The economics of prevention and quality of care: policy insights from the EU's COVID-19 response.

Introduction: Prevention and quality of care are increasingly recognized as fundamental drivers of sustainable, high-performing health systems. Both have demonstrated cost-effectiveness and long-term benefits, yet remain underfunded and fragmented across many European Union Member States. The COVID-19 pandemic offered a natural stress test, revealing significant variation in investment patterns, system responsiveness, and outcome efficiency.

Areas covered: This article integrates economic theory, empirical evidence, and policy analysis to explore how prevention and quality jointly shape system value. It includes analyses of prevention expenditure trends, elasticity to GDP and health spending, and cross-country efficiency indicators across EU Member States (2019-2022). The findings draw from Eurostat data and a targeted review of economic literature on cost-effectiveness and value-based care.

Expert opinion: Empirical results confirm that prevention is income- and budget-elastic, but efficiency and impact depend on institutional capacity and governance. The underuse of economic tools in quality planning and prevention prioritization hampers performance. Embedding efficiency metrics, dynamic modeling, and performance-based allocation into policy frameworks is essential to enhance value and resilience. In the coming years, prevention and quality should be better embedded in fiscal planning and system performance, not just as public health imperatives - but as economic necessities.