Basic Healt h care Packages & European Healthcare Policies

1. Basic Healthcare Packages & European Healthcare Policies Czech Health Care Forum Biannual High Level Conference – 17 April 2009, Darova (CZ) Marcel J.G. Smeets Director-general Tel. +32 2 234 57 00 | marcel.smeets@aim-mutual.org | www.aim-mutual.org

2. An international association for universal priciples

4. Membership 41 national federations 27 countries worldwide Europe, Middle-East, Africa, Latin-America Activities Healthcare financing Healthcare provision Social services, pensions For 240 mln citizens Values and principles Health and well-being Autonomous management Not-for-profit orientation Solidarity Objectives Interest representation Knowledge exchange Lobbying Promotion

5. Issues Social Protection Social economy Public Health Healthcare Commissions International Co-operation European Affairs Thematic groups Working groups Long term care Pharmaceuticals Cross border care Healthcare Systems Disease Management eHealth & Telemedicine Lobby EU Presidencies Europepean statute for mutual benefit societies Patients´ rights directive Pharmaceutical package

6. Members´ classification Developed countries Provision Provider Healthcare Voluntary Limited choice members In-kind services Bismarck Beveridge Re-imbursement Free choice members Payer Statutory Social services Developing countries Insurance

7. Classification of members Developed countries Provision Provider Healthcare Voluntary Limited choice members In-kind services Bismarck Beveridge Re-imbursement Free choice members Payer Compulsory Social services Developing countries Insurance

8. Classification of members Developed countries Provision Provider Healthcare Voluntary Limited choice members In-kind services Bismarck Beveridge Re-imbursement Free choice members Payer Compulsory Social services Developing countries Insurance

9. Classification of members Developed countries Provision Provider Healthcare Voluntary Limited choice members In-kind services Bismarck Beveridge Re-imbursement Free choice members Payer Compulsory Social services Developing countries Insurance

10. 3 models of healthcare financing in Europe

11. Beveridge • Tax-based • Government driven • Public provision

12. Bismarck Insurance-based Employers & Employees Public-private mix

13. Shemasko Government-driven Planning & Control

14. Compulsory Implication of mutual healthcare funds

15. Compulsory Complementary Implication of mutual healthcare funds

16. Compulsory Complementary Supplementary Implication of mutual healthcare funds

17. Compulsory Complementary Supplementary Duplicative Implication of mutual healthcare funds

18. What´s the problem in EU healthcare?

19. Trends and Tendencies • Increased patient responsability • Privatisation and commercialisation • Focus on cost-efficiency • Development of ICT • Cost-control in pharmaceuticals • Growing need of healthcare professionals

20. Increased patient responsability • Financially • Co-payments and out-of-pocket • Deductibles and penalties • Life style • Habits and follow-up • Prevention

21. Privatisation and commercialisation • Healthcare as a market • Patient as a consumer • Standardisation and competition

22. Focus on cost-efficiency • Financing based on pathology • Pay for performance • Gatekeeping • Fading concepts of in- and out-patient • Concentration of funding

23. Development of ICT • Electronic Medical Records • Ownership and sharing information • Integrated and Continuous care • Business case

24. Cost-control in pharmaceuticals • Growth pharma expenditure exceeds growth healthcare budgets • Focus on generic medicines • Rating systems (NL = « Preference policy ») • Re-assessment of marketing and refund policies

25. Growing need of healthcare professionals • Ageing • « Feminisation » sector • Geographical distribution • Education and numerus clausus • Mobility and braindrain

26. Changing Healthcare Settings • From « cure » to « care » • From « instant » to « constant » • From « treatment » to « prevention » • From « institution » to « person » • From « process » to « induvidu » • From « come » to « get »

27. The New Role of Healthcare Mutuals Director of healthcare Director of care Steering capacity Payer and Provider Payer and provider Pay office Engagement in healthcare management

28. Future challanges • Sustainability, solidarity and equity • Transparency and information • Productivity and performance • Prevention and education • Quality improvement

29. Basic Healthcare Packages • 3 dimensions • Who is covered (persons) • What is covered (products & services) • How is it covered (financing) • How to evaluate • How to decide

30. Basic Healthcare Packages- Basic dimensions - What ? How ? Who? Courtesy to Prof.Dr R. Busse

31. Basic Healthcare Packages- Trends & Tendencies - How ? How ? Privatisation • What ? • New techologies • Political choices What ? Who? Who? Universalsation Courtesy to Prof.Dr R. Busse

32. Basic Healthcare Packages • Discussions started in 1980´s • New/rare diseases (UK, Scandinavia) • Waiting lists (NO, NL, UK) • System reforms (NL, IL) • 2 approaches • Developing principles (NL, NO, SE, DK) • Recommend concrete services (UK, IL) Courtesy to L. Sabik & R. Lie, 2008

33. Netherlands = Principles Dunning-Committee (1990) Reduction of coverage 4 principles : Necessity (added value) Effectiveness (evidence) Efficiency (value-for-money) Individual responsability (lifestyle) Dunning´ pyramide Functional description Dental care for adults excluded Israel = Recommend services National Health Insurance Law (1995) Basic cover = largest sickness fund´s offer Updating via HTA Evidence-based Clinical Epidemological Economical Categorisation by Committee Catalogue of services Basic Healthcare Packages

34. Basic Healthcare Packages- Evaluation & decisions - Courtesy to Prof.Dr R. Busse

35. Basic Healthcare Packages- Modes of decision making -

36. Towards a pan-European Healthcare Basket ? • Evidence-based evaluations • Consumer-driven healthcare • Standardisation of accreditation & quality • Unified guidelines for diagnosis & treatments • Patient & provider mobility

37. Pharma Industry DG INDUS

38. European Pharmaceutical Forum Pharma Industry DG INDUS

39. PROPOSAL DIRECTIVE PATIENTS´RIGHTS IN CROSS BORDER CARE Pharma Industry DG INDUS

40. What was proposed by the European Commission

41. What is discussed European Court of Justice European Parliament

42. What is discussed European Commission Member States

43. WWW.AIM-MUTUAL.ORG