(by materials of “Hope” magazine)
PUBLIC HEALTH – FUTURE BUDGET
In mid December 2005, national governments reached an agreement on the EU budget for the period 2007-2013 with an overall financial envelope that was substantially lower than the budget requested by the European Commission and supported by the European Parliament. The three EU institutions, the Council, Parliament and the Commission, have entered a negotiation phase to find a compromise agreement on the overall budget and priorities for spending.
Nevertheless, the proposed budget for heading 3b which includes the key programmes that are accessible and relevant for individual people: youth, culture, education, health and consumer policy, dialogue with citizens and the rapid response and preparatory instrument for major emergencies was significantly reduced. According to initial calculations, the health and consumer programme (3b heading) will get approximately 37 million Euros a year in an enlarged EU compared to the existing annual spend of more than 80 million.
As there is still an opportunity to change the situation, the members of Health Policy Forum are urging the European Institutions to put good health at the heart of EU policies and restore financial balance in Heading 3 in favour of the policy areas that matter to citizens
PUBLIC HEALTH – FUTURE HEALTH AND CONSUMER PROTECTION PROGRAMME
On 6 April 2005 the European Commission adopted a health and consumer protection strategy and proposed for the first time a joint Community Programme for Health and Consumer Protection 2007-2013.Nevertheless two European Parliament committees agree with most health and consumer stakeholders that the Commission proposal to merge health and consumer protection programmes should be rejected.
On 31 January 2006 the European Parliament's Committee on the Environment, Public Health and Food Safety (ENVI) rejected the Commission proposal to merge the health and consumer protection programmes 2007-2013 under the same umbrella. The vote in the committee was nearly unanimous, with 54 MEPs voting for the proposal amended by the rapporteur Antonio Trakatellis and one against.
The Committee on the Internal Market and Consumer Protection (IMCO) in a vote on 21 February 2006 rejected the EC’s proposal as well. Both MEPs and the rapporteur - Marianne Thyssen (EPP-ED, Belgian), consider that public health service users cannot be treated in the same way as consumers of ordinary services or products. M. Thyssen explained that there were also budgetary considerations that justified keeping the two programmes separate.
The Council can, technically, still merge the two programmes. However, as both the Parliament and the majority of the health and consumer stakeholders oppose the merger, it is unlikely that the Council will put the proposal back together.
WORLD OF HEALTH IT 2006 – GENEVE (CH) – 10/13 OCTOBER 2006
The Information Society DG of the European Commission, the World Health Organization, Healthcare Information and Management Systems Society (HIMSS), together with eight European professional organisations (including HOPE, CPME, COCIR, EHMA, EHTEL, EUROREC, CMPi and HINE) are organizing a conference World of Health IT 2006: “Connecting Leaders in Technology and Healthcare”
The conference is designed by and for clinicians and other health professionals; health IT users and buyers; directors and administrators; informatics professionals; academicians; relevant authorities and policy makers on regional and national levels; and vendors (i.e. software and hardware development companies and professional services firms). The conference will focus on the role and impact of Health IT on the health sector in Europe and other parts of the world, including the Middle East and Africa. The educational sessions will primarily address experiences from deployed services, and focus on proven benefits in quality and efficiency. The demonstration activities will give unique insight into the practical aspects of IT systems and their connectivity. The topics of the conference will include standardization, labeling and accreditation of eHealth systems, interoperability and national initiatives.
EUROPEAN HEALTH REFORMS – LISBON (PO) – 16 MARCH 2006
The European Association of Paritarian Institutions for social protection (AEIP) is organising a conference on “European Health Reforms Against the Background of an Ageing Society - Same Challenges –Same Solutions?” in Lisbon on 16 March 2006. AEIP General Secretary Bruno Gabellieri and former Portuguese Health Minister Maria de Belem Roseiro will open the event which will focus on:
- European health reforms - solidarity at stake?
- the challenges of European health services provision;
- free movement of patients and cross border cooperation in health;
- sharing information on the health of elderly people - outlook for the AEIP conference in 2007.
AEIP President Bernard Devy will close proceedings.
GENEVA FORUM: “TOWARDS GLOBAL ACCESS TO HEALTH”- GENEVA (CH) –
30 AUGUST/1 SEPTEMBER 2006
The Forum “Towards global access to health” planned for 30 August/ 1 September 2006 in Geneva, is organised jointly by the Geneva University Hospitals and the Medicine School of the University of Geneva, on the occasion of the 150th anniversary of the Geneva Hospital which has already a long standing tradition of international cooperation in the field of health.
The Forum will aim to define how Hospitals/Universities, individually and through networks, in collaboration with all international organizations active in health and humanitarian fields located in Geneva as well as representatives of the civil society, can improve access to health.
The organisation team of the conference is calling for abstracts.
In Belgian hospitals, a major reform of drug reimbursement is
going to be introduced. Until now, almost all pharmaceuticals, which are
delivered within a hospital, are financed fee for service. The National
Insurers’ Institute RIZIV/INAMI reimburses directly the cost of the important
drugs to the hospital. As a result, inpatients do not have to remunerate their
pharmaceuticals. They only have to pay a fixed amount of 0.62 euro per
hospitalization day. Only a variety of trivial drugs may be charged to the
In 1997, a first initiative regarding a fixed fee methodology was
introduced in the Belgian landscape of pharmaceuticals. Since then, the use of
prophylactic antibiotics is financed by nine different fixed fees, which are
guideline based. This measure aimed at following objectives:
better quality by reducing excess use of antibiotics in order to decrease
better control of directly and indirectly costs (less expensive products and
shorter periods of antibiotic treatment would reduce costs while less
antibiotic resistance will cause a drop in expenses for third generation
antibiotics that tackle resistant bacteria);
signal towards doctors that unlimited therapeutic freedom in prescription
scientifically and deontologically no longer can be defended.
