EU instruments for practical support

to health system reforms

Dr Loukianos GatzoulisUnit "Performance of national health systems"

Directorate-General for Health and Food SafetyEuropean Commission

What is available?

• Guidance material

• Good Practices

• Tools

• Technical assistance

• Financing instruments

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HSPA group report –Integrated care

I. Introduction

II. What do we mean by integrated care: theory, concepts and definitions

III. Building blocks, design principles and system levers for integrated care

IV. Measuring the performance of integrated care

V. Conclusions

https://ec.europa.eu/health/sites/health/files/systems_performance_assessment/docs/2017_blocks_en_0.pdf

Guidance material

Analysis of >60 experiences, from >30 regions, with description of:

Intervention and target groupsSuccess factors

Transferable elements

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Example:

HSPA group report –Integrated care

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III. Building blocks, design principles and system levers for integrated care

HSPA group report –Integrated care

▪ For each building block: ➢ Tips and suggestions ➢ Pointing to real examples

Guidance material

6

Several proposals of frameworks, domains, and indicators to assessintegrated care, with experiences from

USA

New Zealand

WHO

IV. Measuring the performance of integrated care

HSPA group report –Integrated care

Guidance material

• From the EIP AHA

– Repository of practices: https://ec.europa.eu/eip/ageing/repository_en

– "How To" Guide of the Reference Sites: https://ec.europa.eu/research/innovation-union/pdf/active-healthy-ageing/how_to.pdf

– Action Group B3 on Integrated Care: https://ec.europa.eu/research/innovation-union/pdf/active-healthy-ageing/gp_b3.pdf

• Case studies on integrated care: http://is.jrc.ec.europa.eu/pages/TFS/SIMPHS3cases.html

• In the HSPA integrated care report (Annex 1 + links)

• From the Joint Action CHRODIS: http://platform.chrodis.eu/

• DG SANTE – MS Steering Group on “Health Promotion, Disease Prevention and Management of Non-Communicable Diseases” for implementation of good practices

Good practices

Tool for Integrated care assessment

• A contract under the Third Health Programme

• Timeline: January 2017 – March 2018

• Contractor: Optimity Advisors

• Main deliverables:

➢ Mapping of strategies and models of IC across the EU health systems

➢ Proposal of assessment framework for integrated care (tool) 8

Tools

The Maturity Model

(from the EIP AHA Action Group B3 onIntegrated Care)

• Assessing Readiness/Maturity to adopt Integrated Care

• Assessing Maturity Requirements of Good Practices

• Supporting Twinningand Coaching to transfer good practices

Tools

Using the B3 Maturity Model

Tools

Comparing "readiness" and "requirements" for a good practice

Tools

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Seminars How to design and implement integrated care:

Lessons from early adopters in Europe@ ICIC17, 8-10 May, Dublin

• Each seminar focused on a successful example of integrated care in a European region➢ Northern Ireland, Northern Netherlands, Catalonia, Scotland,

the Basque Country, Norrbotten

Technical Assistance

Knowledge transfer

“Twinning” for good practice transfer

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• Started within the EIP AHA context

• Small financial support to regions to kick-off bilateral actions for transfer of knowledge and (elements of) good practices

• Example: Basque Country

Technical Assistance

Risk stratification

Patient empowerment

• Three twinnings as originator Region:

1. New Aquitaine

2. Scotland

3. Liguria Region

• One twinning as adopter Region :

4. Scotland

Twinning

First lessons: Twinning plan

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Technical Assistance

Creation of a Twinning Implementation Group between the transferring and the adopting organisations

Identificationand involvement interested actors in the adopter and originator region

Study visit: Involving actors, Agenda, Visit, documentation

Create working groups Implement possible improvements

Analysis of and potential adaptation of the innovative practice

Provide further information, organize webinars and training sessions

Twinning

First lessons: requisites for adopters

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Technical Assistance

Awareness of the good practice: Basque Country’s whole population risk stratification through the EIP AHA.

