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8

Newsletter N° 169 - June 2019

In this issue:

HOPE activities

HOPE Exchange Programme 2020 launch

HOPE-PAQS 2nd Webinar: Vienna tailor-made quality audit model

Romanian Presidency of the Council of the European Union

Employment, Social Policy, Health and Consumer Affairs Council

EU institutions and policies

European Elections: new MEPs and health

Public Health

Cross-border healthcare: significant ambitions but improved management

required – European Court of Auditors Report

European Semester: Commission proposes health recommendations

Vaccine preventable disease: Roadmap to strengthening cooperation

European Reference Networks: Support for the setting-up of registries of

patients affected by rare diseases

Bulgaria signs the Joint Procurement Agreement

Communications Networks, Content and Technology

Digital innovation stimulated by the EU by increasing the availability of

publicly funded data

1 Million Genomes Declaration: Norway signs

eHealth: First electronic health records of patients exchanged between EU

countries

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 2 of 33

Competition

Service of General Economic Interest- open consultation

Employment, Social Affairs & Inclusion

Better work-life balance for parents and carers in the EU: Council adopts

new rules

Better working conditions in the EU: Council adopts a directive on more

transparency and predictability at work

Working Time Directive – Court of Justice of the European Union

Migration and Home Affairs

Protection of public places

Joint Research Center (JRC)

Evidence-based recommendations on breast cancer screening results

European programmes and projects

IMI – Brain health and diseases

Horizon Europe new ‘missions’

Reports and publications

Reports

➢ OECD

Price setting and price regulation in health care. Lessons for advancing

Universal Health Coverage

➢ World Health Organization (WHO)

Driving forward health equity – the role of accountability, policy coherence,

social participation and empowerment (2019)

Accountability as a driver of health equity (2019)

Policy coherence as a driver of health equity (2019)

Participation as a driver of health equity (2019)

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 3 of 33

Croatia: health and employment (2019)

Environmental health inequalities in Europe. Second assessment report

(2019)

➢ WHO European Observatory on Health Systems and Policies

Poland HiT (2019)

Articles

The introduction of hospital networks in Belgium: The path from policy

statements to the 2019 legislation

New model for prioritised adoption and use of hospital medicine in Denmark

since 2017: Challenges and perspectives

Worlds of Healthcare: A Healthcare System Typology of OECD Countries

Involving the public in decision-making about large-scale changes to health

services: A scoping review

Patient empowerment in risk management: a mixed-method study to explore

mental health professionals’ perspective

Comparison of the Patient Enablement Instrument (PEI) with two single-item

measures among Finnish Health care centre patients

Evaluation of integrated care services in Catalonia: population -based and

service-based real-life deployment protocols

Decision making tools for managing waiting times and treatment rates in

elective surgery

Is antibacterial treatment intensity lower in elderly patients? A retrospective

cohort study in a German surgical intensive care unit

The integrated health service model: the approach to restrain the vicious

cycle to chronic diseases

Other news – Europe

Life Sciences Report – AMCHAM

Regulating for innovation, innovative regulation

Procurement in the hospital setting

EPC Policy Dialogue: Vaccine hesitancy

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 4 of 33

Upcoming HOPE (and co-organised) conferences and events

HOPE-PAQS 2nd Webinar: Vienna tailor-made

quality audit model

10/09/2019

HOPE Study Tour - DIGITAL HEALTH: Virtual

Hospital in Helsinki

Helsinki, 24-25/09/2019

HOPE Agora 2020

Brussels, 5-7/06/2020

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 5 of 33

HOPE Exchange Programme 2020 launch

Every year since 1981 HOPE runs an exchange programme to promote the sharing of

knowledge and expertise within Europe and to provide training and experience for hospital and

healthcare professionals who are directly or indirectly involved in the management of European

health care services and hospitals. It consists in a 4-week training period.

The HOPE Exchange Programme 2020 will start on 11 May and end on 7 June 2020. It will

be concluded by the HOPE Agora 2020 that will take place on 5-7 June 2020 in Brussels

(Belgium) around the topic “Using Evidence in Healthcare Management”.

More information

HOPE-PAQS 2nd Webinar: Vienna tailor-made quality audit model

HOPE and PAQS organise their second webinar on 10 September 2019 at 15.00 CET. The

topic of the second webinar will cover the specific quality audit system from the Vienna Hospital

Association (KAV), KAV-Q-Zert.

KAV-Q-Zert is a tailor-made audit model that was implemented since January 2018 and by

which all clinical departments of the KAV are certified.

The objectives of the webinar are to share:

• The background and development process of the audit model

• The methodology of KAV-Q-Zert

• Experiences from two years of implementation

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 6 of 33

Register

Event page

The presentation of the first HOPE-PAQS Webinar: TeamSTEPPS is accessible on HOPE

website, as well as the youtube video: here

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 7 of 33

Romanian Presidency of the Council of the European Union

Employment, Social Policy, Health and Consumer Affairs Council, 13-

14/06/2019

• Combatting antimicrobial resistance (AMR): Ministers adopted

Council conclusions

On 13 and 14 June 2019, during the Employment, Social Policy, Health and Consumer Affairs

Council, Health ministers adopted Council conclusions on combatting antimicrobial

resistance (AMR). The conclusions reaffirm that the issue of AMR is a top priority for the EU.

According to the Council, member states should be supported in their efforts to combat AMR,

but they also need to do more at national level - develop new antimicrobials, reduce the use

of antibiotics and increase understanding of AMR-related issues by the public and health

professionals.

• Other health-related issues

Health ministers also held an exchange of views on ways of ensuring the most effective use

of EU funds for health-related investments.

The presidency had prepared the debate in the context of discussions on the new EU funding

tools that will be set up under the next EU budget.

The Irish and German delegations provided information on the implementation of Regulation

(EU) 2017/745 on medical devices (MDR). Many delegations raised concerns about the

readiness to implement the regulation by May 2020.

Ministers were informed about the state of play in relation to the proposed Regulation on

Health Technology Assessment.

The Commission briefed health ministers on the measles situation in the EU and the

European Economic Area (EEA).

Health ministers were also informed about the work programme of the incoming Finnish

presidency in the area of health.

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 8 of 33

European Elections: new MEPs and health

The European Elections 2019 took place between 23 and 26 May in the 28 Members states.

While the two main tradition groups (EPP and S&D) have lost seats and do not represent

together the majority of the MEPs as they use to in the previous term, the Greens and Liberals

have made gains, as well as the right-wing nationalist and populist groups.

The Greens/EFA gained a significant number of seats this term from 52 for 2014-2019 (6.94%)

to 75 for 2019-2024 (9.99%). This, if reflected in the different committees and especially in the

Environment, Public Health and Food Safety Committee (ENVI), could favour stronger ties

between environmental and health issues and a higher pressure on healthcare and health

technology-related industries. Indeed, the Greens have presented a solid environment and

public health agenda during the campaign, as they identified this as a shortcoming of the

European Commission action. Although, the higher score for the Greens is concentrated in

Western European countries, such as Germany, France, Finland and Luxembourg, but is not

reflected is in Southern or Eastern Europe.