In 2002, the former Minister of Social Affairs proposed a system to reimburse
certain extensively used drugs with global budgets instead of a product
reimbursement. This budget was meant to be calculated for a distinct number of
pharmaceuticals on condition that they were used for a limited number of
surgical pathology. The aim of the Minister’s measure was to introduce more
rational use of drugs. In fact, the government was going to calculate a cost
price weight per APR-DRG and Severity-class. These weights had to be applied to
the hospital’s surgical case-mix in order to calculate a pharmaceutical budget.
Due to many and profound remarks of doctors, hospitals and insurers, the system
never has been brought into practice.
In 2004, the current Minister of Social Affairs recycled the topic
and asked the sector for advice concerning the application of a global
budgeting system for inpatients’ pharmaceuticals. Besides, he also commanded a
study in order to investigate the financing of drugs in hospitals in the
neighbouring countries. This study showed that Belgium still was the only
country that financed pharmaceuticals fee for service.
As a result, a new proposal of budgeting inpatients’
pharmaceuticals has been puzzled out. Contrary to the former system, the
hospitals’ pharmaceutical budget will incorporate all inpatients’ drugs
consumption, whether it is linked to surgical or medical pathology. This budget
will be case-mix based, which means that for all possible combinations of
APR-DRG and classes of severity, a fixed fee is calculated. These amounts will
be applied to the hospitals’ case-mix and result into pharmaceutical budgets.
Nevertheless, outliers and expensive or innovative products, which figure on a
special designed list, continue to be reimbursed per pharmaceutical.
Normally, the system will be introduced on July 1st, 2006. In
order not to disturb the functioning of the Belgian hospitals, the application
of the budgeting system will be reduced to 50% or 75% in a first phase.
Later on, there also may be calculated a pharmaceutical budget for
day cases, but no tangible suggestions have been put on table up to now.
The public debate is focused on how to finance and organize the
health care sector. One committee of utmost importance was appointed by the
Government to deal with the responsibilities of state, county councils and
municipalities. A proposal is expected at the beginning of 2007. A change of
the structure is under consideration where the actual model with county
councils will be replaced with considerable fewer and greater regions, with
extensive social duties. Government and the county councils have agreed to
implement an enlarged maximum waiting time guarantee including treatments in
the whole of Sweden.
The work out of the guarantee will be implemented on 1st of
There is a strong expectation of a better follow-up with
comparisons about the quality and efficiency in the health care sector and care
for the elderly. Swedish Association of Local Authorities and Regions and
National Board of Health and Welfare have decided to set up and organise
actions concerning transparent comparisons. The indicators will comprise
dimensions as: Productivity and expenditures, medicine quality, accessibility,
equality of health care consumption, patient safety and patients and
populations satisfaction with health care.
Concerning the support to systematic improvement work, many years
experience of successful improvement projects has led to the understanding that
radical and lasting improvements demand a system change. It is not enough that
you attain success with the improvement work in nursing and healthcare in
isolated units/departments. They remain islands in an otherwise unaffected
Next year, work on an authoritative comprehensive strategy for
organizational development and making healthcare more efficient will begin.
Patient Safety Issues as a special dimension in the quality of
healthcare has developed from a special interest of researchers and real
enthusiasts in 1990, into a movement in the entire western world. WHO has
challenged their member countries to integrate patient safety issues into their
national health and medical care policy. A handbook on risk and event analysis
has been produced.
Swedish Association of Local Authorities and Regions has in the
report Swedish Health Care in an
International Context compared the performance of the Swedish
health care system with systems in the other EU-15 countries plus Norway and
United States. The possibility of making similar comparisons is also satisfied
in Swedish programme Focus on Health Care Data.
REGIONAL POLICY – EU FUNDING FOR HEALTH
A workshop on mobilising structural funds for health and
healthcare in the new Member States was organised in Brussels on 23 November
2005, gathering over 100 participants. The event, jointly organized by GVG (the
German non-profit association that promotes social security policy throughout
Europe) and EFPIA (The European Federation of Pharmaceutical Industries and
Associations), was hosted by MEP Dr Georgs Andrejevs, Vice-President of the
European Parliament’s Committee of Environmental Protection, Public Health and
The main message given by Dr Georgs Andrejevs in his introductory
speech and supported by HOPE was the raising awareness that structural funds
are an opportunity to improve healthcare standards and accessibility. The
accession highlighted the health gap separating “old” EU members “EU 15” from
“EU 10” where “the 10” suffer from lower life expectancy, higher infant
mortality, higher rates of cancer, etc. The main reason of the existing gap,
according to Georgs Andrejevs, is the low investment in health in the new
Member States, thus the EU structural funds can be used to close the gap.
Georgs Andrejevs recommended that: healthcare should be appropriately reflected
in the national documents (EU Member State National programmes for spending EU
funds); healthcare authorities and civil society groups should organise
themselves in order to prepare together projects for cohesion policy.
