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Basic Healt h care Packages & European Healthcare Policies Czech Health Care Forum Biannual High Level Conference – 17 April 2009, Darova (CZ) Marcel J.G. Smeets Director-general Tel. +32 2 234 57 00 | [email protected] | www.aim-mutual.org. An international association - PowerPoint PPT Presentation
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AIMAssociation Internationale de la Mutualité
Basic Healthcare Packages &European Healthcare Policies
Czech Health Care Forum Biannual High Level Conference – 17 April 2009, Darova (CZ)
Marcel J.G. SmeetsDirector-general
Tel. +32 2 234 57 00 | [email protected] | www.aim-mutual.org
AIM
Ass
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An international associationfor universal priciples
AIM
Ass
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AIM
Ass
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éMembership
41 national federations27 countries worldwideEurope, Middle-East, Africa, Latin-America
ActivitiesHealthcare financingHealthcare provision
Social services, pensionsFor 240 mln citizens
Values and principlesHealth and well-being
Autonomous managementNot-for-profit orientation
Solidarity
ObjectivesInterest representationKnowledge exchange
LobbyingPromotion
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International Co-operation European AffairsThematic groups
Working groupsLong term care
PharmaceuticalsCross border care
Healthcare Systems Disease Management
eHealth & Telemedicine
IssuesSocial Protection Social economy
Public Health Healthcare
LobbyEU Presidencies
Europepean statute for mutual benefit societies Patients´ rights directive Pharmaceutical package
AIM
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Healthcare
Social services
Bismarck Beveridge
Statutory
Voluntary
Payer
Provider
Free choice members
Limited choice membersIn-kind services
Re-imbursement
Developing countries
Developed countries
Insurance
Provision
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é Classification of members
Healthcare
Social services
Bismarck Beveridge
Compulsory
Voluntary
Payer
Provider
Free choice members
Limited choice membersIn-kind services
Re-imbursement
Developing countries
Developed countries
Insurance
Provision
AIM
Ass
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la M
utu
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é Classification of members
Healthcare
Social services
Bismarck Beveridge
Compulsory
Voluntary
Payer
Provider
Free choice members
Limited choice membersIn-kind services
Re-imbursement
Developing countries
Developed countries
Insurance
Provision
AIM
Ass
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ion
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de
la M
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é Classification of members
Healthcare
Social services
Bismarck Beveridge
Compulsory
Voluntary
Payer
Provider
Free choice members
Limited choice membersIn-kind services
Re-imbursement
Developing countries
Developed countries
Insurance
Provision
AIM
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3 models of healthcare financing in Europe
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Tax-based
Government driven
Public provision
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Insurance-based
Employers & Employees
Public-private mix
AIM
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Government-driven
Planning & Control
AIM
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é CompulsoryImplication of mutual healthcare funds
AIM
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healthcare funds
AIM
Ass
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é CompulsoryComplementarySupplementary
Implication of mutual healthcare funds
AIM
Ass
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Implication of mutual healthcare funds
AIM
Ass
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AIM
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Increased patient responsability Privatisation and commercialisation Focus on cost-efficiency Development of ICT Cost-control in pharmaceuticals Growing need of healthcare
professionals
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é Increased patient responsability
Financially• Co-payments and out-of-pocket• Deductibles and penalties
Life style• Habits and follow-up• Prevention
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Healthcare as a market Patient as a consumer Standardisation and competition
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Financing based on pathology Pay for performance Gatekeeping Fading concepts of in- and out-
patient Concentration of funding
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Electronic Medical Records Ownership and sharing information Integrated and Continuous care Business case
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é Cost-control in pharmaceuticals
Growth pharma expenditure exceeds growth healthcare budgets
Focus on generic medicines Rating systems (NL = « Preference
policy ») Re-assessment of marketing and
refund policies
AIM
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é Growing need of healthcare professionals
Ageing « Feminisation » sector Geographical distribution Education and numerus clausus Mobility and braindrain
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é Changing Healthcare Settings
From « cure » to « care » From « instant » to « constant » From « treatment » to « prevention » From « institution » to « person » From « process » to « induvidu » From « come » to « get »
AIM
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é The New Role of Healthcare Mutuals
Payer and Provider
Director of care
Pay office
Engagement in healthcare management
Stee
ring
capa
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Director of healthcare
Payer and provider
AIM
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éFuture challanges
Sustainability, solidarity and equity Transparency and information Productivity and performance Prevention and education Quality improvement
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é Basic Healthcare Packages
3 dimensions• Who is covered (persons)• What is covered (products & services)• How is it covered (financing)
How to evaluate How to decide
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é Basic Healthcare Packages- Basic dimensions -
Who?
What ?
How ?
Courtesy to Prof.Dr R. Busse
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Who?
What ?
How ?
