dirección general de planificación sanitaria, sistemas de información y prestaciones a europe of...
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Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
A EUROPE OF PATIENTS?A EUROPE OF PATIENTS?
EUROPEAN SYSTEMS IN A CHANGING EUROPEAN SYSTEMS IN A CHANGING ENVIRONMENTENVIRONMENT
POLITICAL DIMENSIONPOLITICAL DIMENSION
SPAINSPAIN
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
PREMISES
• Exclusive competence of MS.
• SEM: freedom of movement: persons, capital, goods and services.
• Pillar of the welfare state.
• Challenge: Consumer? Citizen?.
• ECJ.
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
UniversalityUniversality
EquityEquity
SolidaritySolidarity
GENERAL GENERAL PRINCIPLESPRINCIPLES
Universal coverageUniversal coverage
Wide benefitsWide benefits
Public financingPublic financing
Private sector Private sector
supplementarysupplementary
MAINMAIN
CHARACTERISTICSCHARACTERISTICS
EUROPEAN HEALTH SYSTEMS
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
MINIMUMMINIMUM MAXIMUMMAXIMUM% GDP% GDP
HEALTH EXPENDITUREHEALTH EXPENDITURE
EUROPEAN HEALTH SYSTEMS
6,06,0
4,74,7
56,356,3
8,68,6
6,56,5
75,575,5
10,310,3
7,87,8
92,492,4
Public expenditure
Total expenditure
Public/Total
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
OBJECTIVES
Services closer
Cost containment
Increase citizens’ satisfaction
Improve quality
REFORMSREFORMS
EUROPEAN HEALTH SYSTEMS
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
COST CONTAINMENT
Slow increase
Achieved
Increasing more than Economy
REFORMSREFORMS
EUROPEAN HEALTH SYSTEMS
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
CLOSER TO THE CITIZEN
Devolution/decentralisation
REFORMSREFORMS
EUROPEAN HEALTH SYSTEMS
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
IMPROVE QUALITY
Evaluation, accreditation, homologation, recertification
Health Professionals
Institutions
REFORMSREFORMS
EUROPEAN HEALTH SYSTEMS
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
SATISFACTION?
REFORMSREFORMS
EUROPEAN HEALTH SYSTEMS
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
SATISFACTIONSATISFACTION
EUROPEAN HEALTH SYSTEMS
0
10
20
30
40
50
60
70
80
90
100
0 1000 2000 3000 4000 5000
$ p.c. PPP
% P
ob
. sa
tisfe
cha
I
E
IRLRU
AUSF
ASUE
B
DNFIN
HLUX
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
SATISFACTIONSATISFACTION
EUROPEAN HEALTH SYSTEMS
-20
-10
0
10
20
-5 5 15 25 35
Incremento gasto público p.c. 1995-97
Incr
em
en
to s
atis
facc
ión
19
96
-98
IE
IRL
RU
AUS
F
A
GR
B
DN
POR
H
LUX
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
ASPECTSASPECTS
PUBLIC HEALTH CARE SECTORPUBLIC HEALTH CARE SECTOR
EUROPEAN HEALTH SYSTEMS
• Financing: Solidarity
Citizen’s rights
• Provision: Guarantee of Quality-safety
Sustainability and cost control
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
ACTIONS
Guarantee of quality and safety
Health care rights of European citizens
Compensation systems
Actions to facilitate the movement
MOVEMENT OF PATIENTSMOVEMENT OF PATIENTS
EUROPE OF HEALTH
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
Health affair
Not a problem, but an opportunity
Paradoxe: to protect, regulate
SPANISH VIEWSPANISH VIEW
EUROPE OF HEALTH
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
Politicians, not Courts. Health, not Social Affairs
The Health Ministers wish to have a say in the matters being debated which affect health and health care
SPANISH VIEWSPANISH VIEW
EUROPE OF HEALTH
WHICH ONE?
