Challenges for Health and EC actions

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Challenges for Health and EC actions
Policies and Business Mechanisms in the CEE
Healthcare Sector 23-25 September 2008, Bucharest
Rostislava Dimitrova, MD Health Strategy Health
Systems , DG SANCO European Commission
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What health goal?
EC TREATYArticle 152 High level of health
protection

Charter of Fundamental Rights Universal right to
healthcare
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Increase Healthy Life Years (HLY)

• Longer life expectancy not enough
• Need to distinguish between Life and Life in good
  health
• HLY indicator
• Health social good and factor of economic
  growth (Lisbon Agenda)

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Health values

• Shared EU values for health of universality,
  access for all to good quality care, solidarity
  and equity
• Europes Social model
• BUT REALITY ACROSS EU IS VERY DIFFERENT

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How to Achieve Better Health

• The indiviadual choice of life style and behavior
  
• National health systems- to ensure high quality
  health care for all
• Complementarity and coordination between the
  national policies and the EU health policy to
  improve population health by tackling the
  determinants of health (the risk factors)

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Health Challenges
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Inequalities BETWEEN EU countries

• There is a gap of 8 years in life expectancy at
  birth for women, from 76 years (Bulgaria, Latvia,
  Romania) to 84 (France, Italy, Spain)

Source WHOSIS, 2005
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Inequalities BETWEEN EU countries
There is a gap of 18 years in Healthy Life Years
at birth for women (from 70 in Malta and 68 in
Denmark to 52 in Estonia)
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Inequalities BETWEEN EU countries

• Ischemic heart diseases kill 10.5 more women in
  Lithuania than in France (mortality rate varies
  10.5 fold between EU countries)

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Health in National Budgets

• National expenditure on health in percentage of
  GDP varies more than 2 fold. It is twice higher
  in France (11.2) than in Estonia (5).

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What we do

• Invest more in health - Structural Funds, ESF, FR
  7 , HP
• Health and Social Policy synergies
• Improve Health literacy / data/info
• Health promotion and prevention

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Health in the EU budget
Future
Present
Health and Consumer Protection programmes 0.1
HEALTH IN ALL POLICIES
Health
EAP
SFs, RTD
External relations
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What does the world expect from the EU?

• Help bridge health inequalities throughout EU
• Help promote health and healthy lifestyles
• Integrate health concerns into all policies
• Tackle global health issues
• Use the added value of European cooperation on
  healthcare, ageing, technology, health threats
  prevention etc.
• Disseminate good practices and knowledge

Source DG Sanco consultations 2005-06-07
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EC Actions
Health investments through Structural
Funds, Communication on health Inequalities etc
Projects funded Cross-sectoral work
Health information and Health Portal
Interactions with WHO
ECDC Organ Donation
White paper on Nutrition Communication on
Alcohol Tobacco control strategy
Pharmaceutical Forum
Directive , Green paper, Communication
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Health citizens major concernI. Adapted
from UK Food Standards Agency Consumer
Attitudes Survey 2007
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The EU Health Strategy Together for Health
2008-2013

• More focus , coherence and prioritisation of EU
  health policy
• Bringing different policies together for Health
• Ensuring that e.g. Social, Environment,
  Education, Research, Regional Development
  policies work for health
• Close cooperation with Member States to work
  together on shared objectives
• Broad participation of the stakeholders in
  defining the citizens agenda in the health area
• Implementation mechanism

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The EU Health Strategy Principles and
Objectives

• Principles
• 1. A value-driven approach
• 2. Health is Wealth
• 3. Health in all Policies
• 4. Global Health
• Objectives
• 1. Foster Good Health in an Ageing Europe
• 2. Protect Citizens from Health Threats
• 3. Support Dynamic Health Systems New
  Technologies

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Objective 1 Fostering Good Health in an Ageing
Europe

• By 2050 70 more people aged 65. Must adapt
  health systems to needs of ageing population
• The EU can
• exchange good practice on ageing policy
  measures
• eg Health care/social care
• Stimulate thinking about implications for health
  professionals ( Green Paper launch on 10.12.
  2008)
• Need to promote health in all ages
• The EU can
• Promote use of Healthy Life Years indicator
  (structural Lisbon indicator)
• promote healthy lifestyles
• raise awareness of health impact of risk factors
  (alcohol, smoking etc)

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Objective 2 Protecting Citizens from Health
Threats

• Pandemics, bioterrorism preparedness and
  response to threats
• The EU can
• Gather scientific evidence surveillance of
  threats, recommendations on e.g. immunisation
• Help to address emerging threats Climate Change
• Patient Safety 10 of patients suffer an adverse
  incident in UK
• The EU can
• foster exchange, promote studies, raise awareness

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Objective 3 Supporting Dynamic Health Systems
New Technologies

