"Health and Well-being in Transition Societies"

In 2000, a group of international experts from Finland (National Recearch and Development Centre for Welfare and Health, Russia (Petrozavodsk State University) and Ukraine (Ukrainian Kiev International Institute) and Portugal (Association of Education Development) conducted a research of the current situation in healthcare and provision of social and health services in Ukraine and Karelian Republic (Russia). On the material of this research, a book titled "Health and Well-being in Transition Societies" was published in Finland.

The goal of the conducted research was to create the information base that would allow better understanding of the roots of problems, which transition societies encounter, and help to find the most effective ways of solving these problems.

The financial crisis in the society causes the decrease of opportunities in healthcare sector and social services.

The research has a format of study process and analysis of the collected data on the health status of people in the society, use of health services by various age and social groups, influence of health-related living conditions on health and correlations between people's income and their expenditures for health. Particularly, chapter "A study of health, the need for health and social services, and health related living conditions in Ukraine" that was prepared by Volodymyr Paniotto, Anna Martsinkiv, Natalya Kharchenko, Victoria Zakhozha, and Elena Buslaeva provides the information on the results of the survey, which was done in Ukraine.

Here are selected examples from the abovementioned book concerning Ukraine.

Use of health services

One tenth of the adult respondents had been hospitalized during the six months preceding the interview. The average duration of stay in hospital had been 20 days (not taking outliers into account).

Men had stayed in hospital on average four days longer than women (the percentage difference is significant at the level of 5%). Respondents in younger age groups (up to 44 years) had stayed in hospital eight days less than respondents from older age groups (45 years and more). The difference by level of well-being was not statistically significant.

Also one tenth of the children had been hospitalized during the six months preceding the interview. The average duration of stay in hospital for children had been 12 days. Boys had stayed in hospital on average five days longer than girls (the difference is statistically significant). Children from the poorest and the wealthiest families had spent more time in hospitals than children from other income groups.

Every second adult had visited a doctor during the six months preceding the interview. The survey was carried out in February-March, when there are regularly outbursts of influenza and other respiratory diseases.

The average number of visits to the doctor was four. Women had visited a doctor one visit more than men (the difference was significant). Elderly people had visited a doctor more often than young people (number of visits 2.8 and 5.4 respectively, among the age groups of 15-24 years and 75+ years).

People from wealthier families had visited a doctor because of illness more often.

Most frequently, people had visited doctors in policlinics and hospitals - on average, about three visits, while the average number of visits to doctors at other establishments (such as agency policlinics or hospital, private practice, the doctor had made a house call, etc.) had been less than one. Of all the women interviewed 81% had been pregnant at least once in their lifetime. The average number of reported pregnancies was 2.8.

That Ukraine has a demographic crisis is verified by the fact that the average number of pregnancies among women 25-44 years old was 2.9, while for older age groups it exceeded 3.5.

The average figure for deliveries of live babies was 68% out of all pregnancies, the average figure of stillborn births was 2%, and the average for miscarriages was 6% (there were no significant differences between age groups). Induced abortions comprised 24% out of all pregnancies, i.e. every fourth pregnancy ended in abortion.

This figure peaked in the age group 45-64 years (28%), and the lowest value was found for the age group 15-24 years (11%).

Out of all women of reproductive age (15-49 years), 46% had visited a clinic or children's clinic during the six months preceding the interview. 29% out of all women of reproductive age were using contraception (birth control pills, intrauterine devices, condoms) when the study took place.

Every third of the respondents had visited a dentist during the six months preceding the interview. There were no significant differences between genders and different level of well-being. Respondents aged 15-44 made up 35% of those who had visited a dentist during this period of time, whereas among people above 45 only 26.7% had been to a dentist's office.

Out of respondents who had had a toothache or other dental or denture-related problems during the six months preceding the interview, only half had visited a dentist. During the same time period, 8% of the respondents who had not had dental problems had visited a dentist (this can be considered promotion of dental health).

According to the information obtained from parents, 36% of the children had visited a dentist during the past 6 months (before the interview) .Older children had visited a dentist more often than younger ones (up to the age of 7): 48% and 16%, respectively (the difference is significant at the 1% level).

The interviewed parents of schoolchildren indicated that 98% of their children received health care services at school (e.g. medical check-ups or vaccination). For the children from the wealthiest families, this figure was 100%. Almost all of the children had been vaccinated at least once in their lifetime.

Use of medicines.