Holger Trechow (GVG), author of “EU Funding for Health” did an
overview on structural funds and health in the new Member States. Spending on
health sector in EU 10 is considerably below EU 15: in average, roughly a
modest half (4.5%) of the GDP share devoted by the EU 15 (8.5%). For the period
2004- 2006, EU Structural Funds, with the main objective of reducing
disparities in the level of development between the regions, devoted for the
new Member Stated 24 billion EUR of the 195 billion EUR total. He emphasized
the crucial role of the national governments that are now identifying
priorities on their national programmes, based on the EU framework for funding.
The national authorities should identify healthcare improvements as a key
priority in their programmes, and should allocate sufficient budgetary means to
secure the necessary co-financing requested from the Member States under the EU
WHO – HEALTH REPORT 2005
The WHO Euro Region published its 2005 European Health Report
addressing major health issues facing the European region and in particular its
children. Entitled Public health action for healthier children and populations,
the 2005 report addresses major health issues facing the European region and in
particular its children.
Recognising the challenges posed by the widening health
inequalities between states in the European region, the WHO underlines the
importance of good health as a key to social and economic development. Further
the WHO particularly focuses on children’s health as crucial in establishing
healthy life patterns, enhance social and economic development and hence
reducing the level of inequality found in Europe.
The report summarises the key health issues facing children in
Europe as well as suggesting policy responses and best practices to address
these issues. The authors particularly point out that national and European
responses should follow the four guiding principles of the European strategy
for child and adolescent health and development.
More information: www.euro.who.int/ehr2005
COPENHAGEN (DK) 5-6 SEPTEMBER 2005
The SIMPATIE two-year project financed by Public Health Programme of the
European Commission in which HOPE is involved as a partner intends to establish
a common European set of vocabulary, indicators, internal and external
instruments for improvement of safety in health care. The financial contract
was signed on 11 July 2005. The project, divided into eight Work Packages, aims
to facilitate free movement of people and services by developing EU-wide
commonality and transparency in methodology on patient safety in healthcare.
The Simpatie project has established close links with other
initiatives. A joint WHO Europe, Simpatie and Marquis conference on “Patient
Safety” will be organized on 5-6 September 2005 in Copenhagen, to foster
coordination between the different projects.
BRUSSELS (BE) 13-14 OCTOBER 2005
In the framework of Marquis research project (Methods of Assessing
Response to Quality Improvement Strategies), the consortium in which HOPE is
involved, is organising a two-day conference "Scientific Basis of Health
Services” taking place in Brussels on 13-14 October in Brussels.
The three-year project financed by the 6th Research Framework
Programme and its ongoing study aims to identify, compare and assess the formal
adoption by EU member states of different quality strategies at a national
level (including accreditation, certification, peer review, clinical
guidelines, performance indicators, patient surveys etc). The Marquis project
is composed of seven work packages and HOPE is involved mainly in two of them:
WP 5 (Hospital Survey on the basement of questionnaire and of on-site audit)
and WP 7 (collection and analyses of opinions, preparation of the final report
and dissemination of the information). The Marquis web site has now been
QUALITY IMPROVEMENT IN HEALTH CARE
PRAGUE 24-26 APRIL 2006
Authors are invited to submit abstracts for consideration for both
oral presentation and poster display at the 11th European Forum on Quality
Improvement in Health Care which will be held in Prague on 24- 26 April 2006.
The abstracts should be submitted no later then Friday 30 September 2005.
The themes of the 2006 Forum are:
Improving patient safety
Partnership with patients
Strengthening improvement in education and training
Leadership, culture change and change management
Achieving radical improvement by redesigning care
Health policy for lasting improvement in health care systems
Measurement for improvement, learning and accountability
People and improvement: individual professional quality
Transcultural collaboration in improvement
The organizers are interested in abstracts that describe research
relevant to improvement and in particular work that describes practical
experience of improvement. Open to all, the Forum is aimed at physicians,
nurses, managers, other health professionals, health care leaders, policy
makers, researchers, patients and patients’ representatives. It will benefit
both beginners and those experienced in quality improvement.
More in formation: http://www.quality.bmjpg.com/
HEALTH INSURERS: FROM PAYER TO PLAYER
PRAGUE - 23 SEPTEMBER 2005
The Association Internationale de la Mutualit? (AIM) organises an
international conference in the Czech Republic on the consequences of
demographic ageing and the changed expectancies of "health consumers" and the
new situation of the health systems. Health insurers and other purchasing
bodies are bound to play a vital role in directing patients through the variety
of care, while guaranteeing quality of care and maintaining financial balance.
At the same time it is said that health insurance should be more responsive to
consumer choice. But how will the increased diversity produced by these
developments turn out for the fundamental values of solidarity? Is equal access
to health care still an option for future health policy? What tools do health
insurers need for ensuring quality and controlling costs? Should their focus be
managing health or rather managing health care? Should they reward healthy life
styles or rather concentrate on taking care of sick people? These and other
questions will be addressed at this conference.
PUBLIC HEALTH - HEALTH INDICATORS AT REGIONAL LEVEL
The ISARE (Indicateurs de Sant? pour les R?gions de l'Europe)
project (financed by the Commission) made a recommendation on appropriate
"health regions" for 13 of the 15 EU Member States. The recommended levels
comprise 300 health regions across 13 countries. The average population size is
around 1.2 million, with considerable variations. All recommended levels have
responsibilities in the field of health promotion and all but one carry out the
function of public-health reporting.
The availability of key data at regional level was examined by
means of a questionnaire based on the European Community Health Indicators
(ECHI) project. The ISARE project suggests that despite disparities between the
recommended "health regions", the exchange of health indicators is feasible.