• Health systems under pressure (mobility, ageing
  etc)
• New technologies can revolutionise healthcare but
  must be evaluated and considered (HTA)
• E-health can support safety, quality, access
• The EU can
• Provide EU Framework for cross-border healthcare
• Develop Health Technology Assessment
• Create networks of Centres of Reference
• Initiate e-health pilots and networks

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Working together implementation mechanism

• Commission, Member States, regions, stakeholders
  to work together to implement strategy
• Agree objectives and priorities for EU health
  actions
• Shape together a vision of health in Europe

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Implementation mechanism

• First meeting of the Working Party on Health at
  Senior level - 9 December 2009 in Paris
• Commission sounds out stakeholders
• ?Ideas on best way to involve stakeholders in
  the new mechanism welcome!
• ? How to link new mechanism with existing EU
  platforms e.g. on nutrition, alcohol, HIV, the
  HPF

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Draft Directive on patients rights in cross
border healthcare I

• Help patients to exercise their right to
  reimbursement for health treatment in any EU
  country (cross-border healthcare)
• Provide assurance about safety and quality of
  cross-border healthcare
• 3. Foster cooperation between health systems, to
  improve healthcare for all

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Starting points

• Subsidiarity (respect for MS responsibilities
  for organisation and delivery of healthcare)
• Common values and principles of EU health systems
  (universality, access to good quality care,
  equity and solidarity)
• Free movement rights (in this context for
  patients, not providers)

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What is the aim

• To reduce gaps/conflicts between Member States
  responsibilities in cross-border healthcare
• To bring clarity about patients entitlements for
  cross-border healthcare
• To use the added value of European cooperation on
  healthcare where useful

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What is not the aim

• We do not touch upon the status quo as to freedom
  of establishment of healthcare providers
• This initiative the Commission complements the
  EUs so-called Social security regulation
  (1408/71)
• National benefit packages remain national
  competence
• The Commission does not seek to create new
  rights, only to clarify those identified by the
  European Court of Justice

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Green Paper on Workforce for Health

• Workforce supply issues facing health systems
• The extent of available data and evidence about
  the health workforce and how trends are monitored
• Human resources strategies to recruit and retain
  the workforce
• Healthcare training capacity

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Green Paper on Workforce for Health II

• Public Health capacity ( numbers and training of
  non-clinical health workers)
• The ethical dimension of recruitment from outside
  EU vis à vis the effect on developing countries.
  
• The role of new technologies and telemedicine in
  supporting the workforce. The training
  implications of skilling the workforce to use new
  technologies.
• The role of clinical entrepreneurs in increasing
  provision and access across the EU.

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Pharmaceutical Forum

• To respond to health challenges and strengthen
  competitiveness of the industry
• 2. To strengthen EU co-operation on
  pharmaceutical policies
• 3. To develop concrete proposals on the
  outstanding G10 recommendations Information to
  patients, pricing and relative effectiveness

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Pharmaceutical Forum - themes

• Information to patients
• ways to improve the quality of, and access to,
  information on diseased and treatment options
• Relative Effectiveness
• support Member States apply relative
  effectiveness systems in order to allow
  containment of pharmaceutical costs as well as a
  fair reward for innovation
• Pricing and Reimbursement
• examine pricing and reimbursement mechanisms to
  support Member States fulfilling their commitment
  towards the G10 recommendations, as well as
  towards the public health objectives of offering
  an equal access to medicines at an affordable
  overall cost

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Pharmaceutical Forum Process

• 2006 2007 2008

• Prioritisation of issues
• Consultations/surveys
• Exploring/experiences
•  General Guidelines 

• Set-up of Steering Com
• Set-up of Working Groups
• Overview of issues
•  Trust building 

• Work packages
• Several pilot projects
• Specified guidelines
• Setting up principles

3-year program
Today
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Pharmaceutical Forum - outcomes

• Final high level Pharmaceutical Forum 2 October
  2008
• Forum to endorse a final report
• Conclusions
• Recommendations
• Technical Annexes
• www.ec.europa.eu/pharmaforum (available after 2
  October)

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Single access, more information, healthier choices

• Health-EU Portal

http//health.europa.eu
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Health-EU Portal

• Single access to public health with reliable,
  multilingual and comprehensive information
• Information at
• EU level
• National level
• International organisations
• NGOs
• For citizens, health professionals,
  administrations, policy makers and stakeholders
• News, events, press releases, EU publications, EU
  legislation

http//health.europa.eu
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6 thematic areas

• My Health
• My Lifestyle
• My Environment
• Health Problems
• Care for Me
• Health in the EU

http//health.europa.eu
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E-Newsletter

• Since September 2007, the e-newsletter
  complements the portal, issued twice a month in
  20 languages
• Aims
• develop an active information approach, reaching
  a defined public
• enlarge the scope of visitors to the Portal
• keep EU citizens updated with news from different
  sources at European level
• Each edition is built on a theme and offers a
  wide range of news, links, and events, coming
  from all over Europe http//health.europa.eu/newsl
  etter

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Thank You