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Peter GroenewegenNIVEL, Netherlands Institute for Health Services Research

ERA-NET initiativeBuilding Sustainable and Resilient

Health Systems

• Prehistory

• Why an ERA-NET on health systems?

• European perspective on sustainable and resilient health systems

• What is an ERA-NET?• Core of an ERA-NET programme

• Other activities during EPH Conference

Contents

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Pre-history of the initiative

• 2009-2011: Support action under FP7: HSREPP– Meeting in The Hague in April 2010– Capacity building of the HSR community– Priority setting for HSR including uptake in FP7

• 2012: Malta preconference, idea to write aneditorial for the Lancet

• 2013: meeting in Brussels • & birth of the ERA-NET • initiative

Pre-history of the initiative

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Who and why?

Why an ERA-NET on health systems?

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Why an ERA-NET on health systems?• In Horizon 2020, HSSR is mainly seen as

instrumental for the implementation of (biomedical) innovations

• Hardly room for fundamental research on transferability of innovations across countries

• Answer to challenges facing Member States (economic crisis, ageing, comorbidity, workforce)

• Typical area with EU added value:• All countries are undergoing health

systems reform• Europe is our research laboratory

Why an ERA-NET on health systems?

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What is an ERA-NET?

What is an ERA-NET?

top-up funding of single joint calls for trans-national research and innovation in selected areas with high European added value and rele-vance for Horizon 2020

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What is an ERA-NET

ERA-NET consortium• Members can be MoHs or mandated public funding

bodies, running for multiple years• In one year CO-FUND by EC: contribution max

33% of total eligible costs (on average about 12 m€ per ERA-NET)

• Other (non-public) funding programmes may participate (including Structural Funds)

Third party projects:• Selection following a joint trans-national call for

proposals (two-step procedure)• Must involve at least 2 entities from 2 EU Member

States or Associated Countries.

What is an ERA-NET

ERA-NET consortium• Members can be MoHs or mandated public funding

bodies, running for multiple years• In one year CO-FUND by EC: contribution max

33% of total eligible costs (on average about 12 m€ per ERA-NET)

• Other (non-public) funding programmes may participate (including Structural Funds)

Third party projects:• Selection following a joint trans-national call for

proposals (two-step procedure)• Must involve at least 2 entities from 2 EU Member

States or Associated Countries.

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Starting questionCurrent ERA-NETs in Horizon 2020

Topic Total budget

Budget per project

Translational cancer research 40 m€ 5 m€

Systems medicine (CaSyM) 40 m€ 5 m€

Rare diseases (IRDiRC) 29 m€ 5 m€

Brain related diseases 29 m€ 5 m€

Antimicrobial resistance 29 m€ 5 m€

Cardiovascular disease 29 m€ 5 m€

European perspective on sustainable and resilient health systems

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• Health (care) systems: - Social insurance- State system - NHS- Mixed forms, in parts remnants of communist systems

Integration of public health and health care, health in all policies

• Type of welfare state:- Liberal- Social-democratic- Conservative / corporatistic

Relation between health care and social sector

• Culture and geography:- North-south / east-west gradiënt

The European challenge: as many health (care) systems as countries

Or rather an opportunity?Research lab Europe!

• Differences in system reformsUrgency (e.g., Eastern-Europe in the nineties, economic crisis 2008-…)Role of national or regional government in the systemPolitical institutions and decision making

• Health systems convergence?Comparable challenges (e.g. ageing, comorbidity, etc.)Influence of joint medical technology

• Growing influence of the EC (although health care is a national responsibility)

Public health agenda: active aging, communicable diseases, blood, organs, research etc.

Internal market agenda: cross border care, private markets, professional mobility etc.

Financial agenda: austerity, structural funds, European Semester

Changes in health (care) systems

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• To understand and value good practices and innovative solutions obtained in other countries

• To be able to show what is peculiar to situation in our own country

• To be able to show common patterns with other countries

The added value of an international perspective: Cross-border policy learning

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• Health challenges:– Life style, environment related illnesses– Multimorbidity, frail elderly

• Structure related challenges:– Public health, prevention, health service delivery– Responses to economic crises

• Inequalities– Equal access to services– Health inequalities

• Quality and efficiency:– Containing costs / efficient use of resources– Preventing over-treatment / unnecessary treatment / evidence based medicine– Rationalising pharmaceuticals

Health (care) challenges in Europe

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Large societal turmoil caused by the economic crisis and following reforms

Policy responses to the financial crisisExample: policies on health coverage

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Policy responses to the financial crisisExample: policies on health coverageExample: policies on planning, purchasing & delivery

The European Semester

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Expenditure on long term care as percentage of GPD, Source OECD, 2011

Reforming long-term care was one of the key recommendationsfrom the EC’s European Semester to the Netherlands

Example of the Dutch reform in long term care

Core of an ERA-NET programme

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• Health system:– Aims at solving a population’s health problems. – Broad spectrum of interventions: medical care,

nutrition, life style, environment etc.

• Health care (delivery) system:– Society’s organized response to health problems

of its population

Health system AND health care (delivery) system

• Innovative capacity in public health, prevention and health service delivery

• Transferability of innovative solutions• Absorptive capacity of organizations and

systems• Role of innovative capacity in health system

performance

Core of an ERA-NET programme

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Starting questionFramework of an ERA-NET on health systems

Sustainable and resilient health systems

Quality and efficiencyInequalitiesStructure

Tran

sfer

abili

tyAbsorptive capacity

E.g. sectoralboundaries, intersectoralcooperation, governance

E.g. access, health insurance

coverage, affordability , role of social

services

E.g. performance assessment,

patient safety, quality of care

Methodological requirements (country level, individual level etc)

• Problem context (recognition, definition, urgency)• Financing context• Institutional and cultural context• Roles of different health care providers• And effectivity needs to be proven or at least

probable

Transferability depends on linkage to

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Absorbtive capacity

the ability of organisations or systems to recognise the value of new knowledge, and to assimilate and apply it effectively(Cohen &Levinthal, 1989)

critical for a system’s sustainability and long-term ability to innovate

In our case it can refer to e.g. hospitals or other providers, i.e. their ability to incorporate and modify new innovations from other settings in such a way that they establish better value for money

Other activities during EPH Conference

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• Invitational meeting with core players: representatives of governments and fundingbodies

• Presentation of plans EUPHA research pillar• Annual meeting EUPHA section on HSR• Preconference on Evidence generation and

successful knowledge transfer in public health• Session on European Semester

Other activities during EPH Conference

• Support in the research community• People willing to invest in this initiative• Refinement of our scope• Support and guidance• Different lines of action

– Developing programme– Support from Member States

• …

Where do we want to be next week?