European Health Care Policy: From Diversity to Harmonization? Fórum Mercosul Rio de Janeiro, March 22th 2006 Johann Wolfgang Goethe-University, Frankfurt Institute of Medical Sociology Thomas Gerlinger

2 Contents 1.European Integration and Health Policy 2.Divergence of Health Care Systems in Europe 3.Trends towards Europeanization: The Open Metod of Coordination 4.Presumable Impact on Health Policy in Europe 5.Conclusion and Outlook

3 Diversity in the European Union CountryGross Domestic Product (US-$ PPP, per capita) Portugal Germany Sweden Poland United Kingdom29 826

4 Diversity in the European Union CountryTotal Health Expenditure (% of Gross Domestic Product) Portugal 9,6 Germany11,1 Sweden 9,2 Poland 6,0 United Kingdom 7,7

5 Diversity in the European Union CountryTotal health expenditure (US-$ PPP, per capita) Portugal1 797 Germany2 996 Sweden2 594 Poland 677 United Kingdom2 231

6 Diversity in the European Union CountryPrivate health expenditure (% of total health expenditure) Portugal29,5 Germany21,4 Sweden14,7 Poland27,6 United Kingdom16,6

7 Diversity in the European Union CountryDoctors per inhabitants Portugal3,3 Germany3,3 Sweden3,3 Poland2,3 United Kingdom2,1

8 Diversity in the European Union CountryNurses (per inhabitants) Portugal 4,2 Germany 9,7 Sweden10,2 Poland 4,9 United Kingdom 9,7

9 Diversity in the European Union CountryHospital beds (per inhabitants) Portugal3,6 Germany8,9 Sweden--- Poland--- United Kingdom4,2

10 Open Method of Coordination: Core Elements setting of guidelines including a timetable for short-, medium-, and long-term objectives establishment of quantitative and qualitative indicators and benchmarks to ease comparison of national practices adoption of European guidelines in the policies of the Member States regular supervision, evaluation, and mutual examination

11 A New Mode of Regulation change by coordination and learning dispensation with binding targets and formal sanctions formal authority left with the Member States

12 Objectives in Health Policy establishment of universal access to high-quality health care increased transparency and quality of the health care systems continuation of reforms aimed at cost containment

13 Lisbon Strategy: Objective “the most competitive and dynamic knowledge-based economy in the world”

14 Presumable Impact on Health Policy acceleration of reform and rationalization policy-related goal conflicts ensuring a high level of social protection and open access to health services (implying a high level of public spending) or cost containment by privatizing costs and restricting access to health services

15 Conclusions and Outlook increasing pressure for reform of health care systems deriving from the EU potential for rationalization of services probable future priority for cost containment through privatization of costs further restrictions for unhindered access to services