45.3% of the respondents had taken prescription medications during the six months preceding the interview (again, it is worth mentioning that this survey was carried out in winter, when respiratory diseases are especially common). Many more women than men were taking medications (50% as opposed to 38%). However, taking medications here also includes birth control pills, which can be taken only by women. There were no significant differences by groups with different levels of well-being.

During the past six months, according to the information obtained from parents 52% of the children had taken prescribed medications at least. At the time of the interview, 16% of children were taking prescription medications.

During the six month preceding the interview, 69% of the respondents had taken medications sold without prescription; i.e. were involved in self-treatment. Almost half (45%) of all respondents had taken vitamins, herbs or homeopathic remedies. 56% had taken antibiotics and other medicines.

During the six months before the interview, 63% of the children had taken medications (including vitamins) available without prescription. Here there was a clear difference between the wealthiest and the poorest households: Poor 52% and wealthy 70%.

(On materials of "Hospital" magazine)

HOPE CONFERENCES

MENTAL HEALTH SEMINAR
DUBLIN (IRELAND)
24/25 FEBRUARY 2005

The 5th annual mental health conference will be organized by HOPE from the 23rd to 25th February 2005 'Quality & Choice in Mental Health'. The conference will be hosted by Ireland's Minister for Health & Children and will take place in the historic surroundings of Dublin Castle. The conference is of particular importance and value to the new enlarged Europe and delegates from the new accession countries are particularly welcomed. The conference reflects the Irish government's commitment to support both the development of quality mental health services in Ireland and to learn from and contribute to the development of services in Europe.

The establishment of a Mental Health Commission in 2002 and the innovative practices in delivering of mental health care are hallmarks of the progress made in Ireland.

The conference will hear international speakers from the World Health Organization, Ireland, France, England, Belgium etc. It will provide, through workshop sessions, the opportunity to explore some of the themes, which emerge in the 'Quality & Choice' agenda.

Further details are available at: www.conferencepartners.ie/HOPE

PATIENT SAFETY -
CARDIFF (UK) - 23 JUNE 2005

The UK HOPE delegation will organize in Cardiff in June 2005 the conclusion events of the 2005 HOPE exchange program. The traditional one-day conference linked to the exchange program evaluation will be held on 23 June 2005 dealing with "Patient safety".

CONFERENCES CO-ORGANISED BY HOPE

MIGRANT-FRIENDLY HOSPITALS
AMSTERDAM
9/11 DECEMBER 2004

HOPE is a supporting partner of an International Conference "Hospitals in a culturally diverse Europe", to be held in Amsterdam on December 9-11, 2004. The conference will present results from two years of pooling European expertise from 12 hospitals in the EU member states and several expert consultants and formulate European Recommendations for culturally adequate hospital services and management strategies for migrant and ethnic minority patients. It will also be a forum for colleagues in health care, health policy, quality management, as well as migrant and human rights organizations from around Europe and beyond to discuss effective strategies and promote the exchange of expertise and innovations in the field.

The focus will be on strategies concerning how to improve quality of care in an increasingly culturally diverse environment, including effective approaches to address language barriers, culturally adequate patient education, and staff training towards cultural awareness and communication skills. The conference further invites a discussion of strategies to integrate cultural diversity in hospital policies and (quality) management. More information on: www.mfh-eu.net

PUBLIC PRIVATE
PARIS
20/21 JANUARY 2005

The collaboration between HOPE and AIM (international association of mutuality) will be soon materialized by a conference "Private or Public Hospital? Which choice for the health insurance tomorrow" to be held in Paris next year. This follows the work of HOPE Plenary Assembly in Malta. The purpose of the conference is to draw up a European picture of the hospital sector, in order to see up to what point private for profit, private not for profit and public hospitals are competitors, complementary or mutually exclusive. From there, it is a question of wondering about the most efficient models. Would it be better to support the public hospital sector by modernizing it ?, or the private not for profit and/or for profit one ?, or is a balance the best solution ?

