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Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Health in a New Europe: Health in a New Europe: the view of a newthe view of a new Member StatesMember States
Zsuzsanna Jakab Secretary of State
Ministry of Health, Social and Family Affairs Budapest, HUNGARY
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
1st of May 2004 beginning of a new era in Europe
historical moment for Europe and the new Member States: back to the family of European countries where we belong
new Member States are full of expectations but there are also some worries about the implications of accession
the question often arises: will there be winners and losers or will there be a win-win situation for all?
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
What we expect is a ‘win-win’ situation for every citizen in the field of health!
In our sector (health, social and family affairs)
the balance is supposed to be positiveWHY?
we have
a lot of strengths a number of weaknesses+
We intend to build on our strengths and minimize our weaknesses, close the gap where it exists
as an EU Member State, it will be much easier to do so! this is not the time yet to sit back!
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
What do our citizens expect?What do our citizens expect?
long, wealthy and healthy life; to be protected against illness/disease; to have equal access to good quality health
services; to bring up their children in a healthy environment; safe and hygienic workplace; good working
conditions; decent salary
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
What do we Governments expect?
to modernise our country;
to reduce inequities among/within the countries/regions and population groups;
to follow a common set of objectives in Europe set by various strategies and make progress jointly towards them (e.g. Lisbon strategy; public health strategy; cohesion policy etc.);
create an economy, society with: rapid economic development, with high level of social protection based on the European social model; provide better working conditions for our health personnel; cohesion;
health as a value, investment, economic factor: to generate healthy population
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
What do we expect in the field of health?
to close the gap in life expectancy: live longer (6-8 years behind the EU average); live healthier; reduce the disease burden; increase the number of healthy life years;
macroeconomic impact healthy population healthy manpower productive economy; reduced economic burden of ill-health; on macroeconomy and on the health system;
Main goal
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Progress already made
During the years of preparation for EU accession we made a lot of progress already:
the transposition of the acquis in our sector is an investment in primary prevention
(food safety, pharmaceuticals, medical devices, cosmetic products, environmental protection, water quality, radiation hygiene, health protection at workplace, etc.)
institution - building ensured the implementation of above (using pre-accession funds)
joined the Community Public Health Action Programme and developed our own public health programme
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Assets and gaps in public health
Assets improvement needed
public health
national programme approved by Parliament 2004 is the year of dinamisation
infrastructure
staff
change in approach: health as a value/investment (get rid of paternalistic approach)
responsibility of all individual responsibility modern health promotion
concepts further development of
institutions; training, tools, methodology
modernize infrastructure (pre-accession funds)
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Efforts to close public health gaps
Gap in public health
EU public health strategy framework 2003-2008
National public health programme for 10 years in line with it (bring it down to individuals as the effort of the whole society in 2004.)
technical support: methodology, tools
investment in institution-building and training (EU funds: structural funds for 2004-2006 and 2007-2013 in line with National Development Programme)
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Assets and gaps – health services
health services covers the whole
population provides wide range
of services solidarity principle
improvement needed
- in physical condition- equipment modernized- quality of care improved- patient improved
information
excellent manpower well-trained devoted not very mobile
Assets
reform underway to modernize
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Efforts to close gaps – health services
In the health system:
(reform underway)
Investments, including structural funds needed to upgrade physical condition and equipments; to modernize health system
Basic principles of organising, operating and financing health care in EU Member States
solidarityuniversalitysustainable financing
These values are shared and highly respected by new Member States
It is a real challenge to try to strike the very sensitive balance between providing access to quality services for everyone insure long-term sustainable financing
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
The impact of the internal market on health servicesThe impact of the internal market on health services
Patient mobility: represents a specific challenge with its complex inter-
relationship with all aspects of the organisation, financing, provision and quality of health services being a national responsibility in the EU
the high-level reflection process, the Commission Communication and the Council Conclusions examined the situation and identified the main areas of co-operation
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Patient mobilityPatient mobility 1 1
Information sharing, pooling of best practices in the enlarged EU New Member States bring about their knowledge,
experiences, expertise, e.g. recently adopted or up-dated legislation extensive experiences in health system and financing
