Supporting health systems in Europe: added value of EU actions?

2013 ◽  
Vol 9 (1) ◽  
pp. 49-69 ◽  
Author(s):  
Timo Clemens ◽  
Kai Michelsen ◽  
Helmut Brand

AbstractSince the start of the economic crisis, the European Union's (EU's) predominant discourse has been austerity and fiscal consolidation. The detrimental effects on Europe's health systems and the health status of its citizens are well described. However, little is known about the emerging EU-level initiatives to support national health systems handle the challenges of efficient care provision and system reorganisation aimed to meet their future needs. This review analyses the manner, conditions and prospects of such EU support. First, health system objectives are increasingly entering the EU health policy agenda. Second, professional and patient mobility provisions may support member states (MS) in copying with crisis related health challenges but can potentially acerbate them at the same time. Third, in recent initiatives health system goals are more closely tied to the EU's economic growth narrative. And fourth, health system issues are taken up in existing EU-level structures for debate and exchange between MS. In addition, the design of some policies may have the potential to intensify socioeconomic and health inequalities rather than ameliorate them.

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  

Abstract The European Commission's State of Health in the EU (SoHEU) initiative aims to provide factual, comparative data and insights into health and health systems in EU countries. The resulting Country Health Profiles, published every two years (current editions: November 2019) are the joint work of the European Observatory on Health Systems and Policies and the OECD, in cooperation with the European Commission. They are designed to support the efforts of Member States in their evidence-based policy making and to contribute to health care systems' strengthening. In addition to short syntheses of population health status, determinants of health and the organisation of the health system, the Country Profiles provide an assessment of the health system, looking at its effectiveness, accessibility and resilience. The idea of resilient health systems has been gaining traction among policy makers. The framework developed for the Country Profiles template sets out three dimensions and associated policy strategies and indicators as building blocks for assessing resilience. The framework adopts a broader definition of resilience, covering the ability to respond to extreme shocks as well as measures to address more predictable and chronic health system strains, such as population ageing or multimorbidity. However, the current framework predates the onset of the novel coronavirus pandemic as well as new work on resilience being done by the SoHEU project partners. This workshop aims to present resilience-enhancing strategies and challenges to a wide audience and to explore how using the evidence from the Country Profiles can contribute to strengthening health systems and improving their performance. A brief introduction on the SoHEU initiative will be followed by the main presentation on the analytical framework on resilience used for the Country Profiles. Along with country examples, we will present the wider results of an audit of the most common health system resilience strategies and challenges emerging from the 30 Country Profiles in 2019. A roundtable discussion will follow, incorporating audience contributions online. The Panel will discuss the results on resilience actions from the 2019 Country Profiles evidence, including: Why is resilience important as a practical objective and how is it related to health system strengthening and performance? How can countries use their resilience-related findings to steer national reform efforts? In addition, panellists will outline how lessons learned from country responses to the Covid-19 pandemic and new work on resilience by the Observatory (resilience policy briefs), OECD (2020 Health at a Glance) and the EC (Expert Group on Health Systems Performance Assessment (HSPA) Report on Resilience) can feed in and improve the resilience framework that will be used in the 2021 Country Profiles. Key messages Knowing what makes health systems resilient can improve their performance and ability to meet the current and future needs of their populations. The State of Health in the EU country profiles generate EU-wide evidence on the common resilience challenges facing countries’ health systems and the strategies being employed to address them.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  

Abstract The European Observatory established the Health Systems and Policy Monitor (HSPM) network in 2008, bringing together an international group of high-profile institutions from Europe and beyond with high academic standing in health systems and policy analysis. An important step was taken in 2011, when the Bertelsmann Health Policy Monitor, a 20-country-project with already significant overlap with the current HSPM network, merged with the Observatory's network of national lead institutions. Today, the network includes 40 institutions from 31 countries, with members participating in a wide range of activities and collaborations, such as writing the Observatory's flagship health system reports (HiTs), keeping the health policy community up-to-date on health system developments via the HSPM web platform, and contributing their expertise to reports, studies and knowledge transfer exercises co-ordinated by the Observatory for a variety of audiences, including ministries of health and international organisations such as the World Health Organization and the European Commission. In addition, network members participate in an annual meeting, hosted in a different member country every year, coming together over two days to exchange knowledge and experiences about the various health system reforms happening in their countries. The aim of these meetings is to present, discuss and start comparative research collaborations of the members that can inform policymaking. As part of a collaboration with the journal Health Policy, researchers of the HSPM network have published more than 100 articles on cross-country comparisons of policies or on ongoing nation health reforms in a special section - the Health Reform Monitor - of the journal. This workshop aims to provide the audience with an overview of the network and its expanding range of activities. An introductory presentation will briefly introduce the origins of the network and discuss its current line of work. The second presentation will provide an overview of reform trends that are routinely collected during the annual meetings as part of the “reform roundup”. The third presentation will give an example of how the network has contributed to the European Commission's State of Health in the EU initiative, by performing a 'rapid response” that informed the companion report to the State of Health in the EU country health profiles 2019. The fourth presentation is a typical example of the kind of collaborative work that the network is undertaking, i.e. involving multiple countries on a topic of shared interest. The workshop will conclude with a debate with the audience about the conceptual and methodological challenges as well as opportunities and future directions of cross-country comparative research and the HSPM network in particular. Key messages The Health Systems and Policy Monitor Network provides detailed descriptions of health systems and provides up to date information on reforms and changes that are particularly policy relevant. The Health Systems and Policy Monitor Network increasingly engages in comparative health systems research and knowledge transfer activities.