❖ Significant MEPs in relation to health issues:

MEP Adina-Ioana Vălean (EPP, Romania), the last chair of the ENVI Committee is returning

to Parliament.

MEP Petra De Sutter (Greens, Belgium) has been elected. She is a former senator in Belgium’s

parliament and a physician who runs the department for reproductive medicine at Ghent

University. She is interested in serving on the parliamentary committees for health and justice

and particularly on issues related to endocrine disruptors and female genital mutilation.

Newly elected MEP Gina Dowding (Greens, UK) is a former dietician and MEP Jane Brophy

(ALDE, UK) mentions history of public health project management in the NHS in her campaign

CV.

MEP Véronique Trillet-Lenoir (ALDE, France), is a doctor and president of the Cancer Center

directory Lyon-Auvergne-Rhône-Alpes and MEP Chrysoula Zacharopoulou (ALDE, France) is

a surgeon-gynecologist and president of the Info-endometriosis association. MEP Anne-

Sophie Pelletier (GUE, France) medico-psychological care worker in a home for seniors and

dependant persons in Gévry and leader of a care-givers strike denouncing the work conditions.

❖ In relation to the HTA legislation:

Shadow rapporteur Michèle Rivasi (Greens, France) will remain in the EP and so does MEP

Cristian-Silviu Bușoi (EPP, Romania), who led the HTA opinion for the Internal Market and

Consumer Protection Committee.

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 9 of 33

German EPP MEP Peter Liese was also reelected. He was known to be a strong promotor of

the HTA legislation.

❖ In relation to Medical Devices Regulations (MDR)

Many of the MEPs who worked on the new medical device regulations last session are

returning, including MEP Peter Liese who was co-rapporteur on the file, MEP Mairead

McGuinness (EPP, Ireland), and Biljana Borzan (S&D, Croatia), physician by training.

The main issue regarding the MDR is the implementation process as the regulations were

adopted in 2017 and should fully apply in 2020 and 2022. Only two notified bodies have been

created and are ready to check the quality of devices under the new regulation, creating some

concerns among the stakeholders.

❖ What happens next

MEPs will elect a new Parliament president and confirm the committees at the first plenary

sitting scheduled to begin July 2. The committees will hold their first meetings in July, when

they will elect their chairs and vice-chairs.

The European Parliament will also designate a new President of the European Commission (it

has to be approved by the EP by absolute majority). On the basis of the previous elections

spitzenkandidat system, each political group had nominated a lead candidate and the leader

of the European party that commands the largest coalition after the election is likely to become

the Commission president.

It could then be one of the lead candidates from the four top performing parties — Manfred

Weber (EPP), Frans Timmermans (S&D), Margrethe Vestager (ALDE), Ska Keller (Greens).

Although this system is questioned and there is no guarantee it will be preserved for this term.

Cross-border healthcare: significant ambitions but improved

management required – European Court of Auditors Report

On 4 June 2019, the European Court of Auditors released a report on EU actions for cross-

border healthcare.

The 2011 Cross‐border Healthcare Directive seeks to ensure EU patients’ rights to access

safe and high‐quality healthcare, including across national borders within the EU. These rights

are also intended to facilitate closer cooperation between Member States on eHealth and the

treatment of rare diseases.

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 10 of 33

The report concluded that although EU actions in cross-border healthcare enhance Member

States’ collaboration, the benefits for patients were limited. It found that despite the progress

made on providing EU citizens with information on cross-border healthcare, in some areas this

information remains difficult to access. It identified weaknesses in the Commission’s strategic

planning and project management. It includes recommendations focusing on the

Commission’s support for National Contact Points, the deployment of cross-border exchanges

of health data, and EU’s actions in the field of rare diseases.

The Court regrets that the Commission has not provided a clear vision for their future financing

and how to develop and integrate them into national healthcare systems.

Report

European Semester: Commission proposes health

recommendations

On 5 June 2019, the Commission has adopted proposals for country specific

recommendations, including on health and investments in health as part of its ongoing

assistance to Member States in implementing their health systems reforms in the light of an

ageing population. The Commission recommends that the governments of 16 Member States

invest in their national health systems or improve their effectiveness, increase accessibility and

strengthen their resilience, with the following recommendations. This year, identifying and

addressing investment needs has been a key priority – also with a view to the negotiations

about the future Multiannual Financial Framework, the EU’s budget for 2021 to 2017.

The adoption of proposals for country specific recommendations is a key step in the European

Semester, the EU's yearly cycle of economic, fiscal and social policy coordination.

Although Member States are responsible for their own health policy and the organisation and

delivery of care, in the context of the European Semester the EU can give a recommendation

on certain aspects of its health system - that relate to general economic, fiscal and social

policies - to an EU country.

The Commission's proposals for country-specific recommendations will now be discussed in

the Council, where EU countries have until early July to vote on their final adoption. Following

the approval of the recommendations, their implementation will be monitored. New

recommendations could be proposed by the Commission around May 2020.

Access country recommendations

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 11 of 33

Vaccine preventable disease: Roadmap to strengthening

cooperation

On 6 June 2019 the European Commission released the ‘Roadmap for the implementation of

actions based on the Commission Communication and the Council Recommendation on

Strengthening Cooperation against Vaccine Preventable Disease’. It is a timeline for actions

through 2022.

Access the Roadmap

A large measles epidemic has affected the EU/EEA Member States in the past three years,

with 44 074 cases reported by 30 Member States between 1 January 2016 and 31 March 2019.

This is a high number of cases compared to the previous three years (2012–2015), according

to a report issued by the European Centre for Disease Control and Prevention (ECDC) on 28

May 2019.

Read more

European Reference Networks: Support for the setting-up of

registries of patients affected by rare diseases

On 14 May 2019, a new Call for proposals was published by the European Commission to

allow 19 out of the 24 current European Reference Networks (ERNs) to submit proposals and

receive financial support for the setting-up of registries in their respective fields of expertise.

Five ERNs already receive grants for this purpose. This publication of this call happened on

the same day the networks discussed their work on the registries in the framework of their

cross-ERN Research Working Group.

The registries are fundamental tools for research purposes and are particularly important to

establish in the field of rare diseases where the data are fragmented: they become even more

relevant to follow cohorts of patients and thus the natural course of diseases, as well as to

possibly find diagnosis and treatments. Thanks to the ERNs, the critical mass of available data

makes the exercise more meaningful. Five ERNs already receive a financial support: their

projects started at the beginning of 2018 for a duration of three years. While their work is still

in progress, the newly published call will enable the 19 other ERNs to do the same, by

submitting proposals before 10 September 2019. The 19 ERNs are invited to enhance

synergies between them (and the five other ERNs, also learning from them). Candidates can

apply for a grant to develop their own approach in terms of registries and decide whether to

apply individually or to work together through a joint applications.

