Health Systems and EU enlargement - an accession country’s view

1. Health Systems and EU enlargement - an accession country’s view Tit Albreht, M.D., M.Sc., Institute of Public Health of the Republic of Slovenia Bad Gastein, 28 September 2001 tit.albreht@ivz-rs.si http://www.sigov.si/ivz

2. Introduction • Reforms of health systems as a universal process • Currently at various stages of development • Different historical and political backgrounds and large variation in the economic situation Health Systems and Enlargement - An accession country's view

3. CEE countries heritage • Old and new independent states • Different treatment of the historical and social heritage • Difference in the economic and social development at the start of transition Health Systems and Enlargement - An accession country's view

4. Recent developments at the system level • An almost unanimous decision to introduce Bismarckian-type of systems • Reasons: • part of historical tradition • a more stable system, potentially more independent from daily political changes Health Systems and Enlargement - An accession country's view

5. Recent developments 2. • A reduced role of the State - deregulation process and rearrangement of stakeholders • Financial pressures: constraints, worsening economic situation, budgetary restrictions, etc. • Challenge of the newly gained independence Health Systems and Enlargement - An accession country's view

6. Challenges for accession countries • Changing epidemiologic situation • Patient mobility and mutual influences on each other’s systems • Workforce mobility • Opening of health care markets and international competition • Public health and health care delivery • Definition of a common minimum package Health Systems and Enlargement - An accession country's view

7. Changing epidemiologic situation • Epidemiologic transition with continued maturation of the population • ‘Regression’ processes - renewed importance of communicable diseases and a rising importance of certain chronic diseases (dependency-related) and injuries • Redefinition of priorities from a developing epidemiologic perspective Health Systems and Enlargement - An accession country's view

8. Patient mobility and mutual influences on health care systems • No interference with own health care delivery systems? • Viability of such a policy • Implications for the accession countries • Flows of patients Health Systems and Enlargement - An accession country's view

9. Workforce mobility • An important issue not explored enough yet • Danger of ‘brain drain’ from some countries • A real issue or an overestimated one in importance? Health Systems and Enlargement - An accession country's view

10. Opening of health care markets and international competition • Internal health care markets - new values and priorities • Exposed health care providers • Competition by providers of neighbouring ‘old’ member states • Importance of harmonisation of (existing) accreditation procedures or their introduction Health Systems and Enlargement - An accession country's view

11. Public health and health care delivery • Public health - reaffirmation and redefinition • Importance of European guidelines for Public Health • Privatisation as a trigger for more curatively oriented health care • Role of the State in ensuring Public Health Health Systems and Enlargement - An accession country's view

12. Definition of the common package • Comprehensiveness required vs. more and more market orientation • A minimum package available to any European citizen which would help also the accession countries • Avoiding an increasing variation in type, extent and quality of services provided Health Systems and Enlargement - An accession country's view

13. Slovenia’s own perspectives • Challenges brought about in the accession process: • opening of borders and free movement of workforce and patients • a broader and more demanding health care market Health Systems and Enlargement - An accession country's view

14. Slovenia’s own perspectives 2. • Opportunities lie in: • more professional development and research • offering own facilities on the common health care market (especially certain medical specialities) Health Systems and Enlargement - An accession country's view

15. Slovenia’s own perspectives 3. • A quickly ageing population both in bottom-up as well as top-down • Communicable diseases well controlled both with a surveillance mechanisms and interventions • Importan lagging behind EU in alcohol-related conditions and injuries • Interest in a harmonised effort in defining priorities in health care Health Systems and Enlargement - An accession country's view

16. Slovenia’s own perspectives 4. • Patient mobility and influence on own solutions in health care delivery and financing • Outflow vs. inflow of patients • Workforce mobility - some outflow will occur but Slovenia is likely to be a future target or host country Health Systems and Enlargement - An accession country's view

17. Slovenia’s own perspectives 5. • Slovenia’s urgent need to work on accreditation of hospitals and enter into co-operation with other important providers in the area • Public Health needs a redefinition and reorganisation • Development of own educational structures in the area of Public Health Health Systems and Enlargement - An accession country's view

18. Slovenia’s own perspectives 6. • Ensuring compliance with standardised education in Public Health and harmonised European guidelines for the area • Common minimum package to be revisited and reassessed Health Systems and Enlargement - An accession country's view

19. Conclusions • An exciting process starting with both challenges and uncertainties • Health care delivery standardised in quality of services and in the minimum package for the European citizen • Development of a European surveillance system and standardised indicators Health Systems and Enlargement - An accession country's view

20. Conclusions 2. • Potential brain drain to be assessed and forecasted where and if possible • Enable providers to compete at the common health care market • Reaffirm the role of Public health by modernising it, standardising its guidelines and ensuring effective responsibility of the State Health Systems and Enlargement - An accession country's view