AIM Association Internationale de la Mutualité Basic Healthcare Packages & European Healthcare Policies Czech Health Care Forum Biannual High Level Conference – 17 April 2009, Darova (CZ) Marcel J.G. Smeets Director-general Tel. +32 2 234 57 00 | [email protected]| www.aim-mutual.org
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Basic Healt h care Packages & European Healthcare Policies
Basic Healt h care Packages & European Healthcare Policies Czech Health Care Forum Biannual High Level Conference – 17 April 2009, Darova (CZ) Marcel J.G. Smeets Director-general Tel. +32 2 234 57 00 | [email protected] | www.aim-mutual.org. An international association - PowerPoint PPT Presentation
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International Co-operation European AffairsThematic groups
Working groupsLong term care
PharmaceuticalsCross border care
Healthcare Systems Disease Management
eHealth & Telemedicine
IssuesSocial Protection Social economy
Public Health Healthcare
LobbyEU Presidencies
Europepean statute for mutual benefit societies Patients´ rights directive Pharmaceutical package
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é Members´ classification
Healthcare
Social services
Bismarck Beveridge
Statutory
Voluntary
Payer
Provider
Free choice members
Limited choice membersIn-kind services
Re-imbursement
Developing countries
Developed countries
Insurance
Provision
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é Classification of members
Healthcare
Social services
Bismarck Beveridge
Compulsory
Voluntary
Payer
Provider
Free choice members
Limited choice membersIn-kind services
Re-imbursement
Developing countries
Developed countries
Insurance
Provision
AIM
Ass
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nte
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ion
ale
de
la M
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alit
é Classification of members
Healthcare
Social services
Bismarck Beveridge
Compulsory
Voluntary
Payer
Provider
Free choice members
Limited choice membersIn-kind services
Re-imbursement
Developing countries
Developed countries
Insurance
Provision
AIM
Ass
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atio
n I
nte
rnat
ion
ale
de
la M
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é Classification of members
Healthcare
Social services
Bismarck Beveridge
Compulsory
Voluntary
Payer
Provider
Free choice members
Limited choice membersIn-kind services
Re-imbursement
Developing countries
Developed countries
Insurance
Provision
AIM
Ass
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de
la M
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3 models of healthcare financing in Europe
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Ass
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é Beveridge
Tax-based
Government driven
Public provision
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é Bismarck
Insurance-based
Employers & Employees
Public-private mix
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Ass
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la M
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éShemasko
Government-driven
Planning & Control
AIM
Ass
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la M
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é CompulsoryImplication of mutual healthcare funds
AIM
Ass
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é CompulsoryComplementary Implication of mutual
healthcare funds
AIM
Ass
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é CompulsoryComplementarySupplementary
Implication of mutual healthcare funds
AIM
Ass
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é CompulsoryComplementarySupplementaryDuplicative
Implication of mutual healthcare funds
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é What´s the problem in EU healthcare?
AIM
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Increased patient responsability Privatisation and commercialisation Focus on cost-efficiency Development of ICT Cost-control in pharmaceuticals Growing need of healthcare
professionals
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é Increased patient responsability