Read more

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 12 of 33

Bulgaria sings the Joint Procurement Agreement

On 14 June 2019, Bulgaria became the 25th EU country to sign the Joint Procurement

Agreement to procure medical countermeasures. Health Minister Kiril Ananiev signed the

Agreement for Bulgaria. It will now cover around 455 million people, i.e. around 90% of the

population of the European Union.

Read more

Digital innovation stimulated by the EU by increasing the availability

of publicly funded data

The EU is making a wealth of data held by the public sector more easily available for reuse as

raw material for artificial intelligence, blockchain and other advanced digital technologies.

On 6 June 2019, the Council adopted new rules on open data and the reuse of public-sector

data. This will boost the EU data economy, contribute to the development of a data-based

society and stimulate growth and the creation of jobs in all sectors of the economy.

The new directive extends the scope of the rules on the reuse of public sector information (PSI)

beyond public sector bodies so as to include public undertakings in the transport and utilities

sectors.

It also introduces the concept of high-value datasets which are to be made available free of

charge through an application programming interface (API). The text defines six broad

categories of high-value datasets: geospatial, earth observation and environment,

meteorological, statistics, companies and company ownership, and mobility. The list will be

updated through secondary legislation.

The rules will cover publicly funded research data that is already available in public

repositories. It will also encourage the dissemination of dynamic data, such as real-time

weather or transport data. Overall, public sector data will be available either free of charge or

at very low cost.

In addition, the reform promotes the use of open data, meaning data in open formats that can

be freely used and shared for any purpose.

Directive on open data and the re-use of public sector information (full text)

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 13 of 33

1 Million Genomes Declaration: Norway signs

On 14 June 2019, Norway joined the EU Member States driven initiative on linking genomic

databases across borders, becoming the 21st country to join this cooperation mechanism.

The signature by Norway took place today during the 5th Meeting of the Representatives of the

Signatories of the Declaration 'Towards access to at least 1 Million Genomes in the EU by

2022'. Member States of the EU, the European Economic Area (EEA) and the European Free

Trade Association (EFTA) have committed to collaborate on the secure and authorised access

to national and regional banks of genomic and other health related data. To reach this goal,

they are working on bringing together their existing infrastructures and expertise.

Genome Declaration

eHealth: First electronic health records of patients exchanged

between EU countries

On 21 June 2019, first health records of patients are exchanged in the EU thanks to the cross-

border electronic health services. As of now doctors in Luxembourg will be able to receive

digital Patient Summaries of travellers coming from Czechia. These Patient Summaries

provide background information on important health-related aspects such as allergies, current

medication, previous illness, surgeries, etc., making it digitally accessible in case of a medical

emergency visit in another country. It is a summary of a patient's health data stored in

electronic format. Also, as of this week, Finland and Croatia are exchanging ePrescriptions:

Finnish citizens can now retrieve in Croatian pharmacies the medicines prescribed

electronically by their doctor in Finland. Since January this year, over 2,000 Finnish patients

have already been able to get their medicines in Estonia.

These services are made possible thanks to “My health @ European Union”,

the eHealth Digital Service Infrastructure which connects the eHealth national services,

allowing them to exchange health data, and which is funded by the European Commission's

Connecting Europe Facility. Data protection rules are strictly observed - patients have to

provide their consent before these services are accessed. 22 Member States are part of the

eHealth Digital Service Infrastructure and are expected to exchange ePrescriptions and Patient

Summaries by 2022. Seven Member States (Finland, Estonia, Czechia, Luxembourg,

Portugal, Croatia and Malta) are progressively launching these exchanges by the end of 2019.

More information can be found here.

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 14 of 33

Service of General Economic Interest- open consultation

After several years (Commission Decision of 20 December 2011 on the application of Article

106(2) of the Treaty on the Functioning of the European Union to State aid in the form of public

service compensation granted to certain undertakings entrusted with the operation of services

of general economic interest), the European Commission puts this issue on the agenda again.

On 17 June 2019 a roadmap was published together with a consultation open until mid-July.

Health and social services include medical care provided by hospitals and other healthcare

providers, long-term care, childcare, access to and reintegration into the labour market, social

housing and the care and social inclusion of vulnerable groups. From a State aid perspective,

health and social services form a subgroup of services of general economic interest (SGEI).

State aid control comes into play when these services are provided as an economic activity on

a market and are, at least partially, financed through public resources. The Commission’s State

aid practice, having as a key objective preventing public interventions from distorting the level

playing field for operators, mainly focuses on ensuring that SGEI compensation finances

genuine SGEIs and that there is no overcompensation or cross-subsidisation of commercial

activities. This is in particular relevant considering the trend in some Member States to

liberalise the market in the context of health and social services.

In principle, compensation measures for health and social services are subject to EU State aid

rules and, more particularly, the four texts that the Commission adopted as part of its 2012

SGEI package (SGEI Communication, SGEI Decision, SGEI Framework and SGEI de minimis

Regulation, which is the only text expiring on 31 December 2020).

The purpose of the evaluation is to check if the rules on health and social services of general

economic interest meet their objectives under the 2012 services package. Those objectives

were to support EU Member States in funding the services that are vital to people and society

while preserving the key concepts of state subsidy control and therefore avoiding distortions

of competition. The evaluation will also assess how the Regulation on small-scale government

subsidies (de minimis State aid) for such services has been applied.

Read more

Legislation in force

Roadmap of the Commission's initiative to prolong the SGEI de minimis Regulation

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 15 of 33

Better work-life balance for parents and carers in the EU: Council

adopts new rules

On 13 June 2019, the Council adopted a Directive on work-life balance for parents and carers

which aims to increase the participation of women in the labour market and the take-up of

family-related leave and flexible working arrangements. The new act also provides

opportunities for workers to be granted leave to care for relatives who need support. The

legislation means that parents and carers will be better able to reconcile their professional and

private lives, and companies will benefit from more motivated workers.

Main elements of the directive

• paternity leave - fathers or second parents will be able to take at least 10

working days of leave around the time of birth of a child paid at a level equal to

that currently set at EU level for maternity leave (in line with article 11 of Council

Directive 92/85/EEC). The right to paternity leave will not be subject to a prior

service requirement. However, the payment of paternity leave can be subject to

a six-month prior service requirement. Member states with more generous

parental leave systems will be able to keep their current national arrangements

• parental leave - an individual right to 4 months of parental leave, from which 2

months are non-transferable between the parents and are paid. The level of

payment and the age limit of the child will be set by member states

• carers' leave - a new concept at EU level for workers caring for relatives in need

of care or support due to serious medical reasons. Carers will be able to take 5

working days per year. Member states may use a different reference period,

allocate leave on a case-by-case basis, and may introduce additional conditions

for the exercise of this right

• flexible working arrangements - the right for parents to request these

arrangements has been extended to include working carers.

Background and next steps

The Commission presented its proposal in April 2017. On 21 June 2018, the Council adopted

its position which formed the basis for the negotiations with the European Parliament. The

presidency of the Council and the Parliament reached an agreement on 24 January 2019,

followed by a vote by the EP on 4 April 2019. It will enter into force on the twentieth day

following the publication in the Official Journal of the EU. Member States will then have three

years to adopt laws, regulations and administrative provisions necessary to comply with the

directive.

