Mihály Kökény, M.D., M.P. Republic of Hungary 7 October 2004, Bad Gastein From national solidarity to European solidarity Values, principles and objectives in Europe - From national solidarity to European solidarity

 Dynamically growing economy : Average Growth Rate of 4,15% during and a Average Growth Rate of 4,15% during and a projected Average Growth Rate of 4% during projected Average Growth Rate of 4% during  Declining deficit: from 9,4% in 2002 to 5-5,3% in 2004  Stable political environment  Low wages, high productivity: unit labour costs are the second lowest, productivity is the second highest in Central-Europe Per capita public health expenditures (USD) in PPP: 911 (2003) Health expenditures, % of GDP: 7,1% (2003) Public health expenditures, % of GDP: 5,34% (2003) HUNGARY - IN FIGURES I.

 Traditionally poor, but improving mortality rates - average life expectancy at birth in 2002: males: years, females:76.56 years.  Number of hospitals: 175 (2003)  Hospital bed/10,000 pop.: 78,8 (2002)  GPs/100,000 population: 67,5 (2002) HUNGARY - IN FIGURES II.

 Strengths  Stable public health situation  Safety: social insurance covering entire population, uniformity of emergency & rescue services  High medical standards of services delivered  Modern legislative environment  Weaknesses  Inequalities in health and service provision  Salary/wage differentials  System of ‘gratitude money’  Significant deficit of comfort in services provided  Opportunities  High level healthcare provider within the EU  Threats  Changes hard to accept for public thinking SWOT-ANALYSIS – HUNGARY

 Promote economic and social cohesion further improve economic performance; further improve economic performance; eliminate regional disparities, social and health inequities; eliminate regional disparities, social and health inequities; ensure a high level of social protection, based on the European social model; ensure a high level of social protection, based on the European social model; improve the performance of the health care system; improve the performance of the health care system; provide better working conditions for health personnel; provide better working conditions for health personnel;  Health to be recognized as a value, investment, economic factor: as a pre-condition to a healthy population, healthy workforce and better economic competitiveness  Become winners of EU accession also in the health sector MAIN SOCIO-ECONOMIC OBJECTIVES IN HUNGARY

 Strengths  Stable political, economic and social environment  Strong, extensive and modern legal environment, both Community and national level  Large, well-performing internal market  Lisbon strategy as a main driving force  Long lasting traditions in solidarity, in respecting principles of the European social model  Existence of national social protection systems – diversity of experiences, pool of professional expertise  Application of the open method of co-ordination in the field of social protection  Health recognized as a value, investment, economic, competitiveness factor  Health care systems: operating health care systems, with existing infrastructures, high level of coverage, quality requirements defined, well trained health personnel  High level of medical training, and research  Gradually extending activities in the public health area SWOT ANALYSIS AT EU LEVEL 1.

 Weaknesses   Demographic ageing, high and increasing level of dependency   Low level of labour market participation   Relatively high unemployment rates   Not yet enough experience or knowledge of the overall impact of the operation of the internal market in health services SWOT ANALYSIS AT EU LEVEL 2.

 Opportunities  Developing an even larger European area with political stability, better economic performance and competitiveness, and social cohesion  Converging health policy objectives and strategic aims  Sharing fruits of economic development with the social and health sector, contribute to the further improvement of health status at EU level  Converging the level of health services  Implementing the Community public health action programme  A large pool of health capacities, professionals, expertise and best practices SWOT ANALYSIS AT EU LEVEL 3.

 Threats  Long-term prospects of financial sustainability of the European Social Model, with a view to the European demographic situation, rapid technology development, rising expectations of population as well as to challenges arising from enlargement SWOT ANALYSIS AT EU LEVEL 4.

 In view of the complexity of the situation, I would shortly touch upon some key challenges  Existing gaps due to differences in economic development  Economic and social cohesion  National responsibilities and the impacts of the operation of the internal market  Lisbon Strategy, modernising social protection MAIN CHALLENGES IN THE EU

 Differences in economic development among Member States – growing gaps as a result of enlargement, gaps among others in  economic performance  wage levels  technology development  health status  health system performance  improved chances for economic growth in the enlarged internal market ECONOMIC ENVIRONMENT

 Economic and social cohesion  efforts to carry on economic and social cohesion in the enlarged EU  Agenda 2007: concerted proposals to put health higher on the agenda of existing EU cohesion and structural funds for the financial period 2007 – 2013 chances for converging the level of health care across the EU ECONOMIC AND SOCIAL COHESION

 National responsibilities – versus community acquis regulating the operation of the internal market interference of the application of market rules with national systems ongoing initiatives by Member States to meet these complex challenges CHALLENGES OF THE INTERNAL MARKET 1

 Increased mobility of health personnel:  probable movement from new Member States to old ones  might result in shortages in providing states  further contribution to gaps in health services  would require new forms of co-operation among Member States to try to find common solutions  contributes to exchange of experiences, enhances professional convergence, creates specific links between national health systems CHALLENGES OF THE INTERNAL MARKET 2

 Social security co-ordination and related European Court of Justice jurisprudence  creates complex inter-relationship among national social security systems  people join different social security systems when moving within the European Economic Area join different solidarity based national schemes for shorter or longer periods, pay contributions or taxes there, receive benefits in cash or in kind, and leave it  the balance of individual social security schemes varies  already a kind of European solidarity exists through social security co-ordination accompanying the free movement of persons  European Health Card – easier trans-pass CHALLENGES OF THE INTERNAL MARKET 3

 increasing patient mobility induces complex processes to examine the situation and improve co-operation, in a number of areas, among others  cross-border health care experiences, possible solutions  creation of centres of reference  quality of care issues  patients’ safety, patient right issues  data protection  information needs  IT support inevitably generates certain convergence CHALLENGES OF THE INTERNAL MARKET 4

 Open method of co-ordination in health care and long-term care  Setting common objectives: solidarity, equity, sustainable financing  Elaborating national strategies Together with the patient mobility process might create a basis for  working towards common aims, in line with common principles,  improved co-operation among Member States  creation of a pool of expertise and best practices, including innovative methods and the use of Public-Private Partnership further impetus for convergence MODERNISING SOCIAL PROTECTION

 Extremely complex and difficult challenges  Complicated inter-related, iterative processes  Balance of a number of positive and negative impacts  Hopes:  better economic growth (also induced by enlargement)  sharing fruits of economic development with the social, health sector  efforts to close gaps, economic and social cohesion  efforts to raise employment rates  processes to converge the level of health services, modernise them and improve their effectiveness Might contribute to maintaining the high level of solidarity of the European social model. CONCLUSIONS

Let me finally share with you a Hungarian joke from the 1970s and 1980s. As early as 1972, the Health Act in Hungary specified that health care should be  accessible for each citizen  high level  free of charge. The cabaret joke stated that from among these three conditions not more than two can be met at the same time:  high level health care accessible for everyone cannot be free of charge,  high level health care, free of charge cannot be accessible for everyone  health care accessible for everyone cannot be free of charge. LESSONS FROM THE PAST …

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