. 1/22 Chances of a European social model and sustainable development Dr. Gyula Kincses Ministry of Health, Social and Family Affairs

. 2/22 Basic trends characterising 21st century societies Extension of life, transformation of society’s age structure ; - ageing of the population, - shift in the rate of the economically active and passive Harmonisation of certain diseases with life, thereby increasing the proportion of people living with diseases and disabilities; Increasing demand to improve the quality of life for people with disabilities; Expected leaps in the development of medicine and medical technology (genetic engineering, biotechnology).

. 3/22 Common concerns Tendencies of health care (EU regulation) – technological development – proper prevention, improvement of lifestyle, reduction of adverse environmental effects improve quality of life, though increase expenditures. Social-economic polarisation increases, inequalities are not reduced. Welfare systems left to national regulation cannot follow the free movement of persons and services.

. 4/22 Expected change of age structure in EU states Source: EUROSTAT and ILO

. 5/22 Common principles Operation of the social sphere is based on social care and this – underlies the responsibility of particular states – necessitates extension of Community regulation to this area (first as recommendations, Open Forum etc.). – maintains the priority of public financing in the funding of welfare systems The fundamental goal of the system lies in improving the quality of life, fairness and equity. Value placed on the issue of care beside ensuring medical treatment and financial services. Value placed on the concept of efficiency due to limited resources.

. 6/22 Added problems of accession (CEE) countries Low GDP/capita Poor health status The problems arising from the change of age structure is becoming acute, making quicker impact on countries. (The number of children is already low, but the ageing of the population will follow only afterwards due to improvement in mortality relations.) Looking at subsistence level from a European perspective, large proportions of the societies are poor and owing to cultural differences poverty is bound to stay for the long term. Due to inherited traditions social expectations are exaggerated, the culture of self-care is low.

. 7/22 Demographic data per 1000 population Source: Demographic Yearbook

. 8/22 Demographic data per 1000 population Source: KSH STADAT

. 9/22 Basic problem of health care Economic growth cannot keep up with the cost of the technological and scientific development of health care Cause: the development of technology and science is exponential, whereas the development of economy is linear at best Consequence: conflict of the „technologically possible  economically affordable”

. 10/22 Causes of increase in health care expenditures Increase of general life-expectancy, change in the age-mix of the population, increase of the rate of persons living with disability and permanent health impairment (increase of demand); Increasing value of health, increasing social safety, expansion of needs of care (increase of needs); Development of medical science and technology (increase of treatment possibilities); Development of health technology does not redeem labour force, thus technological development has the result of increasing costs.

. 11/22 Basic challenge of welfare systems The task is not simple: How to solve the problem of securing - sustainability, - fairness, - traceability of quality and technological development.

. 12/22 The balance of the vectors of health care service Financing capacity (sustainability) Access (equity) Quality/ innovation Axes On the basis of Dr. András Jávor’s work

. 13/22 The balance of the vectors of health care service II. Financing capacity Access (equity) Quality/ innovation The situation of balance On the basis of Dr. András Jávor’s work

. 14/22 The balance of vectors of the health care service III. Financing capacity Access (equity) Quality/ innovation The effect of maximization I. On the basis of Dr. András Jávor’s work

. 15/22 The balance of vectors of the health care service IV. Financing capacity Access (equity) Quality/ innovation The effect of maximization II. On the basis of Dr. András Jávor’s work

. 16/22 The balance of vectors of the health care service V. Financing capacity Access (equity) Quality/ innovation The effect of maximization III. On the basis of Dr. András Jávor’s work

. 17/22 Characteristics of health systems in EU countries Due to historical reasons the health systems show great variation across EU member states, and can be classified with difficulties even according to main groups. In the same way there are great differences in the reimbursement systems of services and there is no unified price system. Differences in expenditures are considerable. The solution conceived in the case of pension system does not work in health care, thus the current situation makes the free movement of persons and services quite difficult, that is, it runs counter to the basic principles.

. 18/22 Public health expenditures as a percentage of GDP %

. 19/22 Necessary changes The welfare and public service systems did not follow the changes of social, demographic and professional environment. Decision must be made whether we adhere – to our basic principles and ideas or – to our habits and acquired rights. Necessary changes: - placing value on self-care - strengthening of health savings against the exlusive pay-as-you-go systems.

. 20/22 Revaluation of social care Social care is gaining value, but requires new approaches – beside the unchanged need of solidarity subsidiarity also appears – instead of equality it builds on fairness and equality of chances – public care is exchanged for public service and assisted self-care New elements – strengthening of the institutes of health savings, – integration of social and health care, – restructuring of private health care financing.

. 21/22 Summary I. The integration and mutual strengthening of welfare systems may be the engine of the internal cohesion of EU. In the restructuring process the common perspectives of fairness and efficiency must be kept in mind. The common problem of social system lies in financing capacity and sustainability, which can be reached only by the improvement of efficiency and the strengthening of self-care (health savings). Social care and self-care must not conflict, but a co- operative, synergist system must be established.

. 22/22 In the interest of the above special attention must be given to: integration of the service and financing systems of health care, ensuring free passage between them, restructuring the system, systematisation of self-care elements (health savings), solution of the problems of care in an organised, mixed financing system, tackling poverty, primarily in the accession countries, with the introduction of complex community support programmes. Summary II.