Directive on work-life balance for parents and carers

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 16 of 33

Better working conditions in the EU: Council adopts a directive on

more transparency and predictability at work

On 13 June 2019, the Council adopted a directive which will make working conditions across

the EU more transparent and predictable. The new law introduces new minimum rights, as well

as new rules on the information to be provided to workers about their working conditions. Its

main aim is to respond to labour market challenges triggered by demographic developments,

digitalisation and new forms of employment.

The directive applies to all individuals working more than 3 hours per week over four weeks

(i.e. over 12 hours per month). Certain groups of workers may be excluded from some of the

provisions, e.g. civil servants, armed forces, emergency services or law enforcement services.

The directive requires employers to inform workers, as from their first working day and no later

than the seventh calendar day, of the essential aspects of the employment relationship, such

as:

• the identities of the parties to the relationship and the place and the nature of work

• the initial basic amount of remuneration and the amount of paid leave

• the duration of the standard working day or week when the work pattern is predictable

• the identity of the social security institution receiving social security contributions,

where this is the responsibility of the employer

• When the work pattern is entirely or largely unpredictable, employers will also have to

inform workers of the reference hours and days within which they may be required to

work, the minimum period of advance notice the workers shall receive before the start

of work, and the number of guaranteed paid hours.

The directive sets a number of further minimum rights for workers, including the rights:

• to take up a job in parallel with another employer

• to limit the probationary period to a maximum of 6 months, with longer periods allowed

only in case where this is in the interest of the worker or is justified by the nature of the

work

• to request, after at least six months service with the same employer, employment with

more predictable and secure working conditions

• to receive training cost-free, when such training is required by Union or national

legislation.

• Member states are free to adopt or apply legislation which is more favourable to

workers.

The Commission presented its proposal in December 2017. In June 2018 the Council adopted

its position which formed the basis for the negotiations with the European Parliament. The

provisional agreement between the presidency of the Council and the Parliament was reached

on 7 February 2019. The European Parliament voted in favour of the agreement on 16 April

2019. Following the adoption by the Council, the text of the directive will be published in the

Official Journal of the EU. The directive will enter into force on the twentieth day following the

publication. Member states will then have 3 years to take the necessary legislative measures

to comply with the directive.

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 17 of 33

Working Time Directive – Court of Justice of the European Union

Judgment

On 14 May, the Court of Justice of the European Union has adopted a judgment in which it

states that in order to guarantee employees' rights under the EU's Working Time Directive and

the charter of fundamental rights EU Member States "must require employers to set up an

objective, reliable and accessible system enabling the duration of time worked each day by

each worker to be measured”.

It is up to each Member States to define the system to record those working hours. The right

to fair working conditions is set out in the 10th principle of the European Pillar of Social Rights

“Healthy, safe and well-adapted work environment and data protection”, and in EU’s Working

Time Directive (2003/88/EC).

Read more

Protection of public places

The European Commission DG HOME invited HOPE for the EU Operators' Forum on the

protection of public spaces that took place on 6 June 2019.

The European Commission provided an update on the implementation of the EU Action Plan.

Operators and Member States were invited to provide updates on initiatives and good

practices.

A session was focused on discussing the way forward regarding the paper on Good practices

to support the protection of public spaces. The European Commission gave an update on

available guidance materials. Operators and Member States were invited to exchange views

on possible next steps and areas for further work in particular on how to disseminate the good

practice document, both to public and private stakeholders. Question to be discussed: Do you

see the need for any further guidance documents, for instance for individual sectors?

Several other questions were discussed: How to ensure that clear communication channels

are being established between public authorities and private operators? In which areas does

the cooperation work well and in which areas are further improvements needed? The

Commission gave an overview of the EU vulnerability assessment tool raising several

questions to be discussed: Which sectors carry out regular assessments/ have elaborate

security and crisis management plans? Would it be useful and feasible to develop templates?

How to ensure good communication between public authorities and private operators during

different phases of an incident? On awareness and training three questions were discussed:

Which sectors have awareness programmes or staff security trainings in place? Where is more

work needed? In which sectors do regular exercises take place?

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 18 of 33

Finally, the Commission will give an overview of ongoing initiatives in the area of physical

protection. Questions to be discussed: Which detection technologies are available or needed

to detect threats? What kind of measures are useful to protect public spaces of different

sectors? Would it be useful to develop sectorial guidance material or is such guidance already

available?

• 18th progress report COM(2019)145

• Staff Working Document SWD(2019)140: Good practices to support the

protection of public spaces

Evidence-based recommendations on breast cancer screening

results

On 28 May 2019, the Joint Research Center (JRC) has released 10 new evidence-based

recommendations on how mammogram results and follow-up appointments should be

communicated to women within screening programmes. Early diagnosis of breast cancer

through organised screening programmes can lead to more effective treatments and higher

survival rates.

When women participate in breast cancer screening programmes, they are invited for

mammography. The results of this test can be negative (i.e. everything looks fine and no

suspicious lesions are detected) or further assessment could be needed. In either case, the

way that this information is communicated to women can have a strong impact on their quality

of life and general well-being, especially in terms of the levels of stress and anxiety they

experience. It can also influence their future participation and trust in breast cancer screening

initiatives.

Within the European Commission Initiative on Breast Cancer (ECIBC), the JRC, supported

by an external expert group of professionals and patients, has evaluated existing good

practices for this communication. These newly published ECIBC recommendations indicate

information needs during the screening process. They also contribute to the design of effective

breast cancer screening programmes and to better informing women about their options.

There are now 50 publicly accessible ECIBC recommendations on breast cancer screening

and diagnosis, and further 30 will be published later this year.

The total of 80 recommendations will cover: strategies for the organisation of screening

programmes, types of screening tests in use, recommended diagnostic methods,

communication approaches and the training of professionals involved in breast cancer

screening and diagnosis.

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 19 of 33

IMI – Brain health and disease

On 12 June 2019, IMI organised in Brussels a “Stakeholder Forum 2019: Brain health and

disease in the digital era – 2020 & beyond”.

The first session was on healthy lifestyles, prevention and diagnosis. Brain Health and

prevention Healthcare is shifting from reactive treatment and care to early detection and

prevention, and at the same time patients are taking an increasingly active role in managing

their health. This session will discuss how different stakeholders are engaging with digital

health technologies, and how they are demonstrating reliability and performance of these

technologies while assuring compliance with legal, regulatory and ethical requirements.

Diagnosis Brain disorders have a very complex biology and are still poorly understood.

Diagnosis is still based on symptoms. A session explored the potential of digital technologies

to facilitate timely and accurate diagnosis.

Then a session discussed questions such as how can digital technologies enhance the

development and delivery of pharmacological interventions and what is needed for digital

technologies to become part of the treatment possibilities for brain disorders.

