Impact of Global processes on European health systems by Göran Tomson Div of Global Health (IHCAR), Medical Management Centre (MMC) Karolinska Institutet, Sweden

”It really boils down to this: that all life is interrelated. We are all caught in an inescapable network of mutuality, tied into a single garment of destiny. Whatever affects one directly, affects all indirectly” Martin Luther King Jr.

”organisations, people and actions whose primary intent is to promote, restore or maintain health” - the performance is best measured by the impact on the health outcomes [WHO, 2007]

WHO 2007: Everybody's’ Business. Strengthening health systems to improve health outcomes

Primary health care serves as a guide for the development of diverse health systems based on its principles and values.

Performance should not only be measured in delivery of service, but also across all components:  Stewardship  Financing and the work force  as well as:  Leadership  Institutions  Systems design  Technologies [Frenk, 2010]

Core ideals of the European health care systems: High quality services Responsiveness Efficiency Universal access Main sources of funding: Taxation, social health insurance, voluntary insurances and out-of-pocket.

[ WHO 2006 ]

(WHO 2009)

Demographic and epidemiological challenges Changes in lifestyle; ”microbial traffic” Ideas, innovations

The importance to think and act both on a global and local level

Patient mobility and medical tourism ’temporary visitors abroad’; ’long-term residents’; ’retirement migration’; ’common border residents’ Health workforce migration International migration has increased Shortages in health workforce Innovation and IT Mobile phones and broadband access, Innovative developing countries (IDCs)

Globalisation - an erosion of power within the nation states European values solidarity, equity and human rights with respect to health and health care Ensure that the European values of universal coverage remain equitable in providing good, quality health care

Commercialisation of health care Health care should be seen as a social and public responsibility and not be dependent on ability to pay Health workforce policies Efforts needed to monitor trends and patterns of health worker migrations Technological developments create vast opportunities

The good leader and systems-thinker Important to meet the challenges of health systems design and performance Value-driven policy, social justice, equity, responsiveness Ability to assess good results beyond efficiency and cost savings Balance globalization & privatization also ensuring a health system grounded in public sector A foresight capacity and vision

The empowered patient Self-diagnosis and treatment at home Comparison of health services across borders Informed and demanding consumers Disparities are likely to increase unless measures are taken to avoid exclusion of those with few resources

Benchmarking performance Better systems needed to assess performance Still a lack of a robust evidence base in many health systems Strong institutions needed to gather all available information Opportunities: International comparison possible, increased access of information and communication

New world view based on global responsibilities, interdependence and partnership. Step up the policy dialogue on health systems Ensure social and financial risk protection Improve efficiency and equitability Develop policies concerning the international migration of health workforce Take advantage of social and technological innovations Contribute to improved global health

 Alliance for Health Policy and Systems Research  CADTH: Rx for Change Database  Eldis  Evidence-Informed Policy Network (EVIPNet)  EVIPNet Portal  health-evidence.ca  Health Evidence Network (HEN)  HealthPolicyMonitor – in association with The European Observatory  on Health Systems and Policies  Health Systems Evidence  Human Resources for Health (HRH) Global Resource Center  The Cochrane Library