1. Solange MENIVAL, Vice President in charge of Health, Social and Sanitary Careers Regional Council of Aquitaine, France 14th July 2011 Sevilla, Spain Analyse of the new models of management and health systems in Europe

2. Aquitaine Region

3. Context in France Decrease of GDP in 2009 of 2,9% Public deficit of 7,5% in 2009 Objective of Stability Programme - deficit reduction to 3% in 2013 Financial pressures of aging Decrease of medical demography Increase of hospitalisation (25% to avoid)

4. FrancePortugalUKSpainAverage of OECD Health spending / GDP 11,4% 10,1%9,8%9,5% Spending per person ($) 3978 2508348730873223 Public coverage 77,9% 65%84,1%73,6%71,7% Number of doctors /1000 hab 3,3 3,8 2,73,53,1 Number of nurses/1000 hab 8,2 8,4 4,9 Number of bed in hospitals / 1000 hab 3,5 2,82,72,53,5 Life expectancy 8179,580,4 81,8 79,5 Source: OECD Significant health spending

5. Economic growth FrancePortugalUKSpain Spending health growth over 10 years/GDP 12% (from 10,3% to 11,4%) 8,6% (from 9,3% to 10,1%) 40% (from 7% to 9,8%) 35% (from 7,2% to 9,5%) 2007/ 2009More 3,1%Constant More 8,8% More 4% Source: OECD

6. Monitoring action of the health spending Parliament sets every year National Target of Insurance Health Spending (3% in 2010) Control by action : decrease the reimbursement of primary care. Elimination of undertaking of some chronic illness

7. Willingness to evolve a hospital system based on Law « Hospital, Patinets, Health, territories » from 2009 Establishment of the Regional Health Agencies Launching of the Shared Medical Record. To develop of information system Support by the Shared Information System Agency (SISA or ASIP), implementation of reference et call projet (Aquitaine lead partner)

8. What orientations of the Regional Council of Aquitaine ? Collaboration with the Regional Digital Espace of Health (Télésanté) Establishment of the entreprise cluster «e-health» by the Regional Council of Aquitaine. 50% of the national workforces Political wilingness to joint actions and initiatives

9. Toward what objectives? Strengthen primary care Develop inter-operability Experiment the new compensation professionals Experiment with the delegation of tasks among health care providers Act on the work of Barbara Starfield: Access, Continuity, Coordination, Globality

10. Innovate from the regional perspective, seeing health spending as a territorial investment Develop of entreprises of new technologies : ex.Kilab et le Médoc Objectives : – better coordination between family doctors, nurses, paramedic – for patient > 60 years, at home – using secure internet and mobile technologies Today : 80 patients, 25 professionals Objective : 200 patients, 100 professionals

11. Conclusion and our convictions Focus the innovative and territoral technologies to permit the reorganisation in France Way to overcome the corporatist Issues will be stronger than the threats In a crisis, we must reverse the trend and turn threats into opportunities... entreprise strategy "territorial"

12. Thank you very much for your attention Regional Council of Aquitaine www.aquitaine.frwww.aquitaine.fr solange.menival@aquitaine.fr