Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones A EUROPE OF PATIENTS? EUROPEAN SYSTEMS IN A CHANGING ENVIRONMENT POLITICAL

Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones

A EUROPE OF PATIENTS?A EUROPE OF PATIENTS?

EUROPEAN SYSTEMS IN A CHANGING EUROPEAN SYSTEMS IN A CHANGING ENVIRONMENTENVIRONMENT

POLITICAL DIMENSIONPOLITICAL DIMENSION

SPAINSPAIN


PREMISES

• Exclusive competence of MS.

• SEM: freedom of movement: persons, capital, goods and services.

• Pillar of the welfare state.

• Challenge: Consumer? Citizen?.

• ECJ.


UniversalityUniversality

EquityEquity

SolidaritySolidarity

GENERAL GENERAL PRINCIPLESPRINCIPLES

Universal coverageUniversal coverage

Wide benefitsWide benefits

Public financingPublic financing

Private sector Private sector

supplementarysupplementary

MAINMAIN

CHARACTERISTICSCHARACTERISTICS

EUROPEAN HEALTH SYSTEMS


MINIMUMMINIMUM MAXIMUMMAXIMUM% GDP% GDP

HEALTH EXPENDITUREHEALTH EXPENDITURE


6,06,0

4,74,7

56,356,3

8,68,6

6,56,5

75,575,5

10,310,3

7,87,8

92,492,4

Public expenditure

Total expenditure

Public/Total


OBJECTIVES

Services closer

Cost containment

Increase citizens’ satisfaction

Improve quality

REFORMSREFORMS



COST CONTAINMENT

Slow increase

Achieved

Increasing more than Economy

REFORMSREFORMS



CLOSER TO THE CITIZEN

Devolution/decentralisation

REFORMSREFORMS



IMPROVE QUALITY

Evaluation, accreditation, homologation, recertification

Health Professionals

Institutions

REFORMSREFORMS



SATISFACTION?

REFORMSREFORMS



SATISFACTIONSATISFACTION


0

10

20

30

40

50

60

70

80

90

100

0 1000 2000 3000 4000 5000

$ p.c. PPP

% P

ob

. sa

tisfe

cha

I

E

IRLRU

AUSF

ASUE

B

DNFIN

HLUX


SATISFACTIONSATISFACTION


-20

-10

0

10

20

-5 5 15 25 35

Incremento gasto público p.c. 1995-97

Incr

em

en

to s

atis

facc

ión

19

96

-98

IE

IRL

RU

AUS

F

A

GR

B

DN

POR

H

LUX


ASPECTSASPECTS

PUBLIC HEALTH CARE SECTORPUBLIC HEALTH CARE SECTOR


• Financing: Solidarity

Citizen’s rights

• Provision: Guarantee of Quality-safety

Sustainability and cost control


ACTIONS

Guarantee of quality and safety

Health care rights of European citizens

Compensation systems

Actions to facilitate the movement

MOVEMENT OF PATIENTSMOVEMENT OF PATIENTS

EUROPE OF HEALTH


Health affair

Not a problem, but an opportunity

Paradoxe: to protect, regulate

SPANISH VIEWSPANISH VIEW

EUROPE OF HEALTH


Politicians, not Courts. Health, not Social Affairs

The Health Ministers wish to have a say in the matters being debated which affect health and health care

SPANISH VIEWSPANISH VIEW

EUROPE OF HEALTH

WHICH ONE?


ADDED VALUE

Borders

Centers of excellence

Waiting lists

Long stays

MOVEMENT OF PATIENTSMOVEMENT OF PATIENTS

EUROPE OF HEALTH


Circulation of patients: Methods

The relevance of arrangements made under Regulation 1408/71 in

helping to address the issue, and whether improvements could be

made which would be advantageous

The kind of information needed in order to help European citizens

to improve their choice

The possibilities for studying quality at a European level, and in

what way to ensure added value

The extent to which agreements (eg bilateral, multilateral, or

Europe-wide, etc.) over a basic package of health care services are

essential to facilitate movement of people around Europe

Health card


Circulation of patients: Objectives

To formalise the coincidences of the Ministers of Health on

the important topic of Circulation of Patients and the Impact

of EU on the Health sector.

