1. Coordination of health care in the EU Jakub Wtorek European Commission Directorate General for Employment, Social Affairs and Inclusion Unit: Active Ageing, Pensions, Healthcare Tbilisi, 20 May 2011

2. Modernising Social Protection Lisbon 2000, four key objectives: – Promote social inclusion; – Make work pay and provide secure income; – Make pensions safe and sustainable; – Ensure high quality, sustainable, health care. Europe 2020 ongoing discussion The Open Method of Coordination (OMC) –Common objectives for social protection –Learn from each other, exchange experiences

3. Three Common objectives for health care and long-term care To promote accessible, high-quality and sustainable healthcare and long-term care by ensuring: access for all to adequate health and long-term care and that the need for care does not lead to poverty and financial dependency; quality in health and long-term care and by adapting care, including developing preventive care, to the changing needs and preferences of society and individuals; that adequate and high quality health and long-term care remains affordable and financially sustainable

4. Health care systems in EU Member States Universal health insurance through: –Compulsory social health insurance –National / local health service provision High share of public health expenditure (77% in 2008) Private health insurance remains small through growing share Low share of out-of-pocket expenditure (14% in 2008)

5. Health care challenges: Health Inequalities (1) 14-year difference in life expectancy for men and 8 year gap for women between EU Member States EU Communication October 2009 « Solidarity in health: reducing health inequalities in the EU”

6. Health care challenges: Health Inequalities (2) Causes of health inequalities : Living conditions basic needs, warmth, food, water, housing, environmental quality Services healthcare, education, social protection Work and working conditions job quality, health and safety at work Health related behaviours life skills, smoking, alcohol, exercise

7. EU actions In collaboration with Member States, Regions and other Stakeholders Improve measurement and knowledge especially data collection taking precise factors into account: gender, socio-economic status, geographic dimension. Strengthen means for collaboration with partners Targeted action for vulnerable groups – Roma, migrants Better use of cohesion policy and rural development policy Use PROGRESS and other funds Health care challenges: Health Inequalities (3)

8. Ensuring actual access to long term care: which challenges? Long-Term care is complex: wide range of clinical, medico-social, and social care Several institutional levels (national, regional) involved in decision-making Coordination health care / social services Quality care and preventing elder abuse Strategies to attract and retain human resources: Supporting informal carers Ensuring that long-term care provisions are affordable and financially sustainable

9. Sustainability of health care systems Two components: financial - people Expenditure rise faster than GDP Sources of pressure: ageing, technology, expectations, social and economic situation Rationalise resource use, but in some countries there is a need for additional resources

11. The human resources dimension of care How to ensure stable human resources for the sector? The care sector - a dynamic part of the European economy 1995-2001 - 18% of total new jobs occurred in the health and social sector, more than 2 million jobs Accounts for almost 10% of the total employment Large country differences in the skill-mix of staff

12. Rational use of resources How? Through… –Using primary care and referral systems more in order to also improve access and address long-term sustainability –Improving care coordination between types of health care: e.g. primary and secondary –Greater use of outpatient care and ambulatory/day- case surgery (effectiveness/efficiency) –Implementing new contracts and payments for providers, addressing incentive structures of HC systems –Controlling pharmaceutical expenditure

13. Rational use of resources It is about –Incentives to users and providers to use relevant care –Avoiding duplication in provision and use of care –Economic evaluation – technology assessment and being effective and cost effective –Fostering health promotion and disease prevention to improve overall health of the population and address future sustainability –Using some market mechanisms where appropriate

14. Thank you for your attention http://ec.europa.eu/social/main.jsp?catId=754&langId=en http://ec.europa.eu/social/main.jsp?catId=792&langId=en