Global Trends in Health Care
Reform: Europe
Academyy Health
Boston, 28th June 2010
Josep Figueras
www.healthobservatory.eu
The Europe of the Values?
Oslo - ministerial meeting
12 Recommendations
• Distribute wealth based on
solidarity and equity
• Increase development aid
• Health and wealth; protect
health budgets
• Every minister a health
minister
• Prioritize public health
and primary care
• More
M
money ffor hhealth
lth andd
more health for the money
• Universal social protection
• Universal access to health
services
• Universal,
Universal compulsory,
compulsory
redistributive funding
• Tax and price policy for
tobacco, alcohol, sugar, salt
• Education of health
professionals and ethical
recruitment
• Active public participation in
development of anti-crisis
measures
Some…. ffinancing
g reform
f
trends
• Predominantly
P d i tl public
bli funding
f di
– Limited role of both OOP and PHI
• Mixed role of markets in insurance (regulated)
– Netherlands,, Switzerland,, Germany,
y, Czech Republic
p
•
•
•
•
Towards taxation / social health insurance mix
Funding long term care
Strategic purchasing / selective contracting
Performance-base payment
– Convergence in case mix measures
20%
10%
0%
SII
FR
R
NL
L
SK
K
CZ
Z
BE
E
DE
E
EE
E
PL
L
HU
U
RO
LT
T
CH
H
LU
U
BG
G
EL
L
AT
T
CY
Y
LV
V
FII
ES
S
PT
T
NO
O
IT
T
MT
T
IE
E
SE
E
UK
K
DK
K
Source: W
WHO 2010
Health financing in the EU (2008)
100%
90%
80%
70%
60%
50%
40%
30%
Tax
SHI
PHI
OOP
Other private
Out--ofOut
of-pocket payment as % of total
health expenditure (EU)
70
Countries experiencing an increase in OOP since 1997
60
50
%
40
30
20
10
NLD
LUX
FRA
IRL
GBR
CZE
SVN
DNK
DEU
AUT
SWE
FIN
MLT
EST
ITA
ESP
BEL
HUN
PRT
ROU
SVK
POL
LTU
GRC
LVA
BGR
CYP
0
1997
Source: WHO 2009; OOP = out-of-pocket payments
2007
PHI as % off total health spending
p
g (EU)
20
15
% 10
5
0
SK
CZ SE BG
LT
PL
IT
UK
LV
EE HU DK
EL
LU
1996
Source: Thomson and Mossialos 2009
MT
2006
PT
FI
RO
AT
BE
NL
ES
CY
IE
DE
FR
SI
Beveridge and Bismarck are dead
Otto Von Bismarck
William Beveridge
g
European DRG systems – one family
but often distant cousins
1977
Yale DRG
1983
HCFA DRG
Classification adopted
without or with minor modifications
Classification adopted with
major modifications
GHM 1
(France)
1986
1988
AP DRG
1991
APR DRG
1992
1993
1995
AN DRG
Hungary
Italy
Nord
DRG
1996
1997
1999
AR DRG
2002
2003
GHM 2
(France)
Spain
Denmark
HRG
(England)
Germany
PPS
(France)
2004
From
R Busse
4 June 2010
EfP
(France)
Future demands for DRG systems- the EuroDRG project
10
Enhancing integrated care
Wide
Wid range off strategies
t t i (examples)
(
l )
• N
Nurse-led
l d strategies
t t i
• Nurse-led clinics; discharge planning; case
management
• Common in systems with strong primary care
(teams) (UK, NL, SWE)
• Disease management
g
p
programmes
g
((D,, NL))
• Coordination of providers
• ‘Chains
Chains of care’
care (SWE)
• Health networks (FRA)
• Self-management
S lf
t supportt (EN,
(EN DK)
Managing Chronic Conditions Nolte et al
Some… organizational reform trends
•
•
Enhancing
g integrated
g
care
Strengthening primary care
–
•
•
Enhancing quality of care / patient safety
Health Technology Assessment
–
•
E.g.
g EUnetHTA
Restructuring publicly operated providers
–
•
E g Family practice schemes
E.g.
E g Self governing hospitals
E.g.
Strengthening public health
–
Health in All Policies
Empowering
p
g consumers
• Both ‘Voice’ as well as ‘Exit’ mechanisms
• Patient rights legislations and charters
–L
Legall enforcement
f
t & incentives
i
ti
e.g. Waiting
W iti times
ti
guarantees
• Wide increases in choice across the region
– Some choice of sickness funds e.g. Netherlands, Germany
– Choice of PHC, hospital providers e.g. Nordic systems
– Money
M
ffollows
ll
patient
ti t yett ….
….. issues with consumer information / provider
benchmarking
Would you be willing to travel to another EU
country to receive medical treatment?
YES
5
1
3
2
2
3
5
6
5
10
13 20 19 21 22
19 25
80%
27 28
70%
10
5
7
6
2
4
5
3
7
27 34 36 37 44 42
42 45 41
9
42
10
44
60%
Mainly for
treatments not
50%
88
available
at home,
82 79
40%
78 77 76 75
quicker access
and
30%
b tt quality
better
lit
72
68 67
63 61
57 57 54
20%
10%
3
5
2
4
9
15
52
10
4
EU15 satisfied with
healthcare at home
54
58
54
concerned
NMS:
59
58
47 financial
about
61 70
impact
53 53 52 50
46 45 43
40 40 38 37
33
29 26
Source: Eurobarometer 2007
FI
EE
H
U
AT
BG
R
O
U
K
EU
1
EU 5
27
N BE
M
S1
2
SK
PL
IT
SE
ES
EL
PT
IE
D
K
N
L
LU
SI
B t only
But
l 4% actually
t ll did iin th
the llastt
12 months!
0%
C
Y
M
T
53
3
FR
LV
90%
2
DK/NA
C
Z
D
E
LT
100%
NO
Mobility of EU medical doctors with the EU
Data: EU recognition of diploma in host country 2008*
Migration flows of physicians to the US & Canada
(WHO 2009)
ECJ rulings
IT & expectations
From W Palm
National Subsidiarity?
Two concluding reflections
• No longer State vs Market political debate but
consensus on different mix by
y HS sub-sectors
• F
From the
h Market
M k era, to the
h Governance
G
era to ….
…thee era
…t
e a of
o Alignment
lig e t ((incentives,
ce t ves, strategies,..)
st ateg es,..)
http://www.healthobservatory.eu
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y