2022 ◽  
Vol 17 (1) ◽  
pp. 7-15
Author(s):  
Tamara Rađenović ◽  
◽  
Vladimir Radivojević ◽  
Bojan Krstić ◽  
Tanja Stanišić ◽  
...  

The COVID-19 pandemic has revealed the insufficient capacities and capabilities of countries around the world to deal with global infectious diseases and stressed the need to improve the international health security frame-work. An efficient and comprehensive health system that is able to cope with public health emergencies is an essential prerequisite for strengthening health security. The paper analyzes the efficiency of health systems in the European Union (EU) countries and their responsiveness to the COVID-19 pandemic. The research covers 27 EU countries and it is based on the secondary data contained in the 2019 Global Health Security Index Re-port. The aim of the paper is to identify key determinants for improving the efficiency of health systems in the EU, as well as to examine the interdependence between health expenditures and the efficiency of health system in this sample of countries. The research is conducted through descriptive statistics and correlation and regression analysis. The conclusions can be useful for the EU policy makers in formulating a strategy to improve the efficiency of Member States’ health systems and preparedness for possible new pandemics.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  

Abstract Objective The EU is often criticized for being ‘market-driven’ and practicing a form of ‘cold integration’. Any attempt, however, to strengthen solidarity and social integration in the EU is met by stakeholders in the member states with reservation and often outright refusal, arguing that health systems are national competence subject to the subsidiary principle. This conundrum of asking for more but allowing for less has blocked a scientifically informed public debate about the EU and health policy. The overall objective of this workshop is to discuss how health research can contribute to resolve this conundrum making the EU more conducive to the needs of health systems, public health (PH) and Health in All Policies (HiAP). To this end we will review the following 4 specific topics What are is EU-health policy and what other policies are affecting health and health systems?What tells us the projected Brexit-impact on the UK health system and PH about the value of EU health policy?Are EU-trade policies shaping healthier commercial determinants of health?What is the added value of cross-border care at and beyond border regions? This workshop is based on the update of the seminal volume “Everything you always wanted to know about European Union health policies but were afraid to ask” (2019, 2nd edition). Key note Scott Greer: In health and health systems the European Union is ubiquitous. Health systems in Europe are hard to figure without the cross border mobility of health professions. Patients going cross-borders. We have a European Medicines Agency that is regulating key aspects of the pharmaceutical market. Health systems have become part of the economic governance of the EU. In PH we have the ECDC, a PH programme and policies on health related consumer protection and may mechanism that should protect European citizens from scourges that know no borders. With health in all policies, the EU legislates literally on all known agents and, when in doubt, is using the pre-cautionary principle to protect citizens from health hazards. All this is supported by a large EU research programme. Panellist 1 N Fahy, the projected impact of Brexit on health system functions of the United Kingdom demonstrates how deep the integration goes and how beneficial it is for both health systems and public health. Panellist 2 H Jarman: The discussion around the Transatlantic Trade an Investment Partnership (TTIP) have risen worries about privatization of health services and lowering of food standards. But TTIP is only the tip of the Iceberg given that the EU has several types of trade agreements with many countries and groups of countries, shaping the commercial determinants of health. Panellist 3 W Palm: Cross-border collaboration is already taking place in many border regions. The European reference networks demonstrate the value of the cross-border collaboration beyond border regions, as does collaboration for joint purchasing and health workforce development. Key messages Health is important at the EU level and the EU level is important for health. Not shaping health and health systems at EU level will limit the perspectives of EU integration, health system development public health and HiAP. Panelists Scott Greer Holly Jarman Contact: [email protected] Nick Fahy Contact: [email protected] Willy Palm Contact: [email protected] Contact: [email protected]


2018 ◽  
Vol 10 (9) ◽  
pp. 3186 ◽  
Author(s):  
Madalina Popescu ◽  
Eva Militaru ◽  
Amalia Cristescu ◽  
Maria Vasilescu ◽  
Monica Maer Matei

