1. MRosenmöller– magda@iese.edu Health Financing & Fiscal Sustainability European Experience with Health Insurance and Challenges for the Future Workshop on Health and Enlargement Gastein, 27 th September 2002 …..main points ….. Organised by World Bank in co-operation with European Observatory on Health Care Systems

2. MRosenmöller– magda@iese.eduEHFG 27 Sept 20022/9 Health Financing Experiences H World Bank Report on Expenditures towards Accession H Experiences H Baltic States H Poland H Croatia H German H EU Context H Future Challenges

3. MRosenmöller– magda@iese.eduEHFG 27 Sept 20023/9 “ Expenditures towards accession ” l Important Legacy l No analysis of choice of funding method »historical / neighbours l Social Health Insurance most important l Increase of health expenditures l No incentive contracting l No improvement of efficiency l Resource allocation

4. MRosenmöller– magda@iese.eduEHFG 27 Sept 20024/9 The Experiences: The Baltic States l Social Health Insurance - sustainable? l Cost Pressures – Court cases ? l Additional funding, user charges l Prioritising : choices on benefits, difficult l Pharmaceutical exp: reference pricing l Resource allocation: Needs assessment l Hospital Masterplan

5. MRosenmöller– magda@iese.eduEHFG 27 Sept 20025/9 The Experiences: Poland l Decentralisation – complete change - big challenges »Fights between the regions on competences »Disturbance of information systems »Management of actors and patient expectation l Evaluation difficult, innovation vs. anarchy l Roles at regional / central level

6. MRosenmöller– magda@iese.eduEHFG 27 Sept 20026/9 The Experiences : Croatia l An unfinished agenda in Southern Europe l Cost containment, continuous deficit l Provider payment systems – no incentives for efficiency and quality – cost containment measures l Reform initiatives: revenue base, supplementary insurance l The agenda: efficiency, target subsidies, monitoring, improve allocation

7. MRosenmöller– magda@iese.eduEHFG 27 Sept 20027/9 The Experiences: Germany l Reference for Central Eastern Europe l There is not ONE German system l Increased health expenditures, strongest growth: medical aids & dependency care l There is a willingness to pay (survey: increase contributions vs. reduction in benefits) l Shunts: shifts to other funds, cost control l Achilles heal: not the contribution based financing but institutional restrictions limit innovative management

8. MRosenmöller– magda@iese.eduEHFG 27 Sept 20028/9 The EU Context l Treaty obligation: public health & other areas l New Public Health programme l Health systems aspects »Information, benchmarking, quality, HTA, inequalities »Open coordination, Quality access and financial sustainability, Health Care and Care for the Elderly »Internal Market – Freedom of Movement l Health and Enlargement »YES - Studies, data, dissemination best practices, training (accountants) »NO – health system organisation – competence, societal choice

9. MRosenmöller– magda@iese.eduEHFG 27 Sept 20029/9 Future Challenges for Western Insurance Systems l Social Insurance - risk pooling and redistribution, traditional, slow development, institutional relationships l Funding base narrowing (informal economy in CEE) – future of solidarity ? l Change in health care provision – respond to change in demand (boundaries, multidisciplinary, integration) l Continuous education and quality of care l New role for social insurance - active purchasing

10. MRosenmöller– magda@iese.eduEHFG 27 Sept 200210/9 Upcoming Issues l UK attracting health professionals – CEE »Evidence? Lowering of standards? l Quality insurance - EBM difficult l Active purchasing, who does it? l Interesting experience from Japan l European values, eg. Inequalities, redistributive justice

11. MRosenmöller– magda@iese.eduEHFG 27 Sept 200211/9 Thank you for your attention and contributions to a very interesting discussion !! Have a nice evening !! MRosenmöller magda@iese.edu