Virtually all recommended levels are already involved in
public-health reporting. The ISARE project's approach consisted in identifying
one level in each country according to a set of criteria. These "health
regions" appear to be the best compromise for ensuring an effective exchange of
health information at sub-national level within the EU. A more flexible
approach involving various sub-national levels may be a more suitable approach
for comparing different levels of healthcare (e.g. primary, secondary), or
analysing different epidemiological patterns. Further work might be needed to
identify variations in levels of competencies and autonomy at sub-national
level between and within countries.
On the ISARE short list, the 17 variables surveyed for all the
regions of a given country were grouped into eight subject-areas. The ISARE
long list of the data collected for the selected region in each country
includes the 17 variables above, plus a further 21 variables.
It is hoped that the findings of the EU's ISARE project will make
a useful contribution towards identifying the "health regions" across the EU,
understanding their role, and fostering their use as units for the exchange of
health indicators' under the Community's Public Health Program.
Phase 1 and 2 of ISARE have been completed. The objectives of the
ongoing ISARE 3 project are: to extend the results of the ISARE 1 and ISARE 2
projects to the new Member States, to update the information on the
sub-national levels in the countries covered by the ISARE 2 project; to examine
different possible ways of analyzing and presenting the data contained in the
database; and to make recommendations and check the comments to be incorporated
into the heath reports.
UK PRESIDENCY OF THE EU - HEALTH PRIORITIES
After Luxembourg, the UK took over the Presidency of the EU from
1st of July 2005 for six months.This presidency will be followed by Austria and
then Finland. The UK presidency themes in health are related mainly to two
topics: Patient Safety and HealthInequalities. Concerning health inequalities
the Presidency's objective is to promote action at EU levelto reduce health
inequalities within member states across Europe. Its actions will be:
- to progress pan EU work on effective cross government action to tackle health
inequalities - starting early in life - an support member states in developing
- to progress pan EU work on determinants of health inequalities, including
tobacco, alcohol, and food and nutrition - advance policy and add value to the
work of member states (policy priorities);
- to establish a strong and sustainable leadership to tackle health
inequalities across Europe- andensure a strong voice for EU in global health.
The presidency plans to establish an EC level forum to take
forwards health inequalities as an issue. It intends also to set up proposals
to Commission on regional action to tackle health inequalities.
Concerning Patient Safety, the Presidency wishes to promote action
at EU level to improve patient safety within member states, as it was confirmed
during the briefing session organised by the UK representation in Brussels on
20 June 2005. The Presidency aims to make significant progress on paediatric
regulations and plans to promote good practice for health workers crossing
Regarding the last issue, the Conference on Professionals crossing
borders is planned for October 2005 in Edinburgh, which aim is to showcase a
growing consensus on information exchange between European healthcare
The UK presidency wishes to add value to the EU and its health
agenda by demonstrating a variety of approaches (both regulatory and non
regulatory) to taking forward EU business and to promote a strong voice for the
EU in global health, particularly through partnerships with WHO.
The Presidency announced some main events related to health,
- Health Inequalities Summit: governing for health conference: 17/18 October
- Informal Meeting of Health Ministers: 20/21 October 2005, London;
- Patient Safety Summit: 28/30 November 2005, London;
- Formal Health Council: 9 December 2005, Brussels.
PATIENT SAFETY CONFERENCE
23 JUNE 2005
HOPE together with the NHS Confederation (and more particularly
Wales) organised in Cardiff an international conference on Patient Safety. The
event, part of the HOPE Exchange Programme, gathered over 300 health
professionals from 27 countries. The conference also set the scene for the UK
presidency of the EU, starting on 1st July 2005, and confirmed that patient
safety is a UK chosen health focus for its term.
In a vibrant welcome speech the Welsh First Minister confirmed the
importance of Patient Safety to build up patients' confidence and recommended
that the ideas resulted from the Patient Safety conference should be spread
Speaking as the chairman of the World Alliance for Patient Safety,
Sir Liam Donaldson said that by reporting all incidents including near misses,
hospitals can learn lessons. He gave then some examples of victims of medical
errors. He presented statistics of several studies on adverse events in
hospitals from different part of the world. According to the results of those
studies, in the USA 3.7 % of inpatient episodes lead to unintended harm, in
Australia this level corresponds to 16.6%, in the UK to 10.8 %, in New Zealand
12.9%, in Japan 11%, and 7.5% in Canada. Liam Donaldson gave some reasons of
adverse events, which could include: medication errors (problems of calculation
of doses), handwriting (legibility of doctors), bad administration of drugs;
lack of communication; faulty equipment, lack of staff training. Nevertheless,
usual errors have multiple causes and the awareness is growing in Patient
Safety, he confirmed. He presented then the World Alliance for Patient Safety,
established in 2004 to improve patient safety in all Member States. The
attention was drawn to the role of patients for patients'safety, the impact of
research and taxonomy for medical errors.
Speakers also included Dr David Gozzard from Glan Clywd hospital,
which is one of four in the UK taking part the ?4m Safer Patient Initiative
pilot project organised by the Health Foundation. Dr Gozzard said the scheme
had to be ambitious. He added that prevention from adverse events should be
fundamental. During the afternoon session, the attention was drawn to several
issues: from the use of ICT to support the smart hospital for Tracking Patient
safety, Right Patient and Right Care, the Incident Decision Tree.