An array of promising digital brain health solutions is being proposed to facilitate the healthcare

of people with brain disorders. A panel discussed issues like usability, usefulness, and

acceptance of these technologies by the patients and their carers.

Event page

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NEWSLETTER N° 169 – June 2019 Page 20 of 33

Horizon Europe new ‘Missions’

In May 2019, the European Commission launched a call for expression of interest in Europe

Horizon Missions Areas. Missions are a key novelty of Horizon Europe - the next EU

Framework Programme for Research and Innovation 2021-2027 (proposed budget €100bn).

Missions will consist of portfolios of research and innovation projects at all Technology

Readiness Levels, with a clear goal that matters for EU citizens. Mission contents still have to

be defined, but examples could be: "A plastic-free ocean by 2030" or "100 carbon-neutral EU

cities by 2030".

At the moment, the EU political process has defined five Mission Areas:

1) Cancer;

2) Adaptation to climate change, including societal transformation;

3) Healthy oceans, seas, coastal and inland waters;

4) Climate-neutral and smart cities;

5) Soil health and food.

Mission boards will advise the European Commission how to define and implement each

Mission area. Mission board members will have complementary profiles, covering a wide range

of scientific and non-scientific profiles, such as: research and innovation; communication;

public health; healthcare; environment; nutrition; architecture and design; behaviour;

psychology; engineering; information and communication technology; social sciences and

humanities; management; local, regional, national, international policy; finance; law; etc.

Mission board members may represent highly qualified individuals from: academia; SMEs;

industry; non-governmental organisations; charities; philanthropy; foundations; citizen

associations; young and/or experienced innovators; and investors, international organisations,

to mention a few.

Read more

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NEWSLETTER N° 169 – June 2019 Page 21 of 33

➢ OECD

Price setting and price regulation in health care. Lessons for

advancing Universal Health Coverage

Under international commitments to Universal Health Coverage, the Member States of the

WHO are obliged to strengthen their financing systems to ensure that all people have access

to health services and are protected against financial hardship in paying for these services.

While payment methods have received a great deal of attention among policymakers and

practitioners, less attention has been paid to price setting and how it can also contribute to

broader system objectives. However, if prices are set too high or too low, they can easily

overshadow the incentives in payment mechanisms. The objectives of this study published on

17 June 2019, are to describe experiences in price setting and how pricing has been used to

attain better coverage, quality, financial protection, and health outcomes. It builds on newly

commissioned case studies and lessons learned in calculating prices, negotiating with

providers, and monitoring changes. Recognising that no single model is applicable to all

settings, the study aimed to generate best practices and identify areas for future research,

particularly in low- and middle-income settings.

Link

➢ World Health Organization (WHO)

Driving forward health equity – the role of accountability, policy coherence, social participation and empowerment (2019)

A scientific expert review process coordinated by the WHO European Office for Investment for

Health and Development of the WHO Regional Office for Europe identified societal and

institutional factors that singly and in combination offer new explanations on why progress on

health equity has not been as fast as had been hoped when the association between individual

determinants and inequities was first established. These four key drivers of health equity are:

accountability, policy coherence, social participation and, underlying them, empowerment.

Work on these drivers informs the Health Equity Status Report initiative (HESRi) and has

resulted in three independent companion papers each elaborating further on one of the

common goods for health equity – accountability, policy coherence and social participation –

as well as this summary paper released in June 2019.

Link

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NEWSLETTER N° 169 – June 2019 Page 22 of 33

Accountability as a driver of health equity (2019)

This paper released in June 2019 highlights how accountability mechanisms and processes

can play a vital role in driving progress on the Health 2020 and Sustainable Development

Goals health equity commitments. Using concrete examples, it identifies how accountability

mechanisms and processes assist countries in advancing on health equity and demonstrates

how progress stalls when they are absent. It highlights how advancing on accountability

requires engaging with multiple diverse actors at different levels in dynamic accountability

processes, the importance of collecting and employing disaggregated data to underpin

accountability processes and the potential of new accountability tools to address health equity.

It demonstrates that progress on accountability requires state engagement with its health-

related commitments, both within and beyond the health sector. The examples highlight that

when such commitment is weak or absent, accountability suffers and progress on health equity

is undermined.

Link

Policy coherence as a driver of health equity (2019)

Health is a human right and therefore states must ensure access to timely and affordable

health care of appropriate quality, and provide for the underlying determinants of health, such

as safe and potable water, sanitation, food, housing, health-related information and education,

decent work and gender equality. This highlights the need for coherent action across different

policy domains. The United Nations Sustainable Development Goals provide the framework to

advance policy coherence for health equity. As policy coherence concerns different levels of

governance, the mechanisms for the public health community to drive for policy coherence are

both systemic and administrative. The former concerns transparency (access to health and

other relevant data and capacity to use the data) and accountability (reporting to the legislature,

initiatives by ministries of health and the strength of civil society). The latter mechanism

includes ministerial linkages between health and others (interdepartmental committees and

public engagement), public health legislation, governmental plans and targets, joint budgeting

and delegated finance.

Link

Participation as a driver of health equity (2019)

Social participation is about population involvement in decisions that affect their health. The

promotion of this social innovation as a general rule of governance in all policies would be a

key driver of health equity. In general, responsibility for organisation of participatory processes

falls to the public administration, but participatory processes can also be initiatives of

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NEWSLETTER N° 169 – June 2019 Page 23 of 33

companies, social entities or non-governmental organisations, enabling numerous entry points

and opportunities to promote more participatory social processes even in contexts in which

there is no participatory tradition. Specifically, the health community can promote a greater

level of social participation through the whole policy process, from diagnosis to evaluation,

from health provider-level to health system-level, and when working on intersectoral strategies,

programmes and activities. This paper, released in June 2019, ends with a proposal for

evaluation purposes that identifies six basic components to be measured: inclusion;

deliberation; information flow; decision-making; institutional political will; and community

capacity.

Link

Croatia: health and employment (2019)

Being in good health and improving health is beneficial for individuals, employers and the wider

society, as well as to the nation economy. Although many European Union (EU) countries face

similar problems related to high youth unemployment and an ageing population, in Croatia a

more significant problem is the large number of people not working owing to health problems.

A healthy workforce is more productive and resilient, with reduced absenteeism and

presenteeism. In 2015 the financial costs to employers of occupational health support for work-

related illness and injuries in Croatia were double those of the government (604.6 million vs

297 million Croatian kuna). Poor working conditions are associated with higher rates of stress,

raised blood cholesterol, musculoskeletal disorders and mental health consultations with

medical practitioners. These result in increased costs to Croatia health care system and

represent a large burden for employers. Since 2010 the majority of people with disability have

not found work. The availability of jobs for people with disabilities varies across Croatia regions.

The total number of participants in active labour market programmes (ALMPs) has fluctuated

since 2011. However, the percentage of people with disabilities participating in ALMPs

declined between 2014 and 2016.

