Health in a New Europe: the view of a new Member States

1. Health in a New Europe: the view of a newMember States Zsuzsanna Jakab Secretary of State Ministry of Health, Social and Family Affairs Budapest, HUNGARY

2. 1st of May 2004 • beginning of a new era in Europe • historical moment for Europe and the new Member States: back to the family of European countries where we belong • new Member States are full of expectations but there are also some worries about the implications of accession • the question often arises: will there be winners and losers or will there be a win-win situation for all?

3. What we expect is a ‘win-win’ situation for every citizen in the field of health! • In our sector (health, social and family affairs) • the balance is supposed to bepositive WHY? we have a lot of strengths + a number of weaknesses • We intend to build on our strengths and minimize our weaknesses, close the gap where it exists • as an EU Member State, it will be much easier to doso! • this is not the time yet to sit back!

4. What do our citizens expect? • long, wealthy and healthy life; • to be protected against illness/disease; • to have equal access to good quality health services; • to bring up their children in a healthy environment; • safe and hygienic workplace; good working conditions; • decent salary

5. What do we Governments expect? • to modernise our country; • to reduce inequities among/within the countries/regions and population groups; • to follow a common set of objectives in Europe set by various strategies and make progress jointly towards them (e.g. Lisbon strategy; public health strategy; cohesion policy etc.); • create an economy, society with: • rapid economic development, • with high level of social protection based on the European social model; • provide better working conditions for our health personnel; • cohesion; • health as a value, investment, economic factor: to generate healthy population

6. What do we expect in the field of health? Main goal • to close the gap in life expectancy: • live longer (6-8 years behind the EU average); • live healthier; • reduce the disease burden; • increase the number of healthy lifeyears; • macroeconomic impact healthy population healthy manpower productive economy; reducedeconomic burden of ill-health;on macroeconomy and on the health system;

7. Progress already made • During the years of preparation for EU accession we made a lot of progress already: • the transposition of the acquis in our sector is an investment in primary prevention • (food safety, pharmaceuticals, medical devices, cosmetic products, environmental protection, water quality, radiation hygiene, health protection at workplace, etc.) • institution - building ensured the implementation of above (using pre-accession funds) • joined the Community Public Health Action Programme and developed our own public health programme

8. Assets and gaps in public health improvement needed Assets • change in approach: health as a value/investment(get rid of paternalistic approach) • responsibility of all • individual responsibility • modern health promotion concepts • further development of institutions; training, tools, methodology • modernize infrastructure (pre-accession funds) • public health • national programme approved by Parliament 2004 is the year of dinamisation • infrastructure • staff

9. Efforts to close public health gaps EU public health strategy framework 2003-2008 National public health programmefor 10 years in line with it (bring it down to individuals as the effort of the whole society in 2004.) Gap in public health technical support: methodology, tools investment in institution-building and training (EU funds: structural funds for 2004-2006 and 2007-2013 in line with National Development Programme)

10. Assets and gaps – health services Assets improvement needed • health services • covers the whole population • provides wide range of services • solidarity principle • in physical condition • equipment modernized • quality of care improved • patient improvedinformation • excellent manpower • well-trained • devoted • not very mobile • reform underway to modernize

11. Efforts to close gaps – health services In the health system: (reform underway) • Investments, includingstructural funds needed to upgrade physical condition and equipments; to modernize health system • Basic principles of organising, operating and financing health care in EU Member States • solidarity • universality • sustainable financing • These values are shared and highly respected by new Member States • It is a real challenge to try to strike the very sensitive balance between • providing access to quality services for everyone • insure long-term sustainable financing

12. The impact of the internal market on health services • Patient mobility: • represents a specific challenge with its complex inter-relationship with all aspects of the organisation, financing, provision and quality of health services being a national responsibility in the EU • the high-level reflection process, the Commission Communication and the Council Conclusions examined the situation and identified the main areas of co-operation

13. Patient mobility 1 • Information sharing, pooling of best practices in the enlarged EU • New Member States bring about their knowledge, experiences, expertise, e.g. • recently adopted or up-dated legislation • extensive experiences in health system and financing reforms • well-trained professionals • We are looking forward to learning more and in a more systematic way from each other in the enlarged EU