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
ADDED VALUE
Borders
Centers of excellence
Waiting lists
Long stays
MOVEMENT OF PATIENTSMOVEMENT OF PATIENTS
EUROPE OF HEALTH
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
Circulation of patients: Methods
The relevance of arrangements made under Regulation 1408/71 in
helping to address the issue, and whether improvements could be
made which would be advantageous
The kind of information needed in order to help European citizens
to improve their choice
The possibilities for studying quality at a European level, and in
what way to ensure added value
The extent to which agreements (eg bilateral, multilateral, or
Europe-wide, etc.) over a basic package of health care services are
essential to facilitate movement of people around Europe
Health card
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
Circulation of patients: Objectives
To formalise the coincidences of the Ministers of Health on
the important topic of Circulation of Patients and the Impact
of EU on the Health sector.
To suggest to the appropriate EU institutions to launch a debate that allows the Health responsible of the EU member states to have a voice on matters that influence the performance of the health systems.
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
Circulation of patients: Objectives
To carry out further detailed work on the added
value that might be gained from looking at certain
health issues, identified by Health Ministers in
Malaga, from a perspective that goes beyond
national
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
País de la UE Nº de residentes Porcentaje sobre el totalde residentes de la UE
Gran Bretaña 73.983 24,2%Alemania 60.575 19,8%Francia 42.997 14,0%Portugal 41.997 13,7%
Italia 30.862 10,1%
Foreign residents in Spain, 2000.
SPAIN
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
E-FORMS
SPAIN
E-121 foreigners (until july 2002) 83.600
E-121 foreigners (2001) 9.508
E-121 spaniards (until july 2002) 1.203
E-121 spaniards (2001) 193
E-112 foreigners (2001) 3.156
E-111 foreigners (2001) 133.958
E-112 spaniards (2001) 65
E-111 spaniards (2001) 57.468
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
THE FUTURE
Distribution of competences
among UE and MS
White PaperWhite Paper
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
CONCLUSIONS I: Centres of excellence
• Rare and exceptional disorders.
• Knowledge centres and training centres (high tech or specific skills).
• Main purpose: to treat patients.
• Catalogue of existing facilities and their capacity, resources,
competence and medical results
• Real institutions accepting patients from all over Europe
• Virtual working through networking
• Mobile teams moving to different parts of Europe
• Joint ventures
• subsidiarity
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
CONCLUSIONS II: Spare capacity
• Different procedures
• Quality of treatment
• Not displace local patients
• Not distabilize national security system
• Information exchanges: processes, rights, experiences
• Moving the patients or moving the spare capacity
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
CONCLUSIONS III: Neighbouring regions
• Europe without borders
• Pragmatic procedures
• Euregios
• Standard guidelines for projects
• Provide patients and other actors with information
• Use of posibilities of 1408/71
• Quality standards and regulation for all patients
• Coordinate use of national health insurance cards
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
CONCLUSIONS IV: long-term visits
• European health card
• Basic health care benefits package
• Universal quality standards and indicators
• Guides of clinical practice
• Systems of certification
• European alert system
• Exchange of best practices
• Improve access: health care resources in touristic planning, clarify E-forms, solve language barriers, European-wide information networks, to protocolize all the information
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
HEALTH COUNCIL
• emerging interaction between health systems within the European Union particularly as a result of the free movement of citizens, and their desire to have access to high quality health
• respect the responsibilities of the Member States for the organisation and delivery of health services and medical care
• there is added value in examining certain health issues from a perspective that goes beyond national borders
• the delivery of care shall be another main concern together with the administrative issues
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
HEALTH COUNCIL
• bilateral or regional arrangements can play important role
• patient mobility, especially concerned with tourism or long-term residence abroad: need to exchange clinical and other information, in order to ensure proper follow-up and continuity of care
• benefit of reference centres, in order to facilitate the most effective treatment for those diseases requiring specialist interventions
• the new programme of Community action in the field of public health, the new research and telematics programmes provide a framework, in particular aspects relating to information and exchanges of experience
Dirección General de Planificación Sanitaria, Sistemas de Información y Prestaciones
HEALTH COUNCIL
• need to strengthen co-operation in order to promote the greatest opportunities for access to health care of high quality while maintaining the financial sustainability of healthcare systems in the European Union
• high level process of reflection
• will return to this issue at the next meeting of the Health
Council