policy context -eu level cooperation - esi funds for...

Policy context - EU level cooperation

Katarzyna Kielar-Kowalczyk ; Katarzyna Ptak

European Commission, DG Health and Food Safety

Algarve, 27 September 2018

1.ESIF for Health

2. Access to healthcare

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EU funds' investment in Health

• Overall analysis of the investments financed by ESIF in health

• Internal work with other services to channel ESIF support to health

• Support to Member States' health authorities to channel ESIF support to health

• The next MFF - post 2020

Overall analysis of the investments financed

by ESIF in health

in 2014-2020 more than 40 million people are expected to benefit from improved health services (Cohesion Data Portal estimations)

ESIF Thematic Objectives

Research and InnovationClimate change adaptation,

risk prevention

ICT, incl.e-health

Competitiveness of SMEs

Low carbon economy

Environmental protection

and resource efficiency

Sustainable transport

Better public

administration

Education, training

and LLL

Social Inclusion,

incl.access to healthcare

Employment and mobility,

incl. AHA

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Internal work with other services to channel ESIF

support to health

Since the beginning of the preparations of the current

programming period (2009-2010) DG SANTE has been

involved in intra-Commission work with other services

(DG REGIO and DG EMPL) to channel ESIF support to

health

Internal work with other services to channel ESIF

support to health

• Commission Guide on ESIF support to health 2014-2020 providing policy

guidance for key priority areas of investment in health, pointing at suggested

lines of intervention eligible under the ESIF thematic objectives

• Ex Ante Conditionality ("ExAC") for health

setting requirements related to policy and strategic frameworks, regulatory

frameworks and administrative and institutional capacity that MS must fulfil to

be able to reactive fundings

• Mapping of the planned use of ESIF in health for the period 2014-2020

providing an overview of actions that Member States foresee supporting in

the field of health with ESIF

Access

➢ Addressing health inequalities between geographical areas and between social groups, in particular by ensuring access to healthcare;

➢ Supporting investments in health infrastructure and in new technologies (e-health) if they contribute to increased cost-efficiency and better access to care;

Healthy ageing

➢ Support the development of new ICT based solutions and services to address the needs of an ageing population and empower users to use them to remain active and independent for longer.

Health promotion & disease prevention

➢ Promote health promotion and early intervention programmes for people from groups with increased vulnerability for mental disorders;

➢ Strengthen ambulatory services and primary care, while increasing care coordination, to reduce unnecessary visits to specialists/hospitals, including via prevention and monitoring including telemedicine and telecare solutions.

Available at: http://ec.europa.eu/health/health_structural_funds/docs/esif_guide_en.pdf

Commission guideon health investments through ESIF

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http://ec.europa.eu/health/health_structural_funds/docs/esif_guide_en.pdf

Support to Member States' health authorities to

channel ESIF support to health

1rst project (2013-2015)

aimed to provide assistance to relevant authorities in EU Member Statesin the programming period 2014-2020 and support effectiveimplementation of ESIF actions in the health sector

Outputs:

• Mapping of the planned use of ESIF in health for the period 2014-2020

• series of practical tools and guidelines,

• practical support through visits to 12 countries

• 2 thematic workshops

Project outputs

➢ Guide for effective investments in health under ESIF

➢ Technical toolkit

➢ Dissemination 1 – ‘Roll-out’ to MS

➢ Dissemination 2 – Website

➢ Mapping Report on the use of ESIF in health

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"Effective use of ESIF for health investments in the programming period 2014-2020"

"Effective use of European Structural and Investment Funds for health investments in the programming period 2014-2020" http://esifforhealth.eu/Mapping_report.htm

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http://esifforhealth.eu/Mapping_report.htm

Scope of investments 2007-2013:

- Health infrastructure

- Health promotion and disease prevention

- Education of medical staff

- E-health

- Medical R&D

- Public administration and health services

- Workplace health & safety

- Health tourism

Overview of the Mapping results

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Scope of investments 2014-2020:

- Deinstitutionalisation and community-based care

- Active and Healthy Ageing

- Improving access & quality of health care services

- Health promotion and disease prevention

- Education of medical staff

- E-health

- Medical R&D

- Public administration and health services

- Workplace health & safety

- Health tourism

- Risk prevention and disaster preparedness

Support to Member States' health authorities

to channel ESIF support to health

2nd project (ongoing 2016-2018)