14. Patient mobility 2 • Centres of reference in the enlarged EU • A number of well-operating institutions also in new Member States, with high level of expertise • Need to up-grade infrastructure inexisting institutions • Closer co-operation among Member States in capacity sharing

15. Patient mobility 3 • Diversity of experiences in relation to patient mobility • implementation of bilateral social security agreements – valuable experiences also in new Member States • we worked hard to prepare for the implementation of Community regulations on social security co-ordination • Limited experiences with cross-border health care arrangements with neighbouring countries • Exchange of experiences and best practices in these areas is of high importance

16. Patient mobility 4 • Decisions of the European Court of Justice: • extending rights for citizens • extra financial burdens on health insurance budgets, especially in view of gaps in health care costs in the enlarged EU • Modernisation of the social security co-ordination regulations • further extension of citizens rights • introduction of the European Health Insurance Card • Need for careful examination of reimbursement procedures on EU and national levels to • meet necessary requirements • prevent undermining the financial balance of the health insurance budget

17. Patient mobility 4 • Hungary: joint borders with Austria, Slovakia andSlovenia • cross-border health care might increase essentially due to various motivations; • improved possibilities for co-operation and more rational health service provision in border regions; • major price level differences occur in certain relations; • careful examination of the impact of patient mobility on the health system of the country of origin of the patient gains importance

18. Mobility of professionals • complex and sensitive issue; • examination of possible migration flows is crucial; • increased mobility brings about many positive implications: • extended training and post-graduate training facilities • joint expert pool – common solutions for shortages • the implementation of the Community Working Time Directive as well as related European Court of Justice rulings induce further staffing needs; • increased migration from acceding states might have essential impacts on their labour markets; • training in the health professions in Hungary is of high quality, meeting Community requirements; • we still have a lot to do to improve working conditions, including wages of health professionals, to provide incentives for them to remain in the Hungarian health service

19. Further co-operation possibilities • Application of the open method of co-ordination in the field of health care and long-term care • definition of common objectives in line with principles of solidarity, universality and financial sustainability • strategies and joint reports • Creating more favourable conditions to applications for support under existing Community financial instruments in the filed of • investment in health • health service development

20. Pharmaceuticals 1 • Extensive and modern national legislation in line with Community legislation, covering among others: • product safety, GMP, GCP, GLP • marketing authorisation procedures, • distribution, sales and advertisement, • intellectual property rights, data exclusivity, • transparency of pricing and health insurance reimbursement

21. Pharmaceuticals 2 • Extensive and well developed institutional system: • strong national authority: National Institute of Pharmacy • well developed privatised public pharmacy network • hospital pharmacies • privatised whole-sale network

22. Pharmaceuticals 3 • Strong, traditional pharmaceutical industry in Hungary • privatised, decisively international ownership, • developed generic production • Well-trained professionals • traditionally high level training, meeting community requirements

23. Pharmaceuticals 4 • Extensive health insurance re-imbursement scheme • positive list • involving also major patient co-payment • Dramatic increase in the number of medicinal products available in the Hungarian market • market liberalisation, • accelerated marketing authorisation procedures

24. Pharmaceuticals 5 • Considerable cost pressures on the health care budget during the last 14 years on several reasons • aging society • availability of modern technology • ever-growing demands by the population • increasing input prices • increasing promotion activities by producers • over-consumption • price increase being much higher than inflation

25. Pharmaceuticals 6 • Consequences • Hungary’s pharmaceutical expenditures are significantly high, also in international comparison • 30,7% of health care costs (source: WHO) • in purchasing power parity (PPP) the yearly per capita spending on pharmaceuticals is 280 USD in Hungary, while it is e.g. 266 USD in the Netherlands, 223 USD in Denmark, 240 USD in Great-Britain and 242 USD in the Czech Republic.

26. Conclusions Although, most of the health sector issues belong to national competencies, there is a wide scope for Community level actions, co-operation which might essentially contribute to meeting national objectives.