Policy context - EU level cooperation

European Commission, DG Health and Food Safety

Sylvain Giraud

25 May 2018

To set the scene for today's discussion

1. ESIF investments 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

2. EU level activities on health systems reforms

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 preparation 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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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 States inthe programming period 2014-2020 and support effective implementationof 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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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

Supporting the reforms of national health systems

EU level

• Similar challenges – shared values and objectives• A common policy framework• Knowledge brokering – State of health in the EU• Coordination of economic policy – the European Semester• Cooperation mutual learning and EU support tools

• Similar challenges• Shared values and objectives• A common policy framework

Health systems across the EU need to adapt confronted with many challenges

• Ageing population: longer life expectancy but not "healthy life years"

• Burden of chronic diseases; lifestyle related and often preventable

• Higher expectations for patient-centred, effective and safe care

• Rapid development of new technologies; often costly• Greater movement of people (patients but also health

workforce)• Pressure on public expenditure.

Shared policy objectives follow the 2014 Commission Communication on:

EFFECTIVE,

RESILIENT health systems

ACCESSIBLE &

Principle 16Everyone has the right to timely access to affordable, preventive and curative health

care of good quality

• 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

• Social scoreboard: indicators to monitor progress on the Pillar Principles

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

Knowledge brokering

State of Health in the EU

WHAT IS THE "STATE OF HEALTH IN THE EU" CYCLE?

A concise package of factual, high-quality evidence

A two-year cycle at the service of policy makers, stakeholders and practitioners

In partnership with the OECD and EU Observatory for Health

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November 2016 November 2017 November 2017 First half of 2018

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The Country Health Profiles

1. Highlights

2. Health status

3. Risk Factors

4. Health System (description)

5. Performance of Health

System

5.1 Effectiveness

5.2 Accessibility

5.3 Resilience

6. Key Findings

5 takeaways from 28 healthcare systems

1. Focus on health promotion and disease prevention.

2. Step up primary care, to avoid unnecessary hospital admissions.

3. Provide incentives for health service providers to work together more effectively through integrated care.

4. Improve health workforce planning and forecasting, to address current and future challenges.

5. Invest in patient-centred data on health outcomes to increase knowledge.

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

Coordination of economic policy

The European Semester

EUROPEAN SEMESTER 2018

Public expenditure on health account to about 8% of GDP and 15% of all public expenditure

Health insurance and

healthcare support social

safety nets and active inclusion

strategies

Health of the population is a

productive factor

Health is an economic

sector providing

growth and jobs

CSRs 2018 (adopted 23 May)

• 12 MSs with health-related CSRs in 2018

• Consistency with policy principles

• Continuity : long-term and challenging nature of structural reforms of national health systems

• Focus on cost effectiveness and quality, sustainability and accessibility (coverage)

The Commission recommends

• Implementation of agreed reforms for better cost-effectiveness and accessibility of care in Cyprus, Slovenia and Finland.

• Improving fiscal sustainability and cost-effectivenessof health system in Austria, Malta Portugal and Ireland

• Investing in disease prevention in Lithuania

• Attention to workforce planning in Bulgaria and Slovakia.

• Reducing high out-of-pocket payments for patients in Bulgaria and Latvia

• Strengthening primary and outpatient care in Latvia, Lithuania and Romania.

Cooperation mutual learning EU support tools

The role of the European Union: A policy agenda for health systems

EU provides tools and mechanisms

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The EU Expert Group on Health Systems Performance Assessment(HSPA) was set up in 2014, upon invitation from Member States (inthe Council Work Party on Public Health at Senior Level).

Expert Group's Mission

Provide Member States with a forum for exchange of experiences on the use of HSPA at national level.

Support national policy-makers by identifying tools and methodologies for developing HSPA on concrete priority topics.

Expert Group on HSPA

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+

All EU countries and Norway

WHO Euro, OECD, Eur. Observatory

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2015:Quality of

care

2016:Integrated

care

2017:Primary care

2018:Efficiency

2019:Resilience