Similar problems and policy strategies: Chronic Care Model, patient empowerment

Previous experience: Risk prediction tools, used as part of clinical decision-making, active patients, patient centered programs,…

Existing capacities: Availability of rich individual level datasets and established expertise in modelling techniques and linkage of health and care information.

Benchmarking: Need to evaluate/develop existing initiatives: Sparra (Scotland), Multidimensional Prognostic Indices (Liguria)

Ongoing or planned projects: Extend SPARRA, model Osakidetza´s “OsasunEskola” website,...

Desire to collaborate: Opportunity to stimulate further knowledge transfer to inform and improve how we design and deliver person-centred integrated care services.

Twinning

SRSS

Structural Reform Support Service

• A service of the European Commission with a mandate to:

• Support the preparation, design and implementation of growth-enhancing reforms

• Direct provision of support and coordination of the support provided by the Commission

• Special assignments: Support for the management of migration in Greece and support for Cyprus settlement

• Focus on implementation and support on the ground - covering all reform stages and challenges

• Focus on country-specific perspective; tailor-made support

Technical Assistance SRSS/SRSP

Economic governance processes

• European Semester• Union Law• EU policy priorities • Better use of EU funds

SRSS Technical support to Member States

MS reforms at their own initiative

• Other growth-enhancing reforms to achieve sustainable investment, growth and job creation

Adjustment programmes • Conditionalities

• Ownership of the reforms remains with MS

• Support provided upon request from the MS

INTR

OD

UC

ING

THE

STR

UC

TUR

AL

REFO

RM

SU

PP

OR

TS

ERV

ICE

STRUCTURAL REFORM SUPPORT SERVICE (SRSS)

THE STRUCTURAL REFORM SUPPORT SERVICE, SRSS, IS A SERVICE OF THE EUROPEAN COMMISSION WITH A MANDATE TO:

• SUPPORT MEMBER STATES WITH THE PREPARATION, DESIGN AND IMPLEMENTATION OF REFORMS IN THE HEALTH

SECTOR, AND MANY OTHER POLICY AREAS

• FOCUS ON TAILOR-MADE SUPPORT, ON THE GROUND

• STEER AND COORDINATE TECHNICAL SUPPORT PROVIDED BY THE COMMISSION

• WITH A PROPOSED BUDGET OF EUR 142.8MN (2017-2020), THE SRSP WILL BE A SIGNIFICANT FACTOR FOR FUTURE

SRSS ENGAGEMENTS WITH MEMBER STATES.

SRSS FACTS

• CREATED IN JULY 2015;

• OFFICES IN BRUSSELS, ATHENS AND NICOSIA;

• 130+ STAFF.

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HOW IT WORKS

AT THE REQUEST OF A MEMBER STATE, SRSS:

1) ENGAGES IN A DIALOGUE TO DISCUSS TECHNICAL SUPPORT NEEDS;

2) PUTS IN PLACE A SPECIFIC TECHNICAL SUPPORT PLAN TOGETHER WITH THE

MEMBER STATE; AND

3) SRSS PROVIDES FINANCING FOR THE TECHNICAL SUPPORT AND

COORDINATES THE NECESSARY EXPERTISE.

STUDIES & DIAGNOSTIC

ANALYSES

STUDY VISITS

SEMINARS, CONFERENCES &

WORKSHOPSEXPERT & SCOPING

MISSIONS

EMBEDDED

EXPERTS

TRAINING

REFORM

PARTNERSHIPS

TYPES AND PROVIDERS OF TECHNICAL SUPPORT

SRSS WORKS WITH TA PROVIDERS, SUCH AS

EXPERTS FROM MEMBER

STATES ADMINISTRATIONS; INTERNATIONAL

ORGANISATIONS; PRIVATE

FIRMS, INCLUDING

CONSULTANCY FIRMS; AND

INDIVIDUAL EXPERTS.

TOGETHER WITH IN-HOUSE COMMISSION EXPERTISE, THESE PROVIDERS

ENSURE THE RIGHT ASSISTANCE IS DELIVERED WHERE IT IS NEEDED.