Mental disorders, including depression and anxiety, are the main cause of disability and early

retirement in almost every country in Europe, and are a major burden to economies. This is

also the case in Croatia. On average, people in Croatia work longer hours compared with other

EU countries. They perceive a higher level of job insecurity and have a poorer work–life

balance, contributing to high stress levels. Integrated comprehensive policies and approaches

are more effective and more cost-effective than single interventions in addressing issues

related to work and health. Many key stakeholders are involved in implementing and

developing policies to improve health and well-being and work, including national, regional and

local governments, along with various ministries, employers, unions, and non-governmental

organisations (NGOs). These stakeholders can select from a range of policies and

interventions.

The report released in June 2019 aims to support Croatia in developing a strategic approach

to promote health at work and improve the health, social welfare and well-being of all in society.

Link

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NEWSLETTER N° 169 – June 2019 Page 24 of 33

Environmental health inequalities in Europe. Second assessment report (2019)

Environmental conditions are a major determinant of health and well-being, but they are not

shared equally across the population. Higher levels of environmental risk are often found in

disadvantaged population subgroups. This assessment report, published in June 2019,

considers the distribution of environmental risks and injuries within countries and shows that

unequal environmental conditions, risk exposures and related health outcomes affect citizens

daily in all settings where people live, work and spend their time.

The report documents the magnitude of environmental health inequalities within countries

through 19 inequality indicators on urban, housing and working conditions, basic services and

injuries. Inequalities in risks and outcomes occur in all countries in the WHO European Region,

and the latest evidence confirms that socially disadvantaged population subgroups are those

most affected by environmental hazards, causing avoidable health effects and contributing to

health inequalities.

The results call for more environmental and intersectoral action to identify and protect those

who already carry a disproportionate environmental burden. Addressing inequalities in

environmental risk will help to mitigate health inequalities and contribute to fairer and more

socially cohesive societies.

Link

➢ WHO European Observatory on Health Systems and Policies

Poland HiT (2019)

HiT Poland 2019 was released on 11 June 2019 to describe the functioning of health systems

of the country as well as reform and policy initiatives in progress or under development.

Governance of the public health system is divided between the Minister of Health and three

levels of territorial self-government. This fragmentation helps explain the slow progress in

tackling important and longstanding problems and imbalances, such as high hospital bed

numbers and hospital debt, and related to this, an overreliance on hospital care compared to

community-based care.

Life expectancy at birth has been increasing but remains three years lower than the EU

average. Likewise, preventable and treatable mortality rates have decreased but are much

higher than the average rates in the EU. Health challenges include high rates of obesity, a

rising burden of mental disorders and population ageing, and are likely to increase demand for

health and social care.

Provision of care remains skewed towards inpatient care and there are acute shortages of both

doctors and nurses. These structural imbalances will continue to pose a major challenge for

the effective delivery of care.

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In 2017, Poland devoted 6.7% of its GDP to health, a share that was lower than in most EU

Member States. Private financing (mainly out-of-pocket spending) accounts for 30% of current

spending on health and its role is much larger in Poland than in most EU Member States.

However, the government has pledged to increase public spending from 4.6% of GDP in 2017

to 6% by 2024. This will present an opportunity to address the mounting health challenges as

well as tackle the longstanding problems and structural imbalances.

Link

The introduction of hospital networks in Belgium: The path from

policy statements to the 2019 legislation

In April 2015, the Belgian Federal Minister for Social Affairs and Public Health launched an

Action Plan to reform the hospital landscape. With the creation of “local regional clinical

hospital networks” with their own governance structures, the plan follows the international trend

towards hospital consolidation and collaboration. The major complicating factors in the Belgian

context are that policy instruments for the redesign of the hospital service delivery system are

divided between the federal government and the federated authorities, which can result in an

asymmetric hospital landscape with a potentially better distribution of clinical services in the

Flanders hospital collaborations than in the other federated entities. Yet, the current

regulations stipulate that only hospitals (and not networks) are entitled to hospital budgets.

Although the reform is the most significant and drastic transformation of the Belgian hospital

sector in the last three decades, networks mainly offer a framework in which hospitals can

collaborate. More regulation and policy measures are needed to enhance collaboration and

distribution of clinical services. The highlights of this report released on 12 June 2019 are:

Belgian hospitals must become part of larger geographically delineated hospital collaborations;

the reform should enhance the distribution of clinical services and collaboration between

hospitals; reference centres are required to collaborate on a supra-regional level; more

regulation and policy measures are needed; top-down restrictions and allocation mechanisms

on the network level are required.

Link

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NEWSLETTER N° 169 – June 2019 Page 26 of 33

New model for prioritised adoption and use of hospital medicine in

Denmark since 2017: Challenges and perspectives

This article has been released on 12 June 2019 to describe the challenges and perspective

that the Danish health system will face with the prioritised adoption and use of hospital

medicine model. Technological innovation creates new treatment opportunities, while also

putting healthcare budgets under strain. To deal with the rising costs of hospital medicines, the

regional governments in Denmark have developed a new model for prioritising the adoption

and use of hospital medicine. Marking a shift from previous policies, the new model formalises

the evaluation of clinical benefit, adds an assessment of treatment costs and ensures a

relatively high degree of direct stakeholder involvement. In international comparison, the new

model is ambitious in terms of stakeholder involvement and adherence with principles

advocated to ensure procedural justice and fair decision-making processes. However, these

procedural innovations have also created new challenges. Notably, the newly formed

assessment body, the Danish Medicines Council, is faced with a very high caseload and limited

options to prioritise the use of its analytical resources.

Link

Worlds of Healthcare: A Healthcare System Typology of OECD

Countries

In this paper, released on 12 June 2019, the authors present an extended typology of OECD

healthcare systems. Our theoretical framework integrates the comparative-institutional

perspective of existing classifications with current ideas from the international health policy

research debate. They argue that combining these two perspectives provides a more

comprehensive picture of modern healthcare systems and takes the past decade dynamic of

reforms into account. Moreover, this approach makes the typology more beneficial in terms of

understanding and explaining cross-national variation in population health and health

inequalities. Empirically, they combine indicators on supply, public-private mix, and institutional

access regulations from earlier typologies with information on primary care orientation and

performance management in prevention and quality of care. The results from a series of cluster

analyses indicate that at least five distinct types of healthcare systems can be identified.

Moreover, the authors provide quantitative information on the consistency of cluster

membership for individual countries via system types.

Link

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 27 of 33

Involving the public in decision-making about large-scale changes to

health services: A scoping review

Public involvement in large-scale changes (LSC) to health services is strongly promoted – and

even mandated – in several health systems. This scoping review published on 12 June 2019

aimed to describe the evidence about how public involvement is conceptualised and conducted

in LSC, with what impact, and how different stakeholders perceived this process.

Public involvement remains poorly defined and its aims lack clarity in LSC. Public meetings

are most often used to gather public views but raise the issue of representativeness. However,

evidence in the literature is scarce about which involvement methods – informative and

deliberative – are appropriate for the different stages of the LSC and with what impact. In

several cases, the involved public felt they had no influence on decision-making regarding LSC

proposals, sometimes leading to an environment of mistrust. In those instances, the public

understood the technical arguments for change and actively questioned them, opposed LSC

plans and sought alternative routes to voice their views.