What ?• New techologies• Political choices
Who? Universalsation
How
? P
rivatisation
Courtesy to Prof.Dr R. Busse
AIM
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Discussions started in 1980´s• New/rare diseases (UK, Scandinavia)• Waiting lists (NO, NL, UK)• System reforms (NL, IL)
2 approaches• Developing principles (NL, NO, SE, DK)• Recommend concrete services (UK, IL)
Courtesy to L. Sabik & R. Lie, 2008
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Netherlands = Principles Dunning-Committee (1990) Reduction of coverage 4 principles :
• Necessity (added value)• Effectiveness (evidence)• Efficiency (value-for-money)• Individual responsability
(lifestyle)
Dunning´ pyramide Functional description Dental care for adults
excluded
Israel = Recommend services National Health Insurance
Law (1995) Basic cover = largest
sickness fund´s offer Updating via HTA
• Evidence-based• Clinical• Epidemological• Economical
Categorisation by Committee Catalogue of services
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é Basic Healthcare Packages- Evaluation & decisions -Criteria AT AU CH FI FR NL NO NZ SE UK
Therapeutic value √ √ √ √ √ √ √ √ √ √Patients´ use √ √ √ √ √ √ √ √ √ √Cost-effectiveness √ √ √ √ √ √ √ √Budget effects √ √ √ √ √ √Alternatives √ √ √ √ √ √Social/ethical considerations √ √ √ √ √Societal need √ √R&D costs producers √ √Government priorities √
Courtesy to Prof.Dr R. Busse
AIM
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-
(semi) Independent agency
Based on materials
provided by producers
Based on existing
research & study
Based on own
research & study
NL, NO CH, FI, FR UK, SE
AIM
Ass
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é Towards a pan-European Healthcare Basket ?
Evidence-based evaluations Consumer-driven healthcare Standardisation of accreditation &
quality Unified guidelines for diagnosis &
treatments Patient & provider mobility
AIM
Ass
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é Social protection
Public health
Healthcare
Socialeconomy DG SANCO
DG EMPL
DG MARKT
DG RESEARCH
DG COMP
Social partners
Providers associations
Patient organisations Public health
associations
Social economy
family
Social security organisations
Paritarian organisations
EESC
Public Health Forum
Pension forum
DG INDUS
Pharma Industry
AIM
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é Social protection
Public health
Healthcare
Socialeconomy DG SANCO
DG EMPL
DG MARKT
DG RESEARCH
DG COMP
Social partners
Providers associations
Patient organisations Public health
associations
Social economy
family
Social security organisations
Paritarian organisations
EESC
Public Health Forum
Pension forum
DG INDUS
Pharma Industry
European Pharmaceutical
Forum
AIM
Ass
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Public health
Healthcare
Socialeconomy DG SANCO
DG EMPL
DG MARKT
DG RESEARCH
DG COMP
Social partners
Providers associations
Patient organisations Public health
associations
Social economy
family
Social security organisations
Paritarian organisations
EESC
Public Health Forum
Pension forum
DG INDUS
Pharma IndustryPROPOSAL DIR
ECTIVE
PATIENTS´R
IGHTS IN
CROSS
BORDER CARE
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Ass
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é What was proposed by the European Commission
Feb 2007
Draft 1
Re-imbursement
Liability Patient mobility
MAR
-
DEC
2007
Draft 2
Re-imbursement
Liability Patient mobility
Provider mobility
Draft 3
Re-imbursement
Liability Patient mobility
Provider mobility
In-patient definition
Draft 4-7
Re-imbursement
Liability Patient mobility
Provider mobility
In-patient definition
Quality & safety
JUN
2008
Draft
8
Re-imbursement
Liability Patient mobility
Provider mobility
In-patient definition
Quality & safety
AIM
Ass
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éWhat is discussed
Feb 2007
Draft 1
Re-imbursement
Liability Patient mobility
MAR
-
DEC
2007
Draft 2
Re-imbursement
Liability Patient mobility
Provider mobility
Draft 3
Re-imbursement
Liability Patient mobility
Provider mobility
In-patient definition
Draft 4-7
Re-imbursement
Liability Patient mobility
Provider mobility
In-patient definition
Quality & safety
JUN
2008
Draft
8
Re-imbursement
Liability Patient mobility
Provider mobility
In-patient definition
Quality & safety
European Court of Justice
European Parliament
AIM
Ass
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éWhat is discussed
European Commission
Member States
Feb 2007
Draft 1
Re-imbursement
Liability Patient mobility
MAR
-
DEC
2007
Draft 2
Re-imbursement
Liability Patient mobility
Provider mobility
Draft 3
Re-imbursement
Liability Patient mobility
Provider mobility
In-patient definition
Draft 4-7
Re-imbursement
Liability Patient mobility
Provider mobility
In-patient definition
Quality & safety
JUN
2008
Draft
8
Re-imbursement
Liability Patient mobility
Provider mobility
In-patient definition
Quality & safety
AIM
Ass
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