Financial envelope: two layers

SRSP "dedicated" envelope: EUR 142.8 million (to be split by annual allocations)

"Additional" budget: voluntary contribution from MS – transfer of resources under Article 25 ESIF

• extended to all MS (programme countries or not)

• follows ESIF rules (both procedure and eligibility)

NOTA BENE: NO CO-FINANCING BY MS (COM DIRECT MGMT)

SRSP budget

Request for support (this year two budget cycles:

30 April for 2017; and 31 October for 2018)

• One request encompassing all MS support needs

• Template + instructions for MS (guidance)

• Purpose: to enable MS to prioritise and to provide information relevant for the assessment by COM of the request for support

COM decisional process• General principles: transparency, equal treatment, sound financial

management

• Criteria for analysis: urgency, breadth and depth of problems identified, support needs in relevant policy areas, socio economic indicators, general administrative capacity of MS

CONTACTS: SRSS LABOUR MARKET, HEALTH AND SOCIAL SERVICES UNIT:

GÉRALDINE MAHIEU, HEAD OF UNIT, GERALDINE.MAHIEU@EC.EUROPA.EU, TEL: +32 2 29 63796 / CHRISTOPH SCHWIERZ, DEPUTY HEAD OF UNIT, christoph.SCHWIERZ@ec.europa.eu, TEL: +32-2-296.07.52

SRSP process

EU Health Programme 2014-2020

➢ financial instrument for policy coordination in the area of health

➢ supporting collaborative actions between

• 28 EU Member States

• Iceland, Norway

• Serbia & Moldova

➢ to find solutions to common health concerns

Financing Instruments

The objectives

1) Promote health, prevent diseaseand foster supportive environmentsfor healthy lifestyles

2) Protect citizens from seriouscross-border health threats

3) Contribute to innovative, efficientand sustainable health systems

4) Facilitate access to better andsafer healthcare for Union citizens

Address in particular the

key risk factors with a focus on the Union added

value.

Coherent approaches

integrated into MS

preparedness plans

Innovative tools and

mechanisms in health and

health prevention

Increase access to medical

expertise and information for

specific conditions

Health Programme 2014-2020

HealthProgramme

Joint Action CHRODIS http://www.chrodis.eu/

Repository of Good practices

Examples of outputs

HealthProgramme

Project ACT

http://www.act-programme.eu/

Guidance material

Examples of outputs

HealthProgramme

Project SCIROCCO http://www.scirocco-project.eu/

Maturity Model Tool

Examples of outputs

SRSS

ESIF Thematic Objectives

Research and InnovationClimate change adaptation,

risk prevention

ICT, incl.e-health

Competitiveness of SMEs

Low carbon economy

Environmental protection

and resource efficiency

Sustainable transport

Better public

administration

Education, training

and LLL

Social Inclusion,

incl.access to healthcare

Employment and mobility,

incl. AHA

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Structural Funds

SRSS

One of the guiding principles:

Moderating the use of hospital care in favour of primary and out-patient care, operating a transition from institutional- to community-based services

Investment possibilities in primary care:

➢ As part of the transition from hospital-based to more community-based care, support reorientation of specialist to general practitioners, to strengthen healthcare in primary care settings;

➢ Increase pool of primary care human resources within education and training programmes;

➢ Strengthen and support primary and secondary prevention to reduce the development and onset of major preventable chronic diseases;

➢ Promote innovative integration of care, based on improved communication and coordination, across the levels of health care (incl. primary);

➢ Strengthen ambulatory services and primary care, via prevention and monitoring, including telemedicine and telecare solutions.