More research and consideration are needed regarding who should be involved, with what

purpose and how. The authors argue that in practice two models of involvement, invited and

uninvited participation, coexist and therefore interactions between the two should be given

further consideration in LSC.

Link

Patient empowerment in risk management: a mixed-method study to

explore mental health professionals’ perspective

In the last years, patient empowerment has been increasingly recognised as a crucial

dimension of patient-centred healthcare and patient safety. Nevertheless, little work has been

done so far in the field of patient safety to investigate strategies for empowering psychiatric

patients. Therefore, the aim of this study published on 13 June 2019 was to identify, by using

focus groups, whether and how psychiatric patient empowerment can improve risk

management according to the perspective of healthcare providers (HPs).A mixed-method

approach composed of a qualitative data collection method (i.e., focus groups) and a

quantitative analysis technique (i.e., inductive content analysis) was applied.

The results suggest that HPs consider patients as crucial partners in risk management and

expect them to play a key role in actively enhancing safety. Policy makers should be aware

that risk management in mental health settings particularly relies on the therapeutic

relationship between HPs and patients. Therefore, allocating sufficient human and financial

resources to mental health care aiming to further support the relationship between patients

and HPs is of utmost importance.

Link

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 28 of 33

Comparison of the Patient Enablement Instrument (PEI) with two

single-item measures among Finnish Health care centre patients

The Patient Enablement Instrument (PEI) is an established patient-reported outcome measure

(PROM) that reflects the quality of appointments with general practitioners (GPs). It is a six-

item questionnaire administered to the patient immediately after a consultation. The aim of this

study was to evaluate whether a single-item measure could replace the PEI when measuring

patient enablement among Finnish health care centre patients.

Two single-item measures, Q1 and Q2, were chosen for comparison with the PEI. Firstly, a

pilot study with questionnaire testing and brief interviews with the respondents were performed

in order to assess the content validity of the PEI and the single-item measures. Secondly, a

questionnaire study after a single appointment with a GP was carried out in three health care

centres in Western Finland in order to evaluate the construct and criterion validity of the single-

item measures. A telephone interview was performed 2 weeks after the appointment in order

to assess the test-retest reliability of the single-item measures. The sensitivity, specificity, and

both positive and negative predictive values of Q1 and Q2 were calculated with different PEI

score cut-off points.

Altogether 483 patients with a completed PEI were included in the questionnaire study

analyses. Altogether 149 and 175 patients had completed Q1 and Q2, respectively, both in the

questionnaire and the telephone interview. Q2 seems to be a valid and reliable measure of

patient enablement. Q1 seems to be less correlated with the PEI, but it also has a high negative

predictive value in relation to low enablement scores. The results of this research have been

published online on 13 June 2019.

Link

Evaluation of integrated care services in Catalonia: population-

based and service-based real-life deployment protocols

Comprehensive assessment of integrated care deployment constitutes a major challenge to

ensure quality, sustainability and transferability of both healthcare policies and services in the

transition toward a coordinated service delivery scenario. To this end, the manuscript

published on 11 June 2019 articulates four different protocols aiming at assessing large-scale

implementation of integrated care, which are being developed within the umbrella of the

regional project Nextcare (2016–2019), undertaken to foster innovation in technologically-

supported services for chronic multimorbid patients in Catalonia.

Whereas one of the assessment protocols is designed to evaluate population-based

deployment of care coordination at regional level during the period 2011–2017, the other three

are service-based protocols addressing: home hospitalisation; prehabilitation for major

surgery; and community-based interventions for frail elderly chronic patients. All three services

have demonstrated efficacy and potential for health value generation. They reflect different

implementation maturity levels. While full coverage of the entire urban health district of

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NEWSLETTER N° 169 – June 2019 Page 29 of 33

Barcelona-Esquerra (520 k inhabitants) is the main aim of home hospitalisation, demonstration

of sustainability at Hospital Clinic of Barcelona constitutes the core goal of the prehabilitation

service. Likewise, full coverage of integrated care services addressed to frail chronic patients

is aimed at the city of Badalona.

The population-based analysis, as well as the three service-based protocols, follow

observational and experimental study designs using a non-randomied intervention group

(integrated care) compared with a control group (usual care) with a propensity score matching

method. Evaluation of cost-effectiveness of the interventions using a Quadruple aim approach

is a central outcome in all protocols. Moreover, multi-criteria decision analysis is explored as

an innovative method for health delivery assessment. The following additional dimensions will

also be addressed: determinants of sustainability and scalability of the services; assessment

of the technological support; enhanced health risk assessment; and factors modulating service

transferability.

The current study offers a unique opportunity to undertake a comprehensive assessment of

integrated care fostering deployment of services at regional level. The study outcomes will

contribute refining service workflows, improving health risk assessment and generating

recommendations for service selection.

Link

Decision making tools for managing waiting times and treatment

rates in elective surgery

Waiting times for elective treatments, including elective surgery, are a source of public concern

and therefore are on policy makers’ agenda. The long waiting times have often been tackled

through the allocation of additional resources, in an attempt to reduce them, but results are not

straightforward. At the same time, researchers have reported wide geographical variations in

the provision of elective care not driven by patient needs or preferences but by other factors.

The paper published on 11 June 2019 analyses the relationship between waiting times and

treatment rates for nine high-volume elective surgical procedures in order to support decision

making regarding the availability of these services for the citizens. Using the framework already

proposed for the diagnostic services, the authors identify different patterns that can be followed

to align the supply with patient needs in the Italian context. The results show a high degree of

variation both in treatment rates and waiting times, especially for the orthopaedic procedures:

knee replacement, knee arthroscopy and hip replacement. In Italy, waiting times in elective

surgical services are a main policy issue with a relevant geographical variation. The analysis

reveals that this variation is due to multiple elements. Policy makers and healthcare managers

should follow a two-step strategy firstly identifying the type of context and secondly analysing

the impact of elements such as resource productivity, resource availability, patients’

preferences and care appropriateness. Only in some cases it is required to increase the service

supply.

Link

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NEWSLETTER N° 169 – June 2019 Page 30 of 33

Is antibacterial treatment intensity lower in elderly patients? A

retrospective cohort study in a German surgical intensive care unit

Demographic change concurrent with medical progress leads to an increasing number of

elderly patients in intensive care units (ICUs). Antibacterial treatment is an important aspect of

intensive care but burdened by the associated antimicrobial resistance risk. Elderly patients

are simultaneously at greater risk of infections and may be more restrictively treated because,

generally, treatment intensity declines with age. In this article released on10 June 2019, the

authors described the utilisation of antibacterial in ICU patients older and younger than 80 -

years and examined differences in the intensity of antibacterial therapy between both groups.