The overview of Patient Safety in Denmark, made by Lilja Pedersen,
from Danish Society for Patient Safety who emphasized also the key role of the
system of reporting established already in Denmark, was followed by the
discussion with the participants. Welsh Health Minister Brian Gibbons when
closing the conference said the Welsh Assembly Government's strategy for the
Welsh NHS has patient safety at its heart and he affirmed his support for the
improvement of patient safety.
HEALTH INSURERS: FROM PAYER TO PLAYER
23 SEPTEMBER 2005
The Association Internationale de la Mutualit? (AIM) organises an
international conference in Czech Republic on the consequences of demographic
ageing and the changed expectancies of "health consumers" and the new situation
of the health systems. Health insurers and other purchasing bodies are bound to
play a vital role in directing patients through the variety of care, while
guaranteeing quality of care and maintaining financial balance. At the same
time it is said that health insurance should be more responsive to consumer
choice. But how will the increased diversity produced by these developments
turn out for the fundamental values of solidarity? Is equal access to health
care still an option for future health policy? What tools do health insurers
need for ensuring quality and controlling costs? Should their focus be managing
health or rather managing health care? Should they reward healthy life styles
or rather concentrate on taking care of sick people? These and other questions
will be addressed at this conference.
INFORMATION SOCIETY - eHEALTH
Health ministers and IT experts from across Europe met in the
Norwegian town of Tromso on 23and 24 May 2005 to debate how the potential of
"eHealth" can be realised. The event was jointlyorganised by the Commission,
Luxembourg Presidency and the Norwegian government andencompassed an exhibition
of best practices in healthcare from across Europe. The Commissioner for
health, Mr Kyprianou, is calling on health ministers, technology providers,
patient groups and health NGOs to release the full potential of e-Health in
Europe. The Commission explained that eHealth can give patients the easy access
to high quality health information that they need to achieve this.
More information: www.ehealth2005.no
NEWS FROM THE MEMBERS
Coward policy - fallen reform
A new situation is created by the Audit Office report, since it
contains such definite statements and judgements which cannot be withdrawn
anymore, either in the legal, or in the political sense. The essence of the
Directed Patient Care Model is that the health care of the population is
directed by a local organizing institution instead of the National Health
Insurance Company, and the organizers have a profit share. The money remains in
the health care system, and this model is focused on the family doctor. The
strict critic of the State Auditing Office is based on the statement that the
predecessors of today's Ministry of Health did not keep well in hand the
professional direction of the experiment, moreover, they were not at all
interested in it. The report considers also unacceptable that due to a lack in
legal basis, it cannot be decided whether its aim is the reform of health care
or a modeling of an insurance reform. "Determination, resoluteness, strength
and collaboration were always missing for stating the real objectives of this
model experiment in documents. This experiment brought into movement of health
care, and cost sensitivity increased in all the care provision organizers. The
additional cost was only 433 million forints during its five years period."
Statement of the Ministry
According to the Ministry, a valid evaluation would be necessary
at least for a seven-year period. The Directed Patient Care Model (IBR) was
started in 1999 as a fundamentally new element of the reform processes.
International experience has shown that the models realizing
Directed Patient Care are up-to-date, and their common feature is to stimulate
for a health care management involving a broad spectrum of specialities. They
call the provision organizer interested in a better utilization of resources,
who handles public money as his/her own, thus optimizes patient care, and
follows the path of the patient through the whole process of health care
provision. However, with the lack of appropriate regulation, quality control
and long-term interest it may stimulate under-treatment, moral and ethical
problems may arise, the danger of being fully business-like and the restriction
of the freedom in choice of the patient may also exist.
The home model of this experiment has been functioning for 5
years. In course of open tendering more and more organizers joined the program,
more than 2 million people are included up to September, 2004. These five years
are closed down by drawing conclusions and a survey of the possibilities for
continuing the program. In the centre of the state control mechanism (reports,
internal control) and the examinations (e.g. Audit Office study) efficiency,
successfulness, fairness and patient satisfaction, as well as cost-control
indicators are placed. Special emphasis was placed on prevention of illnesses
and timely health care provision was realized as an initiative of the
Continuous dialogue was performed about a unified practice in the
prevention, detection and care of illnesses, and about how optimum monitoring
of patients can be realized in the complexity of institutions.
As an advantage, it could be seen that the experiment brought into
movement the Hungarian health care system, and at several points it influenced
the development of the health care financial system, and owing to the
provision-organizer, it increased the cost sensitivity of all budgets to a
significant extent. It directed attention to the necessity of developing and
unified use of professional protocols, and the importance of the monitoring of
patient's path. It created an independent, transcendent system of interests
between provision organizers and providers, and it also turned out that it
might be competitive against traditional, stimulating systems leading
eventually to serious deteriorations.
In addition to its advantages, the disadvantages of the system
should also be discussed. At the beginning the experiment, its objectives have
not been determined at the legal level. It did notensure enough resources
(human resources, informatical system development, etc.) for the OEP for the
development and functioning, and as a consequence, neither monitoring and
evaluation of the system could be carried out to a satisfactory extent. Another
serious problem is that the majority of the regulations concerning the system
are not included in laws. The original aims are strongly deteriorated and its
efficiency is weakened by the fact that the system became on many places the
scene of fights between local interest groups.
Economization of hospitals may stall
According to a survey done by the Hungarian Hospital Association
and the Ministry of Health, since the last quadrate of the previous year the
debt of hospitals increased to 26 billion, by 7 billions since then.