Available at:

http://ec.europa.eu/health/health_structural_funds/docs/esif_guide_en.pdf

Commission guide on health investmentsthrough ESIF

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SRSS

"Effective use of European Structural and Investment Funds for health investments in the programming period 2014-2020"

http://esifforhealth.eu/Mapping_report.htm

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SRSS

ESIF Mapping Report

What information you will find:

➢ Overall assessment – summary of the mapping results

➢ Main health-related areas of investment (direct and indirect) per MS and OP, for programming periods 2007-13 and 2014-20

➢ ESIF health-related specific objectives in all MS

➢ Source of funding (the list of all OPs)

➢ Financial allocations as regards some types of health-related investments (4 "categories of intervention")

➢ Contact data for relevant national/regional Authorities

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SRSS

Scope of investments 2007-2013:

- Health infrastructure

- Health promotion and disease prevention

- Education of medical staff

- E-health

- Medical R&D

- Public administration and health services

- Workplace health & safety

- Health tourism

Overview of the Mapping results

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Scope of investments 2014-2020:

- Deinstitutionalisation and community-based care

- Active and Healthy Ageing

- Improving access & quality of health care services

- Health promotion and disease prevention

- Education of medical staff

- E-health

- Medical R&D

- Public administration and health services

- Workplace health & safety

- Health tourism

- Risk prevention and disaster preparedness

SRSS

SRSS

SRSS

Examples of actionsidentified within the "Mappingexercise"

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SRSS

➢ (Estonia) Improving access to primary health care

- Investments in modern, regionally accessible and optimal primary health care and acute

care networks offering high quality and sustainable health care services

- Development of competency centres (pathology, psychiatry, children's clinic, ear clinic),

- Early detection of alcohol abuse, counselling, alcohol addiction treatment and internet-

based counselling will be provided to alcohol abusers and their relatives.

➢ (Greece) E-health investments

- To support operation of the Primary Health Care Information System, development of

Electronic Patient File

ESIF Investments in primary care

examples

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SRSS

➢ (Croatia) Improving access to primary and emergency health

care

- Investments in primary health care infrastructure and equipment, improving emergency health care services, with focus on isolated and deprived areas

- Acquiring the medical equipment and vehicles necessary to provide primary health care.

➢ (Hungary) Improving health services

- Modernization of local government’s primary health care services

- Education and training programmes aimed at providing the health sector with qualified

professionals including primary and specialized care workers, family doctors and physicians

ESIF Investments in primary care

examples

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SRSS

➢ (Latvia) Improving access to primary health care- Development of infrastructure; Development of planning, including access to health

services and infrastructures, patient flow planning, health promotion planning, health care level selection criteria and guidelines for clinical health care

➢ (Malta) Primary care strengthening- Investment in infrastructure for primary health care services

- Optimisation of capacity in the provision of health services and establishment of a more sustainable primary health care system

- Development and / or modernisation of primary health care infrastructure, improvement of the regional health facilities in Gozo (aimed at providing services to ageing population)

ESIF Investments in primary care

examples

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SRSS

Conclusions from the Mapping

➢ Health is a relevant issue both for ERDF and ESF (though no health-OP)

➢ While all MS invest in health through ESIF, such investments prevail in the"new" Member States

➢ Less investment in health infrastructure in 2014-2020 as compared to 2007-13, but more focus on community-based care, access to care, active andhealthy ageing.

➢ Overall combined investment 2014-2020 in health infrastructure, eHealth,access to health and social services, AHA: more than ~9 billion EUR

➢ Figures for investment in other areas that include investment in health(health R&I, health SMEs, health workforce training, institutional capacitybuilding for health authorities, etc.) cannot be given at this stage (for laterevaluations)

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SRSS

Mapping ICT investments in Operational Programmes

http://s3platform.jrc.ec.europa.eu/

38

SRSS

Mapping ICT investments in Operational Programmes

http://s3platform.jrc.ec.europa.eu/

39

SRSS

Where to find information about concrete project possibilities?

