Inclusion, Investment, Innovation:

Keys to building better and

sustainable health in Europe

Dr Hans Kluge

Director, Division of Health Systems and Public Health

Dr Silviu Domente

Senior Adviser, Health Policy, WHO Project Office in Greece

The Future of Healthcare in Cyprus

Nicosia, 3 December 2018

1

The 17 Sustainable Development Goals (SDGs)

Premature NCD mortality in Europe – global

success story

Organization of PHC services: key desired features

• Proximity and integration - dense network, close to community

• Multidisciplinary primary care team, while maintaining the personal

relation

• Care provided to a defined population

• Responsibilities for coordination of all health and social services

• The primary care team is accountable for its performance, with

population’s participation

• Remuneration and other incentives aligned with responsibilities

Include – improving coverage, access and

financial protection for everyone

No one should experience

Financial

hardshipUnmet need

0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

Out-

of-

pocket paym

ent

as %

of

tota

l health s

pendin

g

DANGER ZONE: > 30%

SAFE: < 15%

Source: WHO data for 2014

High and middle-income countries in the European Region

Out-of-pocket spending as a % of total expenditure

on health is a good proxy for financial protection

0

20

40

60

80

100

SV

N

CZ

H

IRE

UN

K

SW

E

FR

A

DE

U

AU

T

CY

P

SV

K

CR

O

TU

R

ES

T

PO

L

LT

U

GR

E

PO

R

HU

N

AL

B

KG

Z

LV

A

UK

R

GE

O

MD

A

Ca

tastr

op

hic

OO

Ps (

%)

Inpatient care

Diagnostic tests

Dental care

Outpatient care

Medical products

Medicines

Which health services are responsible for

catastrophic spending among all households

Stronger protection Weaker protection

WHO Barcelona Office for Health Systems Strengthening

0

20

40

60

80

100

SV

N

CZ

H

IRE

UN

K

SW

E

FR

A

DE

U

AU

T

CY

P

SV

K

CR

O

TU

R

ES

T

PO

L

LT

U

GR

E

PO

R

HU

N

AL

B

KG

Z

LV

A

UK

R

GE

O

MD

A

Ca

tastr

op

hic

OO

Ps (

%)

Inpatient care

Diagnostic tests

Dental care

Outpatient care

Medical products

Medicines

Which health services are responsible for

catastrophic spending among poor households

Stronger protection Weaker protection

WHO Barcelona Office for Health Systems Strengthening

Lack of access to medicines

Weak Regulatory practices

Intellectual property rights

and trade

Lack of effective pricing and

reimbursement policies

WHO Actions at the Global Level

R&D and innovation

Manufacturing

Marketing registration

Selection, pricing and reimbursement

Procurement and supply

Prescribing

Dispensing

Use

PHARMACY

Legislation, regulation, governance, monitoring

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

CY

P 2

009

UK

20

14

CZ

E 2

01

2

IRE

20

09

AU

T 2

01

5

NL

D 2

01

3

SW

E 2

012

GE

R 2

013

FR

A 2

01

1

SV

N 2

015

ES

T 2

012

HU

N 2

014

PO

L 2

01

4

LT

U 2

01

2

GR

C 2

01

4

PO

R 2

010

KG

Z 2

014

LV

A 2

01

3

UK

R 2

01

3

ALB

20

14

GE

O 2

01

5

MD

A 2

01

3

% o

f h

ou

se

ho

lds w

ith

ca

tastr

op

hic

OO

Ps

In Europe, financial protection is closely linked to co-

payment design

Source: WHO Barcelona Office preliminary estimates using national data plus authors’ research

Percentage co-payments

+ limited protection mechanisms

VHI

Caps

Poor are exempt

Flat-rate co-pays

Stronger financial protection

Weaker financial protection

+ weak purchasing

and regulation of

medicines

2

Exempt poor

people and

regular

service users

1

Replace

percentage

co-payments

with low fixed

co-payments

3

Cap all

co-payments

per person

Simple & people-centred

co-payment design

works best for everyone

WH

O B

arc

elo

na O

ffic

e for

Health S

yste

ms S

trength

enin

g

Purchasing of health services in Cyprus

• HIO as the single purchasing agency

• Competition among multiple purchasing

agencies (private insurers)

• Competition between the HIO and private

insurers

Invest – making the case for investing in

health systems and public health

Credit: ONE HealthCare Worldwide (OHWW)

Investments in a PHC network in Greece

• New Law on PHC passed in August 2017

• Roll-out of the Local Health Units (TOMYs)

on-going (98 TOMYs operational)

Innovate – harnessing innovations to meet

people’s needs

Strengthening community care through

integrated services in Romania

Reshaping the balance of care in Greece

• Local initiative to pilot an integrated model of health and care

services in Ioannina region

Globally WHO:• Develops consensus around standards for digital health.• Monitors and reports on global progress.• Sets global priorities and establishes international partnerships.

Regionally WHO:• Supports countries directly in their national digital health implementations• Works with international partners in the region in addressing a range of health

systems digitalization challenges and priorities.• With research bodies helps guide priorities for future research on digital health.• Examines how emerging digital innovations will shape the future of health

systems and health service delivery.

WHO and the importance of digital health

The 11 key factors underpinning national success in

digital health1. National digital

identity for citizens, healthcare personnel

and providers.

2. Strong and visible governance for digital

health

3. Strong integration for health data linking

inside and outside of health sector

4. Clear and unambiguous legislation supporting digital health

5. Political leadership for digital health

6. Digitally literate workforce and methods

for COPD

7. Well-established cultures of trust

8. PPPs for digital health* (when well-governed by public

leadership)

9. Gender equality in digital health

10. Patient engagement in co-creating and

implementing solutions

11. Sustained financing for digital health

Integrated care model in Scotland – use of modern

technologies and innovations

WHO Symposium

The FUTURE of digital health

systems in the WHO European

Region

UN City, Copenhagen

6-8 February 2019