European Health Policy, Enlargement and Health Systems Bernard Merkel European Commission Public Health Directorate Bad Hofgastein, September 2002

OBJECTIVES n To show the bases for EC Health policy n To show its limitations in relation to health systems n To show how nevertheless it is advancing n To relate this to the applicant countries situation

EU Health Policy New Treaty Powers Challenges & Trends Enlargement of the EU

 HEALTH SYSTEMS UNDER STRAIN  Need to improve efficiency and effectiveness  Priority setting and rationing  Finances Challenges  DEMOGRAPHIC TRENDS  Ageing population, falling birth rate dependency ratio  NEW TECHNOLOGY  Innovative pharmaceuticals and treatments, BIOTECH  Information technology  HIGHER EXPECTATIONS  Information explosion  Role of health professionals - want to do more  The public - want more/ want the best

Public Health in the European Union n Treaty Obligation (Article 3 (p)) –contribution to attainment of a high level of health protection n Treaty Obligation (Article 152) –improving health –preventing diseases –obviating sources of danger to health –ensuring that all EC policies protect health

Other EC Treaty Articles with health as a subsidiary or implicit objective n Arts : right of establishment, services; n Art. 71 : transport ; n Art. 95 : internal market n Arts : common commercial policy n Art. 140 : social security and protection ; n Art. 149 : education n Articles 158 and 161 : economic and social cohesion n Article : research and technology n Article 177 : development co-operation n Arts 300 and 302: international agreements

The role of the Community in health care n Exclusion in Art 152 “Community action in the field of public health shall fully respect the responsibilities of the member states for the organization and delivery of health services and medical care.” n Little Competence in Health care/social protection finance (ECJ Poucet & Pistre 1990s)

New Public Health Programme 3 strands of action 1 -Health Information 2 - Rapid Reaction 3 - Health Determinants

Heath system aspects n Information on health care n Benchmarking (?) n A quality agenda n Health technology assessment n Inequalities - social and economic issues

Member State Co-operation Member State Co-operation n New Instrument n Lisbon Process n  Open co-ordination

Open Co-ordination Health Care & Care for the Elderly n Gothenburg European Council asks for report n Commission Communication December 2001: focus on quality, access and financial viability n Report to Barcelona European Council n Barcelona Conclusions: Continue work on the 3 priority areas, prepare report for European Council (Greek Presidency)

Health Care and Care for the Elderly (2) n Questionnaire to Member States n Commission Communication (End 2002) n Report to Athens Council n Main actor: Social Protection Committee

EVEN MORE IMPORTANT: THE INTERNAL MARKET AND HEALTH The internal market: Freedom of movement: Goods Services People Capital Is inevitably the free movement of * Physicians, health professionals, patients * Pharmaceuticals, medical technologies and supplies * Insurance * Hospital investment Recognition of qualifications Demographic pressure

Circulation of Patients (1)  Malaga meeting of Health ministers  Increasing movement of patients  Added value: Reference Centres, sharing unused capacity, border regions, long-term residents  Information on quality and cost of health care

Circulation of Patients (2)  Menorca meeting of experts - gathering experience in four priority areas  Council Conclusions June 2002: –Welcomes the debate launched in Malaga –Supports launch of a high level reflection group –Work in this field to be undertaken by the Public health programme

Circulation of Patients (3)  Launch of a reflection process with health ministers and key stakeholders - autumn  Report: second half of 2003

Health and Enlargement SPECIFIC PROBLEMS SHARED BY MOST ACCESSION COUNTRIES Poorer health status * Poorer health status * Limited public health traditions * Spread of communicable diseases * Fewer resources to spend on health * Weaknesses in quality assurance and surveillance systems and surveillance systems

Health Care Reform in the Candidate Countries AIMS: Equity of access /universal coverage Specific aims differ between countries Measures  Primary care  Decentralization of decision making  Introduction/reform of health insurance schemes  Better cost information  Prevention/promotion?

Health Care Funding in central and eastern Europe 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0%10%20%30%40%50%60%70%80%90%100% Percentage of total health expenditure from taxation Observatory chart percentage of total health expenditure from social health insurance ROM LATPO HU CZ SL ES SK

What Should the Commission Do about Health Care Finance in Applicant Countries ?  Support studies/ analyses e.g. impact of financing systems on public health  Improve healthcare data systems - hardware/software  Disseminate best practice  Support expert exchange  Support training schemes e.g. accountants  Support civil society/ NGOs  Co-operate with major actors in health care

What should the Commission not do? Tell the applicant countries how to organise their health care systems or their healthcare financing

Why Not?  Health care financing does not fall under the competence of the EC  Health care financing does not fall under the competence of the EC  Neither does health system organisation  Neither does health system organisation  Health problems and objectives differ, and so do the means  Health problems and objectives differ, and so do the means  The amount of money for health, and the way it is raised is ultimately a matter of societal choice.  The amount of money for health, and the way it is raised is ultimately a matter of societal choice.