Contact authorities responsible for a given OP implementation

Contact details under the link:

http://ec.europa.eu/regional_policy/en/atlas/managing-authorities/

Or in the Mapping:

http://esifforhealth.eu/pdf/Mapping_Report_Final.pdf

SRSS

"Thematic blocks":

1. Improving access to healthcare (with emphasis on primary and preventive care, especially for vulnerable groups);

2. Support to reform processes towards effective and resilient health systems:

2a) Deinstitutionalisation measures for people with disabilities, mental health problems, older people and children deprived of parental care;

2b) transition from hospital to community-based care i.e. primary/integrated care;

2c) investments in healthcare facilities efficiency and sustainability, in particular in hospitals.

3. Uptake of e-health/digital solutions, in particular related to the Digital Single Market and the interoperability of these solutions within and across Member States;

4. Research and innovation in health and lifesciences.

5. Active and healthy ageing, healthy workforce, health promotion and disease prevention;

6. Health workforce (including i.a. training, lifelong learning, workforce planning, retention).

NEXT STEP: DG SANTE (B1) tender project: ESIF support in the area of health: building knowledge and capacities for monitoring and implementation, supporting innovation and effectiveness

SRSS

More information

ESIF:

http://ec.europa.eu/health/health_structural_funds/policy/index_en.htm

http://esifforhealth.eu/pdf/Mapping_Report_Final.pdf

http://ec.europa.eu/regional_policy/en/policy/what/investment-policy

https://cohesiondata.ec.europa.eu

Contact: sante-consult-b1@ec.europa.eu

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The Investment Plan for Europe & the European Fund for Strategic Investments (EFSI)

43

Aim: to mobilise at least €315 billion in investment across the EU

Give investment advice • European Investment

Advisory Hub (EIAH)• European Investment

Project Portal

Mobilise finance for investment• European Fund for

Strategic Investments (EFSI)

• Cooperation with National Promotional Banks

Investment Plan for Europe

Create an investment friendly environment• Improving the

regulatory environment

• Structural reforms

SRSS

European Fund for Strategic Investment (EFSI)

The main channel to deliver on the Investment Plan for Europe

New EU financial instrument (loan-based) – EFSI is a guarantee on lending granted by the European Investment Bank (EIB) and the EuropeanInvestment Fund (EIF – for SMEs) - addressing market failures and sub-optimal

market situations

Budget (all fields, accross the EU): 21bn EUR, now proposed extension to 33,5bn (EFSI II) to mobilise private financing up to 500bn up to 2020; 183bn investment already committed (May 2017)

Priorities in health:

• New models of infrastructure (e.g. primary care)

• R&D (incl. medical devices & products)

• eHealth and new technologies

• Health workforce

• SMEs and social enterprises

> 10 major health projects granted EFSI support > 500mEUR• Primary care centres (IE)• Medical equipment & care provision(IT)• Medical research (ES, UK, IE, DE)• Healthcare infrastructure facilities

reconfiguration (UK, AT, PL, RO)

+ 2 multi-sector infrastructure projectsincl. health

EFSI and the Health Sector (I)

45

• This is where EFSI can play an important facilitating role.With EFSI acting as a guarantee against first losses, theInvestment Plan for Europe offers an opportunity for thepublic and private sectors to join together in healthinvestments that are deemed high-risk.

EFSI and the Health Sector (II)

• New facilities, such as primary care and community carecentres that will constitute the "hubs" for transformed careservices – "infrastructure" investment

• ICT systems that can support the back-end organisation, aswell as the implementation of integrated care pathways anddecision support systems - "infrastructure and medicaltechnology" investment

• New service models and new technologies, such as ICTdevices and apps (eHealth and mHealth), which can facilitateremote management of chronic patients at their homes, aswell as empowering them to engage in self-care – investmenton "soft" elements with medical technologies embedded

• Capacity-building and "system re-organisation":education of the care workforce in new roles and associatedskills (for example, new roles of "care coordinators"), new carepathways, new governance models, new financing andreimbursement models (more linked to performance, qualityand coordination) – investment on "soft" elements oforganisational change

46

Case Study:Irish Primary Care Centres PPP

● The project comprises the design, build, finance, maintenanceand facilities management of 14 Primary Care Centres locatedthroughout Ireland.