reforms well-trained professionals
We are looking forward to learning more and in a more systematic way from each other in the enlarged EU
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Patient mobilityPatient mobility 2 2
Centres of reference in the enlarged EU
A number of well-operating institutions also in new Member States, with high level of expertise
Need to up-grade infrastructure in existing institutions
Closer co-operation among Member States in capacity sharing
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Patient mobilityPatient mobility 3 3 Diversity of experiences in relation to patient
mobility implementation of bilateral social security agreements –
valuable experiences also in new Member States we worked hard to prepare for the implementation of
Community regulations on social security co-ordination Limited experiences with cross-border health care
arrangements with neighbouring countries Exchange of experiences and best practices in
these areas is of high importance
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Patient mobilityPatient mobility 4 4
Decisions of the European Court of Justice: extending rights for citizens extra financial burdens on health insurance budgets, especially
in view of gaps in health care costs in the enlarged EU Modernisation of the social security co-ordination regulations
further extension of citizens rights introduction of the European Health Insurance Card
Need for careful examination of reimbursement procedures on EU and national levels to
meet necessary requirements prevent undermining the financial balance of the health
insurance budget
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Patient mobilityPatient mobility 4 4
Hungary: joint borders with Austria, Slovakia and Slovenia
cross-border health care might increase essentially due to various motivations;
improved possibilities for co-operation and more rational health service provision in border regions;
major price level differences occur in certain relations; careful examination of the impact of patient mobility on
the health system of the country of origin of the patient gains importance
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Mobility of professionalsMobility of professionals
complex and sensitive issue; examination of possible migration flows is crucial; increased mobility brings about many positive implications:
extended training and post-graduate training facilities joint expert pool – common solutions for shortages
the implementation of the Community Working Time Directive as well as related European Court of Justice rulings induce further staffing needs;
increased migration from acceding states might have essential impacts on their labour markets;
training in the health professions in Hungary is of high quality, meeting Community requirements;
we still have a lot to do to improve working conditions, including wages of health professionals, to provide incentives for them to remain in the Hungarian health service
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
Further co-operation possibilitiesFurther co-operation possibilities
Application of the open method of co-ordination in the field of health care and long-term care
definition of common objectives in line with principles of solidarity, universality and financial sustainability
strategies and joint reports Creating more favourable conditions to
applications for support under existing Community financial instruments in the filed of
investment in health health service development
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
PharmaceuticalsPharmaceuticals 1 1
Extensive and modern national legislation in line with Community legislation, covering among others:
product safety, GMP, GCP, GLP marketing authorisation procedures, distribution, sales and advertisement, intellectual property rights, data exclusivity, transparency of pricing and health insurance
reimbursement
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
PharmaceuticalsPharmaceuticals 2 2
Extensive and well developed institutional system: strong national authority: National Institute of
Pharmacy well developed privatised public pharmacy
network hospital pharmacies privatised whole-sale network
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
PharmaceuticalsPharmaceuticals 3 3
Strong, traditional pharmaceutical industry in Hungary privatised, decisively international ownership, developed generic production
Well-trained professionals traditionally high level training, meeting
community requirements
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
PharmaceuticalsPharmaceuticals 4 4
Extensive health insurance re-imbursement scheme
positive list involving also major patient co-payment
Dramatic increase in the number of medicinal products available in the Hungarian market
market liberalisation, accelerated marketing authorisation procedures
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
PharmaceuticalsPharmaceuticals 5 5
Considerable cost pressures on the health care budget during the last 14 years on several reasons
aging society availability of modern technology ever-growing demands by the population increasing input prices increasing promotion activities by producers over-consumption price increase being much higher than inflation
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
PharmaceuticalsPharmaceuticals 6 6
Consequences Hungary’s pharmaceutical expenditures are
significantly high, also in international comparison
• 30,7% of health care costs (source: WHO)• in purchasing power parity (PPP) the yearly per capita
spending on pharmaceuticals is 280 USD in Hungary, while it is e.g. 266 USD in the Netherlands, 223 USD in Denmark, 240 USD in Great-Britain and 242 USD in the Czech Republic.
Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca
„Health in a New Europe: the view of a New Member State”
ConclusionsConclusions
Although, most of the health sector issues belong to national competencies, there is a wide scope for Community level actions, co-operation which might essentially contribute to meeting national objectives.