Several important hospitals are also indebted. The survey
disapproved of forming a reserve in the inpatient care budget, agreed also by
the Ministry. This is, namely, one of the reasons why the budget for a given
year is incalculable. Due to the indebtedness, it is also difficult to keep to
the law on the state budget. Hospitals need calculable finances, and for this,
it should be ensured that they may use freely the resources accepted in the
budget. The President of the National Health Insurance Budget (OEP) thought it
problematic that the Hospital Association processed only the data of 110
hospitals and correlates it with 154 hospitals, whereas in fact, health
insurance is provided for inpatient care in 186 hospitals. A Chief Head of
Department in the Ministry of Health confirms that some debts will always be
accumulated in hospitals.
Reforms, but for nothing
Health care expenditures are low in Hungary. In the European
countries 80-85% of it is covered by public money, whereas this is only 70% in
Hungary. The remaining part is paid by the patients. The level of provision in
the in-patient care is judged to be hardly 3 in a 5-scale system, and 74% of
the people asked say that health care provision in Hungary is not equal for
People wish the government spends more money into the healthcare,
stated a poll carried out by Szonda Ipsos. Half of the population asked is
unsatisfied with health care provision. According to the majority, there is no
equity in home hospitals, out-patient clinics. Most people are satisfied with
the family doctors, somewhat worse is the qualification of out-patient clinics
and medicine provision and the hospitals are the worst.
There is no "free of charge" reform, says a participating
economist, however, the government should spend some money for a change in the
quality of health care. The professionals think that a good example for cheaper
health care could be the Directed Patient Care model costing only two billions
People beyond control
In Hungary, a lot of people use their so-called TAJ-card
unjustified. According to some estimation, their number could be between 100
000 and 300 000. As this year 98 000 Ft is spent for every card, this means a
sum of 20-30 billion forints.
The big problem is that this card should be given out according to
90 kind of justification, and nobody should prove that there is some payment of
contribution behind them. The total budget of the National Health Insurance
Fund is 1500 billion, but it should finance the health care of 10 million
people, whereas the number of paying citizens last year did not reach 3.9
million. From among them, 1.5 million people pay after the minimum wage, for
the health care provision for the 3 million retired people the state does not
pay, neither is paid extra for children below an age of
14 year, they get the service on the base of the insurance of
their parents. Thus a balance of minus 400 billion forints resulted which is
explained also by the running into each other of social and insurance based
A first step for reforming this weak system will be the change of
the 600 certificates for taking advantage of the so-called public health care
service. The number of invalid certificates is estimated to 10%. The number of
medicines should be widened.
Until the end of this summer, an online connection will be built
out between the pharmacies and the insurance company. A supervisory premium is
planned to be formed.
On materials of "Hospital" magazine
NOTTINGHAM ( UK )
6/17 FEBRUARY 2005
HOPE organised in Nottingham on 16 and 17 February 2005 its first
seminar on DRGs and created HOPE working party on DRGs. As an introduction,
four different systems as well as level of
experience were first of all presented ( Germany , Hungary ,
Nordic countries and England ), followed by an intense discussion to precise
the goals of the working party.
The working party will end up with two concrete results: a report
and a conference. The report will be done within one year. The conference might
be linked to a HOPE event such as the Exchange programme conference.
Dissemination of the results will also be done through regional, national and
The report structure and content will be clearly linked to the
goals set up for the working party: the core objective is to provide HOPE
members with comparative elements on the use of DRGs in European countries and
more specifically the financial use of DRGs.
MENTAL HEALTH SEMINAR
Dublin ( IRELAND )
24/25 FEBRUARY 2005
The 5th annual mental health conference ‘Quality & Choice in
Mental Health' was organised by HOPE, the Standing Committee of the Hospitals
of the European Union in Dublin (Ireland) from the 23rd to 25th February 2005.
The conference was hosted by Ireland 's Tanaiste and Minister for
Health & Children and took place in the historic surroundings of Dublin
Castle . The conference was of particular importance and value to the new
enlarged Europe . It reflects the Irish government's commitment to supporting
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 the delivery of mental health care are hallmarks of the progress
made in Ireland .
This successful seminar gathered almost 150 participants from all
over Europe : planners and policy makers, practitioners, service users and non
governmental organisations. The conference heard international speakers from
the World Health Organisation, France , Belgium , Ireland and England . It
provided, through workshop sessions, the opportunity to explore some of
emerging themes in the Quality & Choice' agenda.
Following the welcoming word of Minister Tim O'Malley and HOPE
President, Gerard Vincent, Michelle Funk, WHO-Geneva coordinator of Mental
Health Policy did a convincing presentation of the “7 steps to quality
align policy for quality improvement (legislation and
design a standards document;
establish accreditation procedures;
monitor the mental health service;
integrate quality improvement into service management
improve or reform services;
review the quality mechanism.
The meeting was also a good opportunity to learn more about
Ireland and Northern Ireland . Northern Ireland has been carrying out an
independent review of the effectiveness of current policy and service provision
relating to mental health. The key words of the first results are transition to
community, partnership, user/carer involvement at all levels, dismantle
clinical distance. On the other side of the 2 border, in Ireland , an expert
group was created to prepare a comprehensive mental health policy, the
framework for the next ten years, following a wide consultation process in
2004. The first results will sound familiar to many countries: person centred,
different levels of care according to need – all integrated, delivered by
community mental health teams, user participation at every level of services.