Elderly patients were generally less likely to be treated with antibacterial. This observation,

however, did not persist in patients with comparable treatment probability. In these,

antibacterial treatment intensity did not differ between younger and older ICU patients, for

some antibacterial classes treatment intensity was even higher in the latter. Patient-level

covariates are instrumental for a nuanced evaluation of age-effects in antibacterial treatment

in the ICU.

Link

The integrated health service model: the approach to restrain the

vicious cycle to chronic diseases

In lifetime nearly each person succumbs to some sort of chronic disease and many develop

complicated chronic diseases. It is critical to focus on preventive services with a relatively high

health impact and favourable cost effectiveness. During routine health facility visits, it is

advisable to evaluate both symptomatic and asymptomatic patients for their needs of health

promotion and disease prevention services. This necessitates the development of an

integrated health service (IHS) approach that incorporates health promotion, disease

prevention and curative services.

There were two phases for this study. Its results were published on 31 May 2019. The

Integrated Health Service (IHS) framework was agreed by experts to be a plausible method in

describing the causal relationship of chronic non-communicable, communicable, and nutrition-

related diseases. The framework can play a vital role by preventing the acquiring, progression,

suffering or dying from diseases through restraining the vicious cycle of chronic diseases.

Link

HOPE – European Hospital and Healthcare Federation

NEWSLETTER N° 169 – June 2019 Page 31 of 33

Life Sciences Report - AMCHAM

HOPE was invited to the presentation of a report commissioned by

AmCham EU (the lobby of the US companies in Brussels) and conducted

independently by Charles River Associates.

The report explores the key trends and challenges (“including those that

prevent the development and access of patients to innovative products and

services in the EU” …) facing the life sciences sector and provides

concrete policy recommendations

Report: Life Sciences for Europe: An integrated strategy for healthcare innovation

(2019-2024)

Regulating for innovation, innovative regulation

HOPE was invited to the conference that took place on 13 June 2019 financed by

pharmaceutical and medical devices companies

Vice-President of the Commission Commissioner for Digital Single Market Andrus Ansip

presented the Digital Single Market. He was followed by four speakers: Christopher

Hodges, Professor of Justice Systems at Oxford University and Fellow of Wolfson College –;

Ruth Steinholtz, Business Ethics Advisor, AretéWork, Elisabeth Crossick, Head of Government

Affairs, RELX.

• Commissioner Andrus Ansip’s speech

• Christopher Hodges’ lecture

• Ruth Steinholtz’s presentation

• Elisabeth Crossick’s speech notes

Procurement in the hospital setting

The pharmaceutical company AMGEN is financing through an educational grant a Synergy

Masterclass on " Procurement, tendering and decision-making processes in the hospital

setting" on 4 and 5 October 2019 organised by the European Association of Hospital

Pharmacists.

In this second EAHP Synergy masterclass the themes of Procurement, tendering and decision-

making processes will be explored. Particularly, nowadays the challenge of costly medication

in hospital pharmacies is a topic that should be addressed. Thus, procurement and tendering

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NEWSLETTER N° 169 – June 2019 Page 32 of 33

are topics related to managing medication costs, which are essential for hospital pharmacists

to understand in order to address the increasing medication costs.

The aim of this Synergy Masterclass is to demonstrate the procurement and tendering

discipline to hospital pharmacists. The learning objectives are to recall important EU-legislation

with regard to procurement; to recognise pros and cons by doing procurement and tenders at

national, regional and hospital level, respectively; to list elements of value-based procurement.

More information

EPC Policy Dialogue: Vaccine hesitancy

On 13 June 2019, HOPE took part in an event CHES Policy Dialogue on “Vaccine hesitancy -

Understanding it to regain trust” organised by EPC (European Policy Center).

The speakers included: Emilie Karafillakis, Research Fellow, The Vaccine Confidence Project;

London School of Hygiene and Tropical Medicine; Annabel Seebohm, Secretary-General,

Standing Committee of European Doctors ; Ivo Vojtek, Member, Vaccines Europe ; Radu

Costin Ganescu, Vice President of the European Patients Forum and the panel was chaired

by Hans Martens, Senior Adviser, European Policy Centre.

The debate focused on the importance of the framing in the communication related to

vaccination. Vaccine hesitancy differs from anti-vaccine behaviour which only concerns a

minority of people (1 to 2% of the total population in Europe) and apply to a range of behaviour

characterised by uncertainty toward vaccination (accept some vaccines and refuse other) as

well as the fear of side effects. It is often caused by misinformation and conflicting information,

as well as a lack of trust in the products and services providing it.

The survey carried out by the Vaccine Confidence Project of the London School of Hygiene

and Tropical Medicine revealed that Europe has a particularly low confidence in vaccine safety.

The top 3 confident countries are Portugal, Denmark and Spain, while the less confident are

Poland and France.

The variation in the confidence index in between EU countries and in between different types

of vaccines can be understood by the importance of the national context. Indeed, the impact

of a previous “bad experience” with a specific vaccine in a country on the level of trust is

generally important. Thus, public communication on vaccination is essential, particularly

through social medias which can amplify the phenomenon in the case of a reluctance.

Upstream action and prevention should be the priority.

Annabel Seebohm, Secretary-General, Standing Committee of European Doctors, stressed

out the fact that even if they are a minority, some practitioners are also reluctant, and this can

have a strong influence on the public opinion. She deplored the lack of harmonization on the

European Vaccination schedule which could be a coherent message to send to the public.

Report: The state of vaccine confidence in the EU 2018

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HOPE Study Tour - DIGITAL HEALTH: Virtual Hospital in Helsinki

HOPE organises a Study Tour to Helsinki (Finland) on 24 and 25 September 2019 during the

Finnish EU-Presidency.

The theme is Virtual Hospital 2.0 which produces specialised medical care -related digital

healthcare services to citizens, patients and professionals. Virtual hospital is a joint project

between the university hospitals in Finland, and their population responsibility and catchment

area covers all Finns. Virtual hospital makes healthcare services available to all Finns

regardless of their place of residence and income level, thus improving the equality of citizens.

Digital services are especially well suited for monitoring the quality of life, symptoms and

lifestyle, and also for living with a long-term illness before and during treatment and in the

monitoring stage of the treatment. The services complement the traditional treatment

pathways.

Production and implementation of services:

• the Terveyskylä.fi ('Virtual village') service offering information, advice, self-care,

symptom navigators, digital treatment pathways, and tools for citizens, patients and

professionals. The service comprises various themed virtual houses, more than 20

houses and services are available for more than 30 groups of patients.

• Innovation farm: innovation workshops, piloting, artificial intelligence, IoT, and research

and the researcher's tools

• Development of services and changes in operation: development model, developer

network and centres of expertise.

The programme includes a site visit to the New Children's Hospital.

Finland is facing the same challenges as the rest of Europe: an ageing population, a dramatic

increase in the number of patients/citizens suffering from chronic diseases, and a rise in health

expenditure. Virtual hospital means that we are supporting an operational change in the health

sector instead of just digitalising old services or providing new services within the old service

framework.

Please find all information related to registration as well as the agenda here.