(by materials of “Hope” magazine)


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


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.


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.


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:

  1. European health reforms - solidarity at stake?
  2. the challenges of European health services provision;
  3. free movement of patients and cross border cooperation in health;
  4. sharing information on the health of elderly people - outlook for the AEIP conference in 2007.

AEIP President Bernard Devy will close proceedings.


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 patient.

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 antibiotic resistance;
  • 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 November 2005.

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 environment.

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.


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 Food Safety.

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 structural rules.


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



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.



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 finalized: www.marquis.be


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/



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.


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.


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 effective strategies;
- 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 borders.

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 professional regulators.

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, notably:
- Health Inequalities Summit: governing for health conference: 17/18 October 2005, London;
- 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.



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 around.

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.




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.


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



George Harmat

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 provision-organizers level.

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 everybody

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 till now

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 expenditures.

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






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 European conferences.

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.



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 improvement”:

•  align policy for quality improvement (legislation and funding);

•  design a standards document;

•  establish accreditation procedures;

•  monitor the mental health service;

•  integrate quality improvement into service management and delivery;

•  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

mental health:

•  French accreditation procedure and its relation with mental health;

•  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 MGEN (France)

•  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.

Information: sg@hope.be





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: whd2005@who.int




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 health accounts;

•  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 important.

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 technologies.






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 lifestyles;

•  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;

•  smoke-free hospitals;

•  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 especially welcome.

Finally, contributions may also cover other relevant issues of health promotion for patients, staff and the population in the local hospital community.

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.







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 Architecture Institute).

Information at:


By materials of European Observatory on Health Systems and Policies' E-Bulletin

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 this policy.

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 Netherlands.

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.

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?"