The conference continued with five parallel workshops dealing with
different aspects of quality in
French accreditation procedure and its relation with
The Belgian master plan for the organisation and
content renewal of mental health care, presented by Jozef Van Holsbeke,
coordinator of the mental health department in VVI, Belgium;
Forensic services in a secure hospital setting, Mike
Harris, executive director of forensic services, Nottinghamshire Trust (UK);
Development of psychological therapy service in
Ireland , Angela Mohan ( Ireland );
EU report on mental health, Viviane Kovess, Fondation
Need for a new paradigm in mental health, Pat Bracken
( Ireland )
A presentation by Mark Davies, department of health ( UK ) of
“Choice in Mental Health, the Challenge for England ” initiated a wide debate
on the way forward.
At all stages, discussions were very lively thanks to audience
comments and answers to the, sometimes provocative, questions of Brian Edwards,
Vice President of HOPE and chair of the plenary sessions.
This conference was open to all those with an interest in
developing quality mental health. It provided a valuable opportunity to share
experiences across the enlarged European Union and to create networks which can
lead to the overall improvement of mental health services.
WHO - WORLD HEALTH DAY - 7 APRIL 2005
WHO announced healthy mothers and children as the theme for World
Health Day 2005. This is also the subject of the World Health Report 2005,
which will be launched on World Health Day, on 7 April 2005. The slogan for
World Health Day 2005 is "Make every mother and child count", which
reflects the reality that today, the health of women and children is not a high
enough priority for many governments and the international community.
For more information please contact: firstname.lastname@example.org
OECD – HEALTH PROJECT
In January 2005, the OECD Council established the Group on Health
to direct the new programme of work on health and to advise Council on
appropriate priorities. A new Health Division within the Directorate for
Employment, Labour and Social Affairs will support the Group and administer its
work programme. OECD is currently recruiting analysts and economists to augment
its staff administering the 2005-2006 programme of work. At their first-ever
meeting at the OECD in May 2004, the OECD Health Ministers discussed the
results of the OECD's three-year Health Project which had investigated ways to
improve the performance of OECD health systems. They also mandated OECD to
carry out future work on health:
Continue to improve and make more reliable the annual
collection of OECD Health Data;
Work with national administrations to implement
Develop, in collaboration with national experts,
indicators of the quality of health care and indicators of other aspects of
health care system performance;
Address analytic issues that OECD countries consider
Studies could be conducted, for example, in the following areas:
efficiency in hospitals, cost-effective provision of primary care, disability
trends and costs of care for older populations, the economics of prevention of
noncommunicable diseases and policies for developing innovative health-related
HOPE CONFERENCES AND EVENTS CO-ORGANISED BY HOPE
HEALTH PROMOTING HOSPITALS (HPH)
18/20 MAY 2005
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. Information on “Empowering for Health –
Practicing the Principles” (The Burlington Hotel, Dublin , Ireland , May 18-20,
2005) is now online available at www.univie.ac.at/hph/dublin2005.
The Main topics of the conference are:
empowering hospital patients – in acute care, for
better living with chronic disease, in rehabilitation, for developing healthy
empowering hospital staff;
empowering specifically vulnerable groups: elderly,
migrants/minorities, persons with mental health problems;
frameworks for Health Promoting Hospitals.
The Scientific Committee invites abstracts for parallel paper and
poster sessions on all topics named above, but also on:
children and adolescents in hospitals;
migrant friendly hospitals;
health promoting psychiatric health care services;
health promoting palliative care and pain management.
A specific strand of parallel sessions will be dedicated to
bridging the gap between theory and practice of health promotion for hospital
patients. For this strand, papers on concepts, models, tools and
recommendations concerning empowering strategies for patients with coronary
heart disease, stroke, cancer, diabetes mellitus, asthma and COPD are
Finally, contributions may also cover other relevant issues of
health promotion for patients, staff and the population in the local hospital
Abstracts can be submitted online at the above web-address,
deadline for submission is January 31, 2005.
HOPE is part of the Scientific Committee of HPH conferences.
GRONINGEN (THE NETHERLANDS )
13/15 APRIL 2005
“The Architecture of Hospitals” Congress is an international
project in the northern town of Groningen in the Netherlands that focuses on
the art of building hospitals. During its upcoming three-day main conference on
April 13-14-15 2005 one can explore the way architecture can contribute to the
hospital's primary function: to promote the patient's health and well being.
Re-discover the hospital as a major architectural challenge that can inspire
architects and management boards to design hospitalbuildings as highlights in
the urban landscape. A series of lectures will give an outline of the general
theme: the art of building healthcare architecture. A significant section will
focus on Evidence Based Design as well as the Maggie Project, as being recent
developments in the philosophy of the healing environment. Other topics are
Interior Architecture for healthcare, the urban setting of hospitals, future
research and the hospital as a work of art. The conference will host scientific
contributions of numerous international experts, designers and theorists in the
fields of architecture, interior design, urban planning, science, environmental
psychology and management. Among them are Stephen Verderber (co-author
Healthcare Architecture), Kirk Hamilton (architect), Roger Ulrich (founder
Evidence Based Design), Charles Jencks (architectural critic), Jain Malkin
(interior architect) and
Aaron Betsky (architect and director of the Netherlands
By materials of European Observatory on Health Systems and
Social and private health insurance: recent developments
Private health insurance,
commercialisation and EU legislation
The next stage in Dutch health care reform
Tom ED van der
Marina W de Lint
Developments such as the ageing and indeed double ageing of the population and
the increased individualisation of society are leading to an explosive rise in
the cost of healthcare in almost every country in Western Europe. In order to
continue to guarantee healthcare access for all in future, national governments
are finding themselves forced to re-examine the organization and structure of
their national healthcare systems. In some cases, this process of
re-examination is leading to drastic changes in the national system. This is
certainly true of the Netherlands.