Healthcare systems aim to provide access to good quality care, while ensuring equity and solidarity. The fiscal sustainability of healthcare systems has become a matter of concern in recent European Union (EU) debates, considering the ever increasing need for adequate healthcare determined by factors such as aging population, investments in technology and infrastructure, medical products and wages. Our paper seeks to measure the health system performances of the EU countries by building up a composite index, which will then be used as a tool in investigating the relationship between health performance and the fiscal sustainability of health systems. A principal components analysis (PCA) was applied to build the composite index through the use of the most relevant health indicators provided by Eurostat and the Sustainable Development Knowledge Platform. The composite index offers a comprehensive performance assessment and provides a clear ranking of the EU countries based on their health system performances. Further investigation of the link between health performance and fiscal sustainability revealed that higher ranks are associated with higher shares of health expenditures in gross domestic product (GDP), a large share of employment in the health sector, and higher duration of working life. These patterns are followed by efficient health systems, encountering reduced sustainability risks.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
N Perić ◽  
T Ullmann ◽  
M M Hofmarcher ◽  
Z Or ◽  
J Simon

Abstract Background As part of the EU funded BRIDGE Health project, 23 headline indicators for assessing and comparing the performance of public health systems were proposed. They were shortlisted out of the currently existing and often overlapping pool of over 2000 health system performance assessment (HSPA) indicators. In this qualitative study, we explored their validity and perceived national-level utility for policy making and factors affecting the potential uptake of an indicator hierarchy (headline, operational & explanatory levels) at Member States' and EU levels. Methods Semi-structured interviews with a purposive sample of 24 policy makers and senior policy advisors from 15 EU Member States and one candidate country were performed between July and November 2018. All interviews were transcribed and coded using summative and directed content analysis to generate thematic categories in MAXQDA. Results Preliminary results suggest that experts positively perceived the overall balance of the shortlist across performance domains reflecting most of the important policy areas. However, some further amendments to the generic set of indicators were recommended to increase their policy relevance and measurement validity while keeping the size manageable. The concept and usage of headline HSPA indicators is mostly viewed as a communication tool whereas more granular information at explanatory levels is perceived to be more appropriate for data driven policymaking and cross-country learning. Conclusions Interviews showed a considerable heterogeneity in the feasibility of applying a generic HSPA framework in an EU-wide health strategy as a compass for improvement through comparisons of health systems. Factors such as flexibility in adaptation to the national context, improvement in building knowledge capacity, potential misinterpretation in the 'European Semester' context, as well as lack of appropriately defined benchmarks were recurrent themes in hindering its uptake. Key messages Policy makers assess explanatory level indicators to be more actionable than headline level indicators. To facilitate the use of headline indicators at EU-level as a navigation tool for health systems, the list has to be stable to create trends and sufficiently flexible in adapting to new priorities.


2012 ◽  
Vol 2 (1) ◽  
pp. 1-21 ◽  
Author(s):  
J Van Olmen ◽  
B Criel ◽  
U Bhojani ◽  
B Marchal ◽  
S Van Belle ◽  
...  

Frameworks can clarify concepts and improve understanding of underlying mechanisms in the domain of health systems research and strengthening. Many existing frameworks have a limited capacity to analyze interactions and equilibriums within a health system overlooking values as an underlying steering mechanism. This paper introduces the health system dynamics framework and demonstrates its application as a tool for analysis and modelling. The added value of this framework is: 1) consideration of different levels of a health system and tracing how interventions or events at one level influence other elements and other levels; 2) emphasizes the importance of values; 3) a central axis linking governance, human resources, service delivery and population, and 4) taking into account the key elements of complexity in analysis and strategy development. We urge  the analysis of individual health systems and meta-analysis, for a better understanding of their functioning and strengthening. 


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  

Abstract Reforming health systems is a priority that is being addressed at local, regional, national and European level. Health system reforms are complex; they require political commitment, know-how, skills and sustained financial investments. The EU can provide support in various stages of such reforms: from initiation to design and to implementation. The session will describe the main EU tools for this, such as the European Semester, programmes that can offer technical assistance, as well as programmes that provide opportunities for financial support. EU tools to support health system reforms Loukianos Gatzoulis DG SANTE Technical support / twinning Sonia Mueller VIGOUR Financing support Dita Protopopová Mental Healthcare reform project, Ministry of Health, Czech Republic


Author(s):  
Flora Amato ◽  
Valentina Casola ◽  
Giovanni Cozzolino ◽  
Alessandra De Benedictis ◽  
Nicola Mazzocca ◽  
...  

e-Health applications enable one to acquire, process, and share patient medical data to improve diagnosis, treatment, and patient monitoring. Despite the undeniable benefits brought by the digitization of health systems, the transmission of and access to medical information raises critical issues, mainly related to security and privacy. While several security mechanisms exist that can be applied in an e-Health system, they may not be adequate due to the complexity of involved workflows, and to the possible inherent correlation among health-related concepts that may be exploited by unauthorized subjects. In this article, we propose a novel methodology for the validation of security and privacy policies in a complex e-Health system, that leverages a formal description of clinical workflows and a semantically enriched definition of the data model used by the workflows, in order to build a comprehensive model of the system that can be analyzed with automated model checking and ontology-based reasoning techniques. To validate the proposed methodology, we applied it to two case studies, subjected to the directives of the EU GDPR regulation for the protection of health data, and demonstrated its ability to correctly verify the fulfillment of desired policies in different scenarios.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.


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