1. Health Systems and EU enlargement - an accession country’s view Tit Albreht, M.D., M.Sc., Institute of Public Health of the Republic of Slovenia Bad Gastein, 28 September 2001 tit.albreht@ivz-rs.sihttp://www.sigov.si/ivz

2. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Introduction n Reforms of health systems as a universal process n Currently at various stages of development n Different historical and political backgrounds and large variation in the economic situation

3. 28 Sept 2001 Health Systems and Enlargement - An accession country's view CEE countries heritage n Old and new independent states n Different treatment of the historical and social heritage n Difference in the economic and social development at the start of transition

4. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Recent developments at the system level n An almost unanimous decision to introduce Bismarckian-type of systems n Reasons: –part of historical tradition –a more stable system, potentially more independent from daily political changes

5. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Recent developments 2. n A reduced role of the State - deregulation process and rearrangement of stakeholders n Financial pressures: constraints, worsening economic situation, budgetary restrictions, etc. n Challenge of the newly gained independence

6. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Challenges for accession countries 1. Changing epidemiologic situation 2. Patient mobility and mutual influences on each other’s systems 3. Workforce mobility 4. Opening of health care markets and international competition 5. Public health and health care delivery 6. Definition of a common minimum package

7. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Changing epidemiologic situation n Epidemiologic transition with continued maturation of the population n ‘Regression’ processes - renewed importance of communicable diseases and a rising importance of certain chronic diseases (dependency-related) and injuries n Redefinition of priorities from a developing epidemiologic perspective

8. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Patient mobility and mutual influences on health care systems n No interference with own health care delivery systems? n Viability of such a policy n Implications for the accession countries n Flows of patients

9. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Workforce mobility n An important issue not explored enough yet n Danger of ‘brain drain’ from some countries n A real issue or an overestimated one in importance?

10. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Opening of health care markets and international competition n Internal health care markets - new values and priorities n Exposed health care providers n Competition by providers of neighbouring ‘old’ member states n Importance of harmonisation of (existing) accreditation procedures or their introduction

11. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Public health and health care delivery n Public health - reaffirmation and redefinition n Importance of European guidelines for Public Health n Privatisation as a trigger for more curatively oriented health care n Role of the State in ensuring Public Health

12. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Definition of the common package n Comprehensiveness required vs. more and more market orientation n A minimum package available to any European citizen which would help also the accession countries n Avoiding an increasing variation in type, extent and quality of services provided

13. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Slovenia’s own perspectives n Challenges brought about in the accession process: –opening of borders and free movement of workforce and patients –a broader and more demanding health care market

14. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Slovenia’s own perspectives 2. n Opportunities lie in: –more professional development and research –offering own facilities on the common health care market (especially certain medical specialities)

15. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Slovenia’s own perspectives 3. n A quickly ageing population both in bottom- up as well as top-down n Communicable diseases well controlled both with a surveillance mechanisms and interventions n Importan lagging behind EU in alcohol- related conditions and injuries n Interest in a harmonised effort in defining priorities in health care

16. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Slovenia’s own perspectives 4. n Patient mobility and influence on own solutions in health care delivery and financing n Outflow vs. inflow of patients n Workforce mobility - some outflow will occur but Slovenia is likely to be a future target or host country

17. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Slovenia’s own perspectives 5. n Slovenia’s urgent need to work on accreditation of hospitals and enter into co- operation with other important providers in the area n Public Health needs a redefinition and reorganisation n Development of own educational structures in the area of Public Health

18. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Slovenia’s own perspectives 6. n Ensuring compliance with standardised education in Public Health and harmonised European guidelines for the area n Common minimum package to be revisited and reassessed

19. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Conclusions n An exciting process starting with both challenges and uncertainties n Health care delivery standardised in quality of services and in the minimum package for the European citizen n Development of a European surveillance system and standardised indicators

20. 28 Sept 2001 Health Systems and Enlargement - An accession country's view Conclusions 2. n Potential brain drain to be assessed and forecasted where and if possible n Enable providers to compete at the common health care market n Reaffirm the role of Public health by modernising it, standardising its guidelines and ensuring effective responsibility of the State