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OBSERVATORY VENICE SUMMER SCHOOL 2010
Reinhard Busse, Prof. Dr. med. MPH FFPHDept. of Health Care Management, Berlin University of Technology
(WHO Collaborating Centre for Health Systems Research and Management)
& European Observatory on Health Systems and Policies
Lecture A1
Context: building blocks of
health systems
EU integration and health systems:
challenges and opportunities for
patients, professionals and policymakers
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OBSERVATORY VENICE SUMMER SCHOOL 2010
Definition of “Health systems“ (I)
people, institutions and resources, arranged together in accordance with established policies,to improve the health of the population they serve, while responding to people’s legitimate expectations and protecting them against the cost of ill-healththrough a variety of activities whose primary intent is to improve health.
European Observatory for Health Systems and Policies (2007).Glossary. http://www.euro.who.int/observatory/Glossary/Toppage.
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OBSERVATORY VENICE SUMMER SCHOOL 2010
WHO World Health Report 2000
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OBSERVATORY VENICE SUMMER SCHOOL 2010
What are the Health system
boundaries?
Source: Murray, CL. and Evans, DB. (2003) Health systems performance assessment: Debates, Methods and
Empiricism. Geneva: World Health Organization.
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OBSERVATORY VENICE SUMMER SCHOOL 2010
Commonwealth Fund Framework (2006)
Source: Commonwealth Fund. (2006) Framework for a high performance health system for the United
States, New York: The Commonwealth Fund.
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OBSERVATORY VENICE SUMMER SCHOOL 2010
Atun Systems Framework (2008)
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Solidarity EquityParticipation
Equity in utilization
and resource
distribution
Quality
Transparency and
accountability
Efficiency
Choice
Equity in finance
Financial protection
Health gain
Equity in health
Responsiveness
Health system goals (WHR2000)
Purchasing
Benefits
Revenue collection
Pooling
Health financing system
How health financing can influence goals
Service delivery
Ste
wa
rds
hip
Resource generation
Health financing within overall system
Core values
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OBSERVATORY VENICE SUMMER SCHOOL 2010
… ensemble of all public and private organizations, institutions and resources mandated to improve, maintain or restore health. … encompass both personal and population services, as well as activities to influence the policies and actions of other sectors to address the social, environmental and economic determinants of health.
WHO European Ministerial Conference on Health Systems (2008). Tallinn Charter: Health Systems for Health and Wealth. Resolution EUR/RC58/R4.
Definition of “Health systems“ (II)
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Health care outcome:
satisfaction, complications
etc.Structures
and organisation
Patients
Process
Population health status
(need)
Health
gain/
Outcome
Human resources
Technologies
Financial resources Stewardship/ regulation/ incentives
“actions of other sectors to address the determinants of health”
“public and private organizations, institutions
and
resources to improve, maintain or restore health”
Health Production Model forHealth Systems Research
“activities to influence the policies“
Other sectors
Nutrition/ agriculture
Environment
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Health care outcome:
satisfaction, complications
etc.Structures
and organisation
Patients
Process
Population health status
(need)
Health
gain/
Outcome
Other sectors
Nutrition/ agriculture
Environment
Personnel sufficient
and well qualified?
Institutions of high standards?
Technologies effective?
Human resources
Technologies
Financial resources
Fair and sustainable funding?
Utilization responsive,
appropriate, coordinated …?
Health care system
Needs-based,
equitable
access?
Patients satisfied,
services safe and
of high quality?
Re
so
urc
e c
rea
tio
n
adequate
?
How much?
Is it worth it
(cost-effective)?
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Health care outcome:
satisfaction, complications
etc.Structures
and organisation
Patients
Process
Population health status
(need)
Health
gain/
Outcome
Other sectors
Nutrition/ agriculture
Environment
Personnel sufficient
and well qualified?
Institutions of high standards?
Technologies effective?
Human resources
Technologies
Financial resources
Fair and sustainable funding?
Utilization responsive,
appropriate, coordinated …?
Health care system
Needs-based,
equitable
access?
Patients satisfied,
services safe and
of high quality?
Re
so
urc
e c
rea
tio
n
adequate
?
How much?
Is it worth it
(cost-effective)?
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Art. 152 (5) Community action in the field of public health shall fullyrespect the responsibilities of the Member States for the organisation and delivery of health services and medical care.
Population health status
(need)
Health
gain/
Outcome
Human resources
Technologies
“actions of other sectors to address the determinants of health”
Health Production Model forHealth Systems Research
Other sectors
Nutrition/ agriculture
Environment
Is EU health policy like this imaginable?
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Art. 152 (5) Community action in the field of public health shall fullyrespect the responsibilities of the Member States for the organisation and delivery of health services and medical care.
Population health status
(need)
Health
gain/
Outcome
Human resources
Technologies
“actions of other sectors to address the determinants of health”
Health Production Model forHealth Systems Research
Other sectors
Nutrition/ agriculture
Environment
Is EU health policy like this imaginable?
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OBSERVATORY VENICE SUMMER SCHOOL 2010
“At European level, health services have to adapt to
market rules, while at national level, health
services are seen as part of a social model.
To overcome this situation and to ensure the social status of health services,
we need – possibly paradoxically – to develop a European health policy.“
2002
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OBSERVATORY VENICE SUMMER SCHOOL 2010
The core issue – no matter if persons, goods or services are entitled/ licensed/ authorised to cross borders
Whose regulations are/ should be applied?
• Those of the country of origin?
• Or those of the country of destination?
• Or should common regulations exist?
– If yes, are they applicable also within countries?
– Or only for border-crossing and/or upon choice (de facto
establishing a 28th law within the EU)?
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OBSERVATORY VENICE SUMMER SCHOOL 2010
Concretely
• Who does (and who should) determine the necessary
qualifications of a Polish nurse working in Germany?
• Who authorises a UK-made drug sold in Portugal?
Who regulates the price, the reimbursement, the
dispensing rules …?
• Who regulates entitlements, quality, price … of
services available to a Greek tourist in Finland? Are
the regulations the same if the Greek person travels
to Finland to receive the services?