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The impact of the Financial Crisis on Health and Health Systems What we do and don’t know?

The impact of the Financial Crisis on Health and Health Systems What we do and don’t know?. Brussels, 21 st February 2013 Josep Figueras. www.healthobservatory.eu. Outline. 0. What impact? Health expenditure trends Health system response

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The impact of the Financial Crisis on Health and Health Systems What we do and don’t know?

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  1. The impact of the Financial Crisis on Health and Health Systems What we do and don’t know? • Brussels, 21st February 2013 • Josep Figueras www.healthobservatory.eu

  2. Outline • 0. What impact? • Health expenditure trends • Health system response • Health levels: from crisis & health system response • Protect the health budget: Health & Wealth? • Raise extra statutory revenues: Sin taxes? • Ration coverage: Shifting to private expenditure? • Improve performance: Squeeze efficiency? • Strengthen Prevention: Public Health & HiAP

  3. Impact of austerityongrowth? Welcome back Keynes? • Fiscal multiplier: larger impact than thought • Explains damaging impact of austerity

  4. What is happening to health expenditure? • Data quality • Timeliness Source: Health at a Glance: Europe 2012 (based on OECD Health Data 2012; Eurostat Statistics Database: WHO Global Expenditure Database)

  5. 1. Protect the health budget? ‘Health is Wealth’ Health Systems Direct contribution to the economy Cost effectiveness ??? Health Wealth Effects of ill health on economic growth Figueras J, McKee M 2011

  6. 2. Raise extra statutory revenues? SIN TAXES ?? • Effectiveness of sin taxes • Substitution • Income effects • Feasibility of implementation • Subsidies Mladovsky P. Thomson S. Evetovits T. Cylus J. Karanikolos M. McKee M. Figueras J. 2012

  7. 3. Ration coverage Shifting to private expenditure? Public / Private mix funding in the EU Coverage Dimensions • Cost (user charges) coverage • Increased user charges in 13 countries • New charges: EE, FR, IE, IT, LT, NL, PT, RO, ES • Raising charges: CZ, DK, FI, FR, GR, IE, PT • Services targeted • Drugs (8) Hospital (5) Ambulatory (3) A&E (2) • But decrease in some (vulnerable populations) • AT, BE, GR, HU, IE, IT, LT • Health Technology Assessment • Priority Setting / Benefit Packages • User charges evidence • Cost control • Access / equity • Service (benefits) coverage • Limited (explicit) rationing: specific services • IVF (DK, NL), Ambulance (FR, SI) GP Home Visits (RO) Dental care, Cosmetic Surgery, ... • Significant (implicit) rationing • Waiting lists increases in several countries What is the scope for increasing User Charges & Voluntary Insurance • Population (breadth) coverage • Overall universal access maintained • Some exceptions CZ, HU & ES (migrants) Source: WHO 2010 R. Busse

  8. 4. Improve performanceSqueeze efficiency • Restructuring care delivery • Hospital closures, mergers,.. DK, GR, LT, PT, SI • Shifting to outpatient settings IR,GR, LT • Strengthen primary care LT,NL • Restructuring Admin. SHI & MoH- 8 countries • Pharmaceuticals & medical devices -18 countries • Price reduction, procurement reforms • Strengthening prescribing, promoting generics • Positive lists, public awareness campaigns Mladovsky P. Thomson S. Evetovits T. Cylus J. Karanikolos M. McKee M. Figueras J. 2012

  9. 4. Improve performanceSqueeze efficiency • Cost effectiveness • ICT, Ehealth • Integrated care • P4P, incentives • Skill mix • Knowledge brokering • Evidence to policy • Implementaiton • Reduced / freeze professional salaries & pensions • CY, FR, GR, IE, LT, ROM • EN, PT, SI • Hospital closures, mergers,.. DK, GR, LT, PT, SI • Reform provider payment methods • Reduce price for services EE, IE, RO, SI • Introduce DRGs in BG, CZ • Pay for Performance & Capitation in PHC Mladovsky P. Thomson S. Evetovits T. Cylus J. Karanikolos M. McKee M. Figueras J. 2012

  10. Outline • 0. What impact? • Health expenditure trends • Health system response • Health levels: from crisis & health system response • Protect the health budget: Health & Wealth? • Raise extra statutory revenues: Sin taxes? • Ration coverage: Shifting to private expenditure? • Improve performance: Squeeze efficiency? • Strengthen prevention: Public Health & HiAP?

  11. Concluding • Crisis an unprecedented opportunity for change • Yet ... • Focus on cost containment regardless of efficiency • Not enough emphasis on long term structural reform • Public health: a missed opportunity • ‘Cutting the lower branches rather than pruning’ • Lessons • Fiscal and policy preparedness • Governance, vision and leadership • Political economy /implementation • Transparency, communication and involvement

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