and by cutting the number of acute service beds to shift care away from overnight admissions. Szocska noted difficulties faced here that will be familiar to any politician in a constituency facing a hospital closure – it’s not easy convincing the general public that what they want is a “local health centre” rather than a local hospital.

Romania also advocated moving services from hospitals into community care, and it increased state ownership by taking on management of more emergency services throughout the country. Arafat noted that countries should remember that reform processes, even if they are to improve efficiency, are still going to cost money. The potential for a cyclical process of centralisation and decentralisation of services was potentially wasteful and he urged countries to learn from each other’s mistakes as well as from best practice. At EU level, Szocska also noted there was room to better improve co-ordination across the directorates where health issues were involved; he cited the difficulties Hungary had faced in trying to introduce a food tax on unhealthy products.

Jennifer Hislop is a Young Gasteiner and a research associate at Newcastle University, England.

I declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.