➢ Objective: to further develop capacities of the relevant actors inEU Member States and regions to support the effective andconsistent implementation of ESIF for health, to supportcapacity buildings in Member States through knowledge sharing,developing and promoting exchange of information and goodpractices among interested Member States

Outputs of 2nd project

▪ Thematic mapping ▪ Inventory of projects▪ Geographic mapping: 28 Country fact-sheets▪ Series of workshops▪ Overall analysis of ESIF support to health investments

MultiannualFinancial Framework 2021-2027

A BUDGET FOR EUROPE'S PRIORITIES

Simplification, transparency and flexibility

Source: European Commission

REGIONAL DEVELOPMENT AND COHESION

❑ A strengthened link with the European Semester

❑ A simplified framework and less red tape for the beneficiaries

of the funds

❑ A more tailored approach to regional development

Source: European Commission

STRONGER LINK WITH THE EUROPEAN SEMESTER OF ECONOMIC POLICY COORDINATION

coordination and

complementarity of

financing from cohesion

policy funds and the

new Reform Support

Programme

roadmap for the short,

mid- and long-term

planning and monitoring

of investments

technical and financial

support for reforms at

national level

Cohesion Policy objectives

▪PO 1: a smarter Europe…

▪PO 2: a greener Europe…

▪PO 3: a more connected Europe...

▪PO 4: a more social Europe…

▪PO 5: a Europe closer to citizens…

▪ All ESF+ specific objectives fall under PO 4 : “a more social

Europe, implementing the European Pillar of Social Rights”

▪ Investments in health and long-term care may be envisaged both under PO1 and PO4.

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ERDF to support investment in health and in particular

(…) ensuring equal access to health care through developing infrastructure, including primary care(…)

The ESF+ components

Total Budget: €101 174 000 000

Investment for Jobs and Growth: €100 000 000 000 of which- Transnational cooperation €200 000 000

- Outermost regions: €400 000 000

Employment and social Innovation and Health strands: € 1 174 000 000- EaSI €761 000 000- Health €413 000 000

Specific objectives of the ESF+

EU Pillar

of Social Rights

(i) improving access to employment(ii) modernising labour market(iii) Promoting women’s labour market participation, work/life balance, childcare, working environment, adaptation to change, active and healthy ageing(iv) Improving quality of education and training systems(v) Promoting equal access to education and training and lifelong learning, (vi) active inclusion (vii) integration of third country nationals and

marginalised communities e.g. Roma; (ix) access to services; social protection healthcare

systems and long term care

(x) people at risk of poverty including / most deprived and children;(xi) addressing material deprivation

yy) Health promotion

Horizontal principles

Gender equality

Equal opps

Non discriminatio

n

Contribution to "Smarter Europe"“Greener Europe”

Structural funds to support

• reforms of health systems

• improving accessibility, effectiveness and resilience of healthcare systems

• equal access to affordable, accessible, sustainable and high-quality healthcare with a view to reducing health inequalities

• Investment strategies, which consider together human capital needs, innovative technologies and new care delivery models

• strengthened primary care;

• integration of care; transition from residential care to independent living community-based services

• patient empowerment structures and new patient pathways;

• planning and training of the health workforce;

• increased capacity to measure quality and outcomes

• Health promotion and disease prevention

2. Access to healthcare

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CHALLENGES

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"Access is a multi-dimensional issue. Barriers to access can be found at the level of individuals, health service providers and the health system. Access is also affected by public policy beyond the health system –especially fiscal policy, but also social protection, education, employment, transport and regional development policy."Expert Panel Opinion on access to healthcare, 2016.

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Challenges

Unmet medical needs

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Challenges

0

2

4

6

8

10

12

14

16

EU

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AT BE BG CH CY CZ DE DK EE EL ES FI FR HR HU IE IT LT LU LV MT NL PL PT RO SE SI SK UK

Self-employed 2009

Employees 2009

Self-employed 2015

Employees 2015

Unmet medical needs: self-employed

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Challenges

•

Access to care and access to medicines –the rational use of medicines :

cost effectiveness and affordability

-Improving the rational prescribing and usage ofmedicines,

-Incentivising the uptake of generics,

-Improving access to cost-effective new medicines,

-Using joint/cross-border/centralised procurementprocedures,

-Introduction of HTA to inform on coverage and funding,

-Measuring cost-effectiveness and sustainability ofpharma expenditure.

