Solange MENIVAL, Vice President in charge of Health, Social and Sanitary Careers

Regional Council of Aquitaine, France

14th July 2011 Sevilla, Spain

Analyse of the new models of management and health

systems in Europe

Aquitaine Region

Context in France

• Decrease of GDP in 2009 of 2,9%

• Public deficit of 7,5% in 2009

• Objective of Stability Programme - deficit reduction to 3% in 2013

• Financial pressures of aging

• Decrease of medical demography

• Increase of hospitalisation (25% to avoid)

France Portugal UK Spain Average of

OECD

Health spending / GDP

11,4% 10,1% 9,8% 9,5% 9,5%

Spending per person ($)

3978 2508 3487 3087 3223

Public coverage 77,9% 65% 84,1% 73,6% 71,7%

Number of doctors /1000 hab

3,3 3,8 2,7 3,5 3,1

Number of nurses/1000 hab

8,2 8,4 8,4 4,9

Number of bed in hospitals / 1000 hab

3,5 2,8 2,7 2,5 3,5

Life expectancy 81 79,5 80,4 81,8 79,5

Source: OECD

Significant health spending

Economic growth

France Portugal UK Spain

Spending health growth over 10 years/GDP

12%

(from 10,3% to 11,4%)

8,6%

(from 9,3% to 10,1%)

40%

(from 7% to 9,8%)

35%

(from 7,2% to 9,5%)

2007/ 2009 More 3,1% Constant More 8,8% More 4%

Source: OECD

Monitoring action of the health spending

• Parliament sets every year National Target of Insurance Health Spending (3% in 2010)

• Control by action : decrease the reimbursement of primary care.

• Elimination of undertaking of some chronic illness

Willingness to evolve a hospital system based on

• Law « Hospital, Patinets, Health, territories » from 2009

• Establishment of the Regional Health Agencies

• Launching of the Shared Medical Record. To develop of information system

• Support by the Shared Information System Agency (SISA or ASIP), implementation of reference et call projet (Aquitaine lead partner)

What orientations of the Regional Council of Aquitaine ?

• Collaboration with the Regional Digital Espace of Health (Télésanté)

• Establishment of the entreprise cluster «e-health» by the Regional Council of Aquitaine. 50% of the national workforces

• Political wilingness to joint actions and initiatives

Toward what objectives?

• Strengthen primary care

• Develop inter-operability

• Experiment the new compensation professionals

• Experiment with the delegation of tasks among health care providers

• Act on the work of Barbara Starfield: Access, Continuity, Coordination, Globality

Innovate from the regional perspective, seeing health spending as a territorial investment

• Develop of entreprises of new technologies : ex.Kilab et le Médoc

• Objectives : – better coordination between family doctors, nurses, paramedic– for patient > 60 years, at home– using secure internet and mobile technologies

• Today : 80 patients, 25 professionals• Objective : 200 patients, 100 professionals

Conclusion and our convictions

• Focus the innovative and territoral technologies to permit the reorganisation in France

• Way to overcome the corporatist

• Issues will be stronger than the threats

• In a crisis, we must reverse the trend and turn threats into opportunities ... entreprise strategy "territorial"

Thank you very much for your attention

Regional Council of Aquitaine www.aquitaine.fr

solange.menival@aquitaine.fr