European Health Policy, European Health Policy, Enlargement and Health Enlargement and Health

Systems Systems

Bernard MerkelBernard Merkel

European Commission European Commission

Public Health DirectoratePublic Health Directorate

Bad Hofgastein, September Bad Hofgastein, September 20022002

OBJECTIVESOBJECTIVES

To show the bases for EC Health policyTo show the bases for EC Health policy To show its limitations in relation to To show its limitations in relation to

health systems health systems To show how nevertheless it is To show how nevertheless it is

advancing advancing To relate this to the applicant To relate this to the applicant

countries situationcountries situation

EU Health PolicyEU Health Policy

New Treaty Powers

Challenges & Trends

Enlargement of the EU

HEALTH SYSTEMS UNDER STRAINHEALTH SYSTEMS UNDER STRAIN Need to improve efficiency and effectivenessNeed to improve efficiency and effectiveness Priority setting and rationingPriority setting and rationing FinancesFinances

ChallengesChallengesDEMOGRAPHIC TRENDSDEMOGRAPHIC TRENDS Ageing population, falling birth rate dependency ratioAgeing population, falling birth rate dependency ratio

NEW TECHNOLOGYNEW TECHNOLOGY Innovative pharmaceuticals and treatments, BIOTECHInnovative pharmaceuticals and treatments, BIOTECHInformation technologyInformation technology

HIGHER EXPECTATIONSHIGHER EXPECTATIONSInformation explosionInformation explosionRole of health professionals - want to do moreRole of health professionals - want to do moreThe public - want more/ want the bestThe public - want more/ want the best

Public Health in the Public Health in the European UnionEuropean Union

Treaty Obligation (Article 3 (p))Treaty Obligation (Article 3 (p))– contribution to attainment of a high contribution to attainment of a high

level of health protectionlevel of health protection Treaty Obligation (Article 152)Treaty Obligation (Article 152)

– improving healthimproving health– preventing diseasespreventing diseases– obviating sources of danger to healthobviating sources of danger to health– ensuring that all EC policies protect ensuring that all EC policies protect

healthhealth

Other EC Treaty Articles Other EC Treaty Articles with health as a with health as a

subsidiary or implicit subsidiary or implicit objectiveobjective

Arts. 43-50 : right of establishment, services;Arts. 43-50 : right of establishment, services; Art. 71 : transport ; Art. 71 : transport ; Art. 95 : internal marketArt. 95 : internal market Arts. 131-133 : common commercial policyArts. 131-133 : common commercial policy Art. 140 : social security and protection ; Art. 140 : social security and protection ; Art. 149 : educationArt. 149 : education Articles 158 and 161 : economic and social Articles 158 and 161 : economic and social

cohesioncohesion Article 163-173 : research and technologyArticle 163-173 : research and technology Article 177 : development co-operation Article 177 : development co-operation Arts 300 and 302: international agreementsArts 300 and 302: international agreements

The role of the The role of the Community in health Community in health

carecare Exclusion in Art 152Exclusion in Art 152 ““Community action in the field of public Community action in the field of public

health shall fully respect the health shall fully respect the responsibilities of the member states responsibilities of the member states for the organization and delivery of for the organization and delivery of health services and medical care.”health services and medical care.”

Little Competence in Health care/social Little Competence in Health care/social protection protection financefinance (ECJ Poucet & Pistre (ECJ Poucet & Pistre 1990s)1990s)

New Public New Public Health ProgrammeHealth Programme

3 strands of action3 strands of action

1 -Health Information

2 - Rapid Reaction

3 - Health Determinants

Heath system aspectsHeath system aspects

Information on health careInformation on health care Benchmarking (?) Benchmarking (?) A quality agendaA quality agenda Health technology assessmentHealth technology assessment Inequalities - social and economic Inequalities - social and economic

issuesissues

Member State Co-operationMember State Co-operation

New InstrumentNew Instrument Lisbon Process Lisbon Process Open co-ordination Open co-ordination

Open Co-ordinationOpen Co-ordinationHealth Care & Care for the Health Care & Care for the

ElderlyElderly

Gothenburg European Council asks for Gothenburg European Council asks for reportreport

Commission Communication December Commission Communication December 2001: focus on 2001: focus on quality, access and quality, access and financial viabilityfinancial viability

Report to Barcelona European CouncilReport to Barcelona European Council Barcelona Conclusions: Continue work Barcelona Conclusions: Continue work

on the 3 priority areas, prepare report on the 3 priority areas, prepare report for European Council (Greek Presidency)for European Council (Greek Presidency)