● The project is in line with the Irish Government Health Reformto reduce reliance on acute sector and is part of the nationalprogramme of establishing around 300 primary care centres,14 of which are procured as a PPP (the project).

47

Amount Up to EUR 70 million

Maturity Up to 27 years

Location 14 different locations throughout Ireland

Timeline 2016-2018

The Promoter

● Ireland, represented by the Minister for Health, acting by itsagent, the National Treasury Management Agency (NTMA)during the construction phase

● As of the service commencement, the agent for the Ministerfor Health will be the Health Service Executive (HSE)

● HSE defined the Project scope, the output specifications andthe budget for the Project

● NTMA is the statutory financial advisor to State authorities forall public investments and it has full responsibility for deliveryof most of Ireland’s PPPs (except transport sector)

48

Case Study:Irish Primary Care Centres PPP

Conclusions / Summary

● The Project will have a strongdemonstration effect for future heathcare projects to be financed in thecountry, but also potentially forprimary health care projects to befinanced across Europe.

● The Irish government specificallyrequested the Bank to support theproject.

● The improved project funding costs dueto EIB presence will be passed through tothe public sector by lowering theavailability payment due by the publicsector to private operators.

● The project will facilitate the delivery ofaccessible, high-quality integratedprimary care services aimed at improvingthe health and well-being of the localpopulation. There is a clear economicbenefit because patients can return tothe workforce and be more productive asa result of better clinical outcomes and

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Case Study:Irish Primary Care CentresPPP

The European Investment Advisory Hub

Investment Plan for Europe

Support investment in the real economy

…through the European Investment Advisory Hub (EIAH) and the European Investment Project Portal

Mobilise EUR 315 bn of additional financing

…through the European Fund for Strategic Investments (EFSI)

Create an investment friendly environment

…through improvements in the European regulatory environment (SRSS, CMU)

5027 February 2017

The European Investment Advisory Hub

Launched in September 2015 as part of the Investment Plan for Europe, the

EIAH is a tool to strengthen Europe's investment environment and improve

the quality of investment projects

A cooperation platform to leverage and exchangeexpertise from EIAH partners(NPIs, Managing Authorities)

An instrument to assess and address unmet needsfor advisory support

A single access point to a comprehensive offer ofadvisory and technical assistance services

A joint initiative

51

The EIAH’s purpose

Support for projects and investments

Advisory and technical support in identification,

prioritisation, preparation, structuring and implementation of

investment projects

Enhance use of EU funds

Advisory and capacity

building support in the

implementation of ESIF

financial instruments

Improve access to finance

Enhancing financing

conditions and creating

bankable propositions

52

What is the Advisory

Hub?

A cooperation platform to deliver advisory services

locally

MoUs with National Promotional Institutions and other partnership agreements (LoIs, MoUs with Member States, other relevant parties)

3

An instrument to assess market gaps and unmet needs

4

An instrument to provide advisory

support to project promoters

Requests coming via the website

1

Requests coming from expert sources

2

• Process to handle all requests

• Key Performance Indicators for EIAH

• Build on/exploit the expertise of already existing advisory services and activities both within and external to EIB

4 stre

ams o

f activity

► Through consolidation of information on projects► Through assessments of policy implications► Through market studies

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FAQs about the Advisory HubWhat is the geo scope of the Hub?The European Union

Is the Hub only linked to EFSI projects?

No, support will not be limited to projects to be financed by EFSI

(and/or the EIB)

Does the Hub provide financing?

The EIAH does not provide financing of any sort. Requests for financing addressed to the Hub are redirected to relevant resources as appropriate.

Who concretely delivers the advisory support

provided via the Hub?

Experts of the EIB, its partner institutions and/or appointed

external consultants

Is the support provided via the Hub free of charge?