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Challenges

POLICY RESPONSE

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Policy principles

Policy principles

October 2016, Commission-EPC Joint Report on Health Care and Long-term Care systems & Fiscal Sustainability',

Good practices on improving the cost-effectiveness of health systems

November 2016 Council Conclusions"The Council CONSIDERS that achieving the twin aim of ensuring fiscal sustainability and access to good quality health care services for all, by improving the efficiency and effectiveness of health and long-term care systems, is therefore particularly important."

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EU Pillar of Social Rights

- 20 key principles - Joint InterinstitutionalProclamation

- Social Scoreboard – monitor progress

- Reflection paper on the social dimension of the future of the EU

- Initiatives accompanying the Pillar: first step implementation: work life balance, rules on labour contracts,

access to social protection, working time

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- Guiding principles for Member States and EU institutions to support fair and well-functioning labour markets and welfare systems

- A compass for a renewed process of upward convergence towards better working and living conditions.

- Encourage race to the top

- No change to competencies – no EU legislation on everything

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EUROPEAN PILLAR

OF SOCIAL RIGHTS #SocialRights

PRINCIPLE 16: Everyone has the right to timely access to affordable, preventive and curative health care of good quality

Social Pillar – Principle 16

•Building upon art 35 of the EU Charter of fundamental rights,

• Access to good quality preventive health care and medical treatment is recognised as a fundamental principles in many national health systems in the EU,

• Action at EU level (Cooperation, Legislation, Semester) and national level.

Les soins de santé


Social Pillar – Principle 16

• Timely access means that everyone is able to access health care whenever they need it.

• Affordable health care means that people should not be prevented from using needed care because of the cost.

• Healthcare of good quality, means that healthcare should be relevant, appropriate, safe and effective.

• Access to care should mean access to both preventive and curative healthcare.

Les soins de santé


Proposal: Council Recommendation on

access to social protection for workers and the self-employed; 13/03/2018

• - to close formal coverage gaps by ensuring that workers and the self-employed in comparable conditions can adhere to corresponding social security systems;

• - to offer them adequate effective coverage, so that they can build up and claim adequate entitlements;

• - to facilitate the transfer of social security entitlements from one job to the next;

• - to provide workers and the self-employed with transparent information about their social security entitlements and obligations.


Les soins de santé

Access to health care in the European Semester

• Access as a policy principle in the AGS years after years.

• Analysed in Country Reports.

• Highlighted in CSRs for 6 countries.

EU Economic Governance

Access to health care in the European Semester

EU Economic Governance

CSRs

Bulgaria In line with the National Health Strategy and its action plan, improve access to health services, including by reducing out-of-pocket payments and addressing shortages of health professionals.

Cyprus Take measures to ensure that the National Health System becomes fully functional in 2020, as planned.

Latvia Increase the accessibility, quality and cost-effectiveness of the healthcare system.

Lithuania Improve the performance of the healthcare system by a further shift from hospital to outpatient care, strengthening disease prevention measures, including at local level, and increasing the quality and affordability of care.

Romania Improve access to healthcare, including through the shift to outpatient care.

Slovenia Adopt and implement the healthcare and health insurance act and the planned reform of long-term care.

Expert Panel on Effective Ways of Investing in Health

Opinion on access to health care - 2016

• - presents available indicators on access to healthcare,

• - discusses how to best measure access,

• - provides a comprehensive framework of analysis on

the issue of access,

• - suggests actions that can be taken both at national and

European level to ensure and improve equity of access.

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Knowledge on access to healthcare


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Opinion on Benchmarking Access to Healthcare in the EU

• Hands-on tool to identify the gaps in access to healthcare and their distribution within societies,

• A quantitative benchmark/target on access to healthcare based on the unmet needs for medical examination indicator as well as a target for the EU and a target which can be adapted for each Member State;

• A qualitative benchmark to improve access to healthcare in Member States;

• The possible utilisation of EU funds and/or other mechanisms to support the improvement of access to healthcare according to the benchmarks proposed. 49



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State of health in the EU

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EU ADDED VALUECountry Knowledge

November 2016 November 2017 November 2017 First half of 2018

Health promotion and disease prevention pave the way for a more effective and efficient health system #1

A strong primary care guides patients through the health system and helps avoid wasteful spending

#2

Integrated care tackles a labyrinth of scattered health services to the benefit of the patient

#3

Proactive health workforceplanning and forecasting make health systems resilient to future shocks

#4

The patient is at the centreof the next generation of

better health data for policy and practice

#5

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Thank you!

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