These questions will be raised through: the influence of the international and European legislation on services and the risks which it makes run on the question of the transformation of the hospital sector towards private market concrete cases illustrating the types of public-private division and partnerships in the hospital sector with advantages and disadvantages conditions of the competition a panel of discussion will deliver the opinion of some experts on this point, starting from precise questions of the moderator a final synthesis will summarize the important elements of the conference with possible proposals for activities and/or studies (for the AIM hospital working group and HOPE and in collaboration with other stakeholders)

More information: sg@hope.be

GREATER REGION - ECONOMIC FUTURE FOR HOSPITALS - LUXEMBOURG

23 FEBRUARY 2005

The Entente des Hopitaux Luxembourgeois and the Institute Universitaire International Luxembourg are organizing the Hospital Day 2005 with the following topic: "Which Economic Future for the Hospital Sector in the Greater Region?" This congress of experts is aimed at decision makers and will be held in Mondorf-les-Bains on 23 February 2005. It will provide an inter-regional platform in order to exchange on new organizational and managerial possibilities for hospital institutions. The focus will be on the strategic aspects of a growing market. This congress is part of an interdisciplinary project made up of research studies, training and communication initiatives. It includes in particular a study "Healthcare in the Greater Region 2020" that will analyze synergies and co-operation opportunities between institutions in the Greater Region. It will be completed by scientific research on organizational structures in hospitals, on needs in managerial competences and specific training. A post-graduate training "MBA Healthcare Management" is also among the activities as well as other training or information initiatives. Contact: Marc Hasten, marc.hastert@ehl.healthnet.lu

PATIENT SAFETY

LUXEMBOURG
4/5 APRIL 2005

HOPE is co-organizing a conference to be part of the official program of the Luxembourg presidency. The main topic is Patient Safety covering three themes: First do no harm - Therapies, Medicines and Communication in Primary Health Care; Making it happen - How to develop national frameworks for Patient Safety?; First, do no Harm - Ensuring Patient Safety in Hospitals. This conference is in line with the work of HOPE and in particular the work of the Sub Committee Coordination.

More information: sg@hope.be

HEALTH PROMOTING HOSPITALS (HPH)

18/20 MAY2005 The upcoming 13th International Conference on HPH will be hosted by the Irish and Northern Irish Networks of HPH and will take place in Dublin, Ireland, from May 18-20, 2005. HOPE is part of the Scientific Committee of HPH conferences. More information: sg@hope.be

Belgium

Health care budget

Since expenditure always happens to be growing faster than expected by the authorities, the National Institute for Health Insurance faces a yearly growing deficit. Considering 2004-2007, Federal Government has accepted an annual growth of 4.5 %, inflation excluded. Compared to a pessimistically expectation on economic growth, in 2004 beneath 2 %, this caused tension on the economical and political level. In order to strengthen competitiveness of business in a globalizing economy, Social Partners are convinced to have no other choice than reducing public expenditure. It has been argued several times that rationalizing health care delivery is not the right answer to the challenges of an ageing population, dreaming of the growing scope of brilliant innovative technology.

As long as Social partners and Finance Ministers calculate health care expenditure as a public cost, and not as a long-term capital investment in economic prosperity, they will think about nothing else than limiting budgets.

For the year 2004, budget was tight up to 16,257 billion euro.

For the year 2005, health care budgets are allowed to increase up to € 17.389.938.000. This amount incorporates a yearly growth rate of 4,5%, as fixed by governmental agreement. On top of this comes the index mass (1,7%). Until now, we have no insight how this means will be divided towards the different health care actors. Nevertheless, it's generally known that pharmaceutical products' finances may enjoy a growth path of almost 12%. With regard to the hospital budgets, an increase of merely 1% is expected.

Recently alarming signals about the derailment of the Belgian health care expenditures have been sent out. Budget exceeds of more than 5,4% are predicted. This equivalents more or less € 800 million. If this estimated exceeds will become reality, above referenced technical budget computation for 2005 will impossibly be able to cover real expenditures of the year 2005.

As a result, the Minister of Social Affairs and Public Health has convoked all health care players for a special meeting, which will take place on November 9, 2004. All are asked to present proposals and measures to cut down health care expenditures.

Financing Hospitals

Hospital Budget for the year 2005 is € 3.763.520.000 (exclusive + 25% Ministry of Health). With regard to health care budgets for the year 2005, the Minister has announced a first, however small, step to reduce the hospitals' lack of financial means. Over a period of three years, a budget of € 100 million will be delivered. This implicates a budget rise of € 33 million for the year 2005. Besides, an important amount of € 349 million will be injected in the acute care sector in order to pay off arrears.

The minister also has announced following initiatives:

He wants to close small pediatric care units as he estimates them too costly.

He also has the intention to pay a premium for the surgeons' liability.

Besides, he intends to freeze the physicians' contributions in the hospital's operational costs.