The government of the Netherlands recently opted for a new basic insurance for
curative care, which has its basis in private law and which can be implemented
by both non-profit and for-profit health insurers and healthcare providers.1
This approach does not represent a departure from the course followed in the
Netherlands for some 15 years in terms of system reform, on the way to
regulated competition, but the government can now be said to be leaning quite
radically towards a private, commercial implementation. This new Dutch
experiment is likely to be of interest to other European countries, not least
due to the discussion it has generated regarding the issue of how this intended
approach relates to European law.
In this article we discuss the new plans for the Dutch system of health
insurance, the choice for a basis in private law and the argumentation the
government employs in this respect against the background of the European
regulations. We conclude by expressing a number of reservations with regard to
Plans to reform the Netherlands' system of health insurance.
The present Dutch system of health insurance is divided into three compartments
The first concerns insurance to cover the cost of long-term care. Under the
Exceptional Medical Expenses Act, all citizens of the Netherlands are insured
for the cost of such care by law. The insurance in the second compartment,
which encompasses curative care, has a dual character: approximately two-thirds
of the population, that is to say every citizen whose income is below a certain
threshold, are insured by law in accordance with the Compulsory Health
Insurance Act, while the remaining section of the population is required to
take out insurance on the private insurance market.
All other care is seen as belonging to the third compartment, for which
everyone can take out supplementary insurance on the private market.
According to the government, the current system of health insurance is unable
to counter the challenges facing the countries of Western Europe in particular.
The cost of care is increasing dramatically, while the care system has also
been found wanting in its ability to respond to patient and customer demand. In
order to tackle these problems, the government sees reform of the care system
as essential. The point of departure for this approach is competition between
care providers and between health insurers, in combination with a stronger
position for customers/patients. The government will set the framework and
remain responsible for the accessibility, affordability and quality of care. In
order to bring this about, the division of responsibilities needs to be
modified and the associated instruments must be reviewed.
In terms of the health insurance system, the government believes it is
essential to abandon the dual insurance structure in the second compartment and
replace it with a single general insurance provision for curative care (and
that this new insurance should be integrated with the existing Exceptional
Medical Expenses Act provision in the long term). This is because there are
major differences between the compulsory forms of health insurance set out in
the Compulsory Health Insurance Act on the one hand and the private health
insurance schemes on the other hand.
First of all, there is the legal basis for the insurance: the former are
public-law insurance provisions, which means that everyone who meets certain
criteria laid down by law is insured. This also means that the law imposes
obligations on the organizations that implement these compulsory forms of
insurance, such as the duty of acceptance, the obligation to offer a clearly
defined basic package and obligatory participation in an equalisation fund.
Private health insurance schemes, on the other hand, have their legal basis in
private law: insured status is not determined directly by law but by an
insurance agreement between the insurer and the policy holder. In principle,
the insurer is free to determine the conditions under which he is prepared to
enter into such an agreement (with the exception of policies under the Health
Insurance Access Act).
A second important difference between these two types of insurance is that the
organisations that implement the Compulsory Health Insurance Act are subject to
a not-for-profit regulation not applicable to the private insurers. Doing away
with these differences creates a level playing field for health insurers in the
second compartment, thereby strengthening the desired competition.
The government's aim of removing the duality in the second insurance
compartment enjoys wide-ranging support and is not subject to discussion.
However, there is controversy surrounding the type of action to be taken in
this regard. In order to do away with this duality, there are in fact two
options available: a public-law approach (along the lines of the current
compulsory health insurance funds) and a private-law approach (along the lines
of the current private health insurance). The government has opted for the
second approach, a controversial choice because it represents a radical shift
in the way typical government tasks are carried out. Since the advent of the
welfare state, the Dutch government has managed the structure, organisation and
implementation of social health insurance as part of the social security
system, sharing responsibility with the social partners and organisations in
the field (an approach known as neo-corporatism).
Now, however, the government has put considerable faith in private initiative
and commerce, without being able to fully foresee what consequences this move
will have for how the system functions.
One possible consequence of the government's choice deserves to be examined
particularly closely, since it forms the focus for the discussion in the
Various observers have pointed out that the choice for the private-law approach
brings with it the risk that the European Union's internal market regulations
will apply in full to the new health insurance, thereby undermining the
foundation of income solidarity and risk solidarity upon which the system is
based. A particular concern in this regard is that the new health insurance
will fall within the scope of Europe's regulations governing private insurance,
the non-life directives.
EU legislation and health insurance
The Member States of the European Union have the power to structure their own
social security systems as they see fit.
However, recent legal precedents set by the European Court of Justice have made
it clear that even health insurance systems, which are clearly identified as
part of a system of social security, are not exempt from European influence. It
therefore seems likely that this influence will extend further as more
market-related elements are incorporated into a social security system.
The government plans in question have been designed with the express intention
of increasing the influence of the market on the health insurance At the same
time the government also wants to anchor the system firmly in social parameters
(risk and income solidarity) by regulating the conduct of those implementing
the new insurance.
It is at this point that the above-mentioned non-life directives appear on the
horizon. These directives are based on the treaty provisions for the free
movement of services and freedom of establishment and "will the non-life
directives apply to the new standard insurance for curative care?"