Sustainable Financing of Health Care Systems

1. SustainableFinancingofHealth Care Systems Bucharest, 24th-25th March 2011 Financinghealth: a 360º recognition Amaía Buján, Equity in Health Institute

2. Key points to finance health (HP, HC, LTC, MH) in the European Union: • National Funds for Public Health (the cut of the costs without knowing the cost of the cuts, the “never born”) • European Funds for Public Health • Pension Funds • Private Insurances • Eurobonds • Financial Transaction Tax (FTT)

3. A comparison of GDP and Health Expenditure in the European Union Sources: Eurostat, 2008 OECD ( Health at Glance, Europe 2010)

4. GDP per capita of EU member states

5. Population at risk of poverty after social transfers

6. Population suffering from severe material deprivation

7. National Funds for Public Health 1. The cut of the costs without knowing the cost of the cuts • This is the MS common tendency after the economic crisis despite the enormous variability of economic conditions and poverty incidence • Cutting costs in health for poor people has devastating effects 2. The “never born” • The never born is the lack of the introduction of Health Promotion, e-Health, ICT, Cloud Computing, Social and Technological Innovation on a large scale

8. National Funds for Public Health “ The first transfusion in surgery is a good haemostasis” Professor Pietro Valdoni, Director of Rome University Surgical Clinic (1900-1976)

9. A comparison of European GDP, National Health Expenditure and EU Funds for Health Sources: Eurostat 2008, OECD ( Health at Glance, Europe 2010) European Commision, Dg SANCO 2007

10. European Funds for Public Health Principal European Funds • Structural Funds (ESF, ERDF) • 7th Research Framework Programme (FP7) • EU Health Programme 2008-2013 Potentially positive elements • The discussion of European Cohesion Funds after the presentation of the 5th Annual Report • Eurobudget discussion • Multi Funding discussion

11. European Pension Funds Sources: Eurostat 2008, OECD ( Health at Glance, Europe 2010) European Commision, INVERCO 2008

12. Pension Funds

13. European Health Insurances Sources: Eurostat 2008, OECD ( Health at Glance, Europe 2010) European Commision, CEA (European Insurance Federation), 2008

14. Private Health Insurances • The European Health Insurance Premium is about twice the value of European Funds for Health but it is less than one tenth of total Health Expenditure in Europe • The expenditure of European Private Health Insurance is a hidden public expenditure! • Could it be possible to use this funds for Health Systems?

15. Eurobonds

16. Financial Transaction Tax (FTT) Sources: Eurostat 2008, OECD ( Health at Glance, Europe 2010) European Commision, European Parliament

17. A comparison of World GDP & Global Financial Resources However, this estimation in uncertain; Some sources say that Global Financial Resources are 74 times the World GDP, others 12 times, others again 4 times… On 8th March 2011 Europarliament approved a resolution about FTT (Financial Trasaction Tax) = 200-300 billions of euro each year for Europe

18. Conclusions • For a 360° recognition of financing health it is necessary to start with a longhard work • Our proposals: to create a High Level Group to consider financial issues in order to analyze the interdependence, interaction and integration of these six sectors towards an European Public Health System before discussing financing equity and excellence we need a clear and shared Equity and Excellence in Health Model based on: bottom-up planning on a large scale, regional implementation role with the same budget dignity for Health Promotion, Health Care, Long Term Care and Mental Health

19. Thank you for your attention! Amaía Buján, Equity in Health Institute amaia.bujan@ehinst.net +39 3804748032 www.ehinst.net