In most cases, yes. A contribution may be requested from private sector beneficiaries in order to

align interests and ensure ownership of results

Does the Hub have local offices?Currently the Hub operates mainly via the EIB headquarters in Luxembourg and its local offices. A network of local partner Institutions is developing

€

€

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EIAH health sector requests – a case study

● MOH request via the local Jaspers team

● EIB general consultant supporting MOH to fulfil EC countryconditionalities for accessing ESI funds (8 regionalmasterplans for health services reorganisation based on thenational strategy)

● EIAH Advisory Services Agreement with the MOH, to supportthe preparation of three regional hospitals plans andsubmission of applications for the ESI funds

● Potential support for the implementation (through the EIBAdvisory Services)

● Potential loan to cover the difference between

the available funds and total final costs

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Would you like to know more about the EIAH?

Consult the Hub’sadvisory offer

www.eib.org/eiah

Contact the Hub for more info

eiah@eib.org

Request support fromthe Hub

www.eib.org/eiah/contact

5627 February 2017

SRSS

57

Main considerations for the future

• How to support health system reforms

1. Build and improve the know-how & capacity of care authorities to implement reforms/new care models

2. Mobilising investments for implementation at scale

SRSS

Now…

Infrastructure(hospitals)

Medical innovations(medicines, imaging, diagnostics, devices…)

New care models & services

Investments in healthcare

SRSS

Main messages

▪ Sustained financing is essential: for up-front investments and during a transitional period; long-term contracts also help with certainty

▪ Combine funding from multiple sources EFSI and other EU-supported financial instruments managed by the EIB/EIF can be essential enablers▪ Plan how to access and blend financing components▪ Need to raise capacities at all levels to manage new instruments

▪ Broad scope of health investments, not just infrastructure but e-health, service provision and reorganisation

▪ Integrated investment: Infrastructure, technology and service models to be considered together

Seminar on "Strategic investments for the future of healthcare"

SRSS

The investment triangle in health

The future

Infrastructure (primary care &

community care centres)

Medical innovations(diagnostics, data analytics,decision support systems,

eHealth/mHealth)

investment triangle

New care models & services(patient pathways; workforce skills and roles;

governance, financing and reimbursement models, …)

SRSS

▪ Long-term thinking and strategy required, with dual aim: a) Reform and delivery of transformed health servicesb) Investment planning➢ with (a) conditioning (b), not the other way around

▪ Involvement of a broad range of public and private partners and investors& combination of bottom-up and top-down approaches

▪ Several communities have to talk to each other: investors, health providers, policy-makers, regulators, universities, SMEs▪ The objective is to break barriers and end up talking the same

language▪ Need to create eco-systems where all different players can work

together: platforms, hubs, etc.

Seminar on "Strategic investments for the future of healthcare"

SRSS

▪ Partnerships among payers and providers of care services:➢ Various models are possible – the local context must be considered➢ Partnerships preferably driven by local communities➢ Role for a lead provider / service integrator➢ Basic principle of trust and sharing responsibility, risks and benefits➢ Incentives: payment-for-results, outcome-based payments, value-based

contracting etc.

▪ Rethink contractual models for healthcare: no specific "new model" is evidently superior to others - results depend hugely on relationships, financial incentives, cultures and leadership

Seminar on "Strategic investments for the future of healthcare"

SRSS

ACCESSIBLE

RESILIENT

▪ DG SANTE Public Health: http://ec.europa.eu/health

▪ Seminar "Strategic investments for the future of healthcare": http://ec.europa.eu/health/investment_plan/events/ev_20170227_en

▪ Investment Plan for Europe http://ec.europa.eu/priorities/jobs-

growth-and-investment/investment-plan_en & Investment Plan

for Europe &

health http://ec.europa.eu/health/investment_plan/policy/index_en.htm

▪ European Fund for Strategic Investments (EFSI) via the EIB

https://www.eib.org/efsi & via the EIFhttp://www.eif.org/what_we_do/efsi/

▪ European Investment Project Portal (EIPP) - project promoters can publicise their projects to European and global investors https://ec.europa.eu/priorities/european-investment-project-

portal-eipp_en

▪ European Investment Advisory Hub (EIAH) – project promoters can get advice http://www.eib.org/eiah/about/index