To suggest to the appropriate EU institutions to launch a debate that allows the Health responsible of the EU member states to have a voice on matters that influence the performance of the health systems.


Circulation of patients: Objectives

To carry out further detailed work on the added

value that might be gained from looking at certain

health issues, identified by Health Ministers in

Malaga, from a perspective that goes beyond

national


País de la UE Nº de residentes Porcentaje sobre el totalde residentes de la UE

Gran Bretaña 73.983 24,2%Alemania 60.575 19,8%Francia 42.997 14,0%Portugal 41.997 13,7%

Italia 30.862 10,1%

Foreign residents in Spain, 2000.

SPAIN


E-FORMS

SPAIN

E-121 foreigners (until july 2002) 83.600

E-121 foreigners (2001) 9.508

E-121 spaniards (until july 2002) 1.203

E-121 spaniards (2001) 193

E-112 foreigners (2001) 3.156

E-111 foreigners (2001) 133.958

E-112 spaniards (2001) 65

E-111 spaniards (2001) 57.468


THE FUTURE

Distribution of competences

among UE and MS

White PaperWhite Paper


CONCLUSIONS I: Centres of excellence

• Rare and exceptional disorders.

• Knowledge centres and training centres (high tech or specific skills).

• Main purpose: to treat patients.

• Catalogue of existing facilities and their capacity, resources,

competence and medical results

• Real institutions accepting patients from all over Europe

• Virtual working through networking

• Mobile teams moving to different parts of Europe

• Joint ventures

• subsidiarity


CONCLUSIONS II: Spare capacity

• Different procedures

• Quality of treatment

• Not displace local patients

• Not distabilize national security system

• Information exchanges: processes, rights, experiences

• Moving the patients or moving the spare capacity


CONCLUSIONS III: Neighbouring regions

• Europe without borders

• Pragmatic procedures

• Euregios

• Standard guidelines for projects

• Provide patients and other actors with information

• Use of posibilities of 1408/71

• Quality standards and regulation for all patients

• Coordinate use of national health insurance cards


CONCLUSIONS IV: long-term visits

• European health card

• Basic health care benefits package

• Universal quality standards and indicators

• Guides of clinical practice

• Systems of certification

• European alert system

• Exchange of best practices

• Improve access: health care resources in touristic planning, clarify E-forms, solve language barriers, European-wide information networks, to protocolize all the information


HEALTH COUNCIL

• emerging interaction between health systems within the European Union particularly as a result of the free movement of citizens, and their desire to have access to high quality health

• respect the responsibilities of the Member States for the organisation and delivery of health services and medical care

• there is added value in examining certain health issues from a perspective that goes beyond national borders

• the delivery of care shall be another main concern together with the administrative issues


HEALTH COUNCIL

• bilateral or regional arrangements can play important role

• patient mobility, especially concerned with tourism or long-term residence abroad: need to exchange clinical and other information, in order to ensure proper follow-up and continuity of care

• benefit of reference centres, in order to facilitate the most effective treatment for those diseases requiring specialist interventions

• the new programme of Community action in the field of public health, the new research and telematics programmes provide a framework, in particular aspects relating to information and exchanges of experience


HEALTH COUNCIL

• need to strengthen co-operation in order to promote the greatest opportunities for access to health care of high quality while maintaining the financial sustainability of healthcare systems in the European Union

• high level process of reflection

• will return to this issue at the next meeting of the Health

Council

Documents

Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones A EUROPE OF PATIENTS? EUROPEAN SYSTEMS IN A CHANGING ENVIRONMENT POLITICAL