Health Care and Care Health Care and Care for the Elderly (2)for the Elderly (2)

Questionnaire to Member StatesQuestionnaire to Member States Commission Communication (End Commission Communication (End

2002)2002) Report to Athens CouncilReport to Athens Council

Main actor: Social Protection Main actor: Social Protection CommitteeCommittee

EVEN MORE IMPORTANT:EVEN MORE IMPORTANT:THE INTERNAL MARKET AND THE INTERNAL MARKET AND

HEALTHHEALTH

The internal market:The internal market:

Freedom of movement:Freedom of movement:

GoodsGoods

ServicesServices

PeoplePeople

CapitalCapital

Is inevitably the free movement ofIs inevitably the free movement of

* Physicians, health professionals, patients

* Pharmaceuticals, medical technologies and supplies

* Insurance

* Hospital investment

• Recognition of qualifications

• Demographic pressure

Circulation of Patients Circulation of Patients (1)(1)

Malaga meeting of Health ministersMalaga meeting of Health ministers

Increasing movement of patientsIncreasing movement of patients

Added value: Added value:

Reference Centres, sharing unused Reference Centres, sharing unused capacity, border regions, long-term capacity, border regions, long-term residentsresidents

Information on quality and cost of Information on quality and cost of health carehealth care

Circulation of Patients Circulation of Patients (2)(2)

Menorca meeting of experts - Menorca meeting of experts - gathering experience in four priority gathering experience in four priority

areas areas

Council Conclusions June 2002: Council Conclusions June 2002: –Welcomes the debate launched in MalagaWelcomes the debate launched in Malaga–Supports launch of a high level reflection Supports launch of a high level reflection groupgroup

–Work in this field to be undertaken by the Work in this field to be undertaken by the Public health programmePublic health programme

Circulation of Patients Circulation of Patients (3)(3)

Launch of a reflection process with Launch of a reflection process with health ministers and key health ministers and key

stakeholders - stakeholders - autumnautumn

Report: second half of 2003Report: second half of 2003

Health and EnlargementHealth and Enlargement

SPECIFIC PROBLEMS SHARED BY SPECIFIC PROBLEMS SHARED BY MOST ACCESSION COUNTRIESMOST ACCESSION COUNTRIES

* Poorer health statusPoorer health status* Limited public health traditions* Limited public health traditions* Spread of communicable diseases* Spread of communicable diseases* Fewer resources to spend on * Fewer resources to spend on healthhealth* Weaknesses in quality assurance * Weaknesses in quality assurance and surveillance systemsand surveillance systems

Health Care Reform in Health Care Reform in the Candidate Countriesthe Candidate Countries

AIMSAIMS: Equity of access /universal coverage : Equity of access /universal coverage

Specific aims differ between countriesSpecific aims differ between countries

MeasuresMeasures

Primary carePrimary care

Decentralization of decision makingDecentralization of decision making

Introduction/reform of health insurance Introduction/reform of health insurance schemesschemes

Better cost informationBetter cost information

Prevention/promotion?Prevention/promotion?

Health Care Funding in Health Care Funding in central and eastern central and eastern

EuropeEurope

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Percentage of total health expenditure from taxation Observatory chart

perc

enta

ge o

f tot

al h

ealth

exp

endi

ture

from

soc

ial

heal

th in

sura

nce

ROM

LATPO

HU

CZSL

ESSK

What Should the What Should the Commission Do about Commission Do about Health Care Finance in Health Care Finance in Applicant CountriesApplicant Countries??

Support studies/ analyses e.g. impact of Support studies/ analyses e.g. impact of financing systems on public healthfinancing systems on public health

Improve healthcare data systems - Improve healthcare data systems - hardware/softwarehardware/software

Disseminate best practiceDisseminate best practice

Support expert exchangeSupport expert exchange

Support training schemes e.g. accountantsSupport training schemes e.g. accountants

Support civil society/ NGOsSupport civil society/ NGOs

Co-operate with major actors in health Co-operate with major actors in health carecare

What should the What should the Commission Commission notnot

do?do?

Tell the applicant countries Tell the applicant countries how to organise their how to organise their

health care systems or health care systems or their healthcare financingtheir healthcare financing

Why Not?Why Not?

Health care financing does not fall Health care financing does not fall under under the competence of the ECthe competence of the EC

Neither does health system organisationNeither does health system organisation

Health problems and objectives differ, Health problems and objectives differ, and so do the means and so do the means

The amount of money for health, The amount of money for health, and and the the way it is raisedway it is raised is ultimately is ultimately

a a matter of matter of societal choice. societal choice.