Pharmaceutical Group of the European Union Annual Symposium, 15 June 2004 Palma de Mallorca Health...

Pharmaceutical Group of the European UnionAnnual Symposium, 15 June 2004 Palma de Mallorca

„Health in a New Europe: the view of a New Member State”

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

Zsuzsanna Jakab Secretary of State

Ministry of Health, Social and Family Affairs Budapest, HUNGARY



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?



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 be positiveWHY?

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 do so! this is not the time yet to sit back!



What do our citizens expect?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



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



What do we expect in the field of health?

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 life years;

macroeconomic impact healthy population healthy manpower productive economy; reduced economic burden of ill-health; on macroeconomy and on the health system;

Main goal



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



Assets and gaps in public health

Assets improvement needed

public health

national programme approved by Parliament 2004 is the year of dinamisation

infrastructure

staff

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)



Efforts to close public health gaps

Gap in public health

EU public health strategy framework 2003-2008

National public health programme for 10 years in line with it (bring it down to individuals as the effort of the whole society in 2004.)

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)



Assets and gaps – health services

health services covers the whole

population provides wide range

of services solidarity principle

improvement needed

- in physical condition- equipment modernized- quality of care improved- patient improved

information

excellent manpower well-trained devoted not very mobile

Assets

reform underway to modernize



Efforts to close gaps – health services

In the health system:

(reform underway)

Investments, including structural 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

solidarityuniversalitysustainable 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



The impact of the internal market on health servicesThe 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



Patient mobilityPatient mobility 1 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




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 in existing institutions

Closer co-operation among Member States in capacity sharing



Patient mobilityPatient mobility 3 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




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




Hungary: joint borders with Austria, Slovakia and Slovenia

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



Mobility of professionalsMobility 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



Further co-operation possibilitiesFurther 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



PharmaceuticalsPharmaceuticals 1 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




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




Strong, traditional pharmaceutical industry in Hungary privatised, decisively international ownership, developed generic production

Well-trained professionals traditionally high level training, meeting

community requirements




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




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




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.



ConclusionsConclusions

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.

Pharmaceutical Group of the European Union Annual Symposium, 15 June 2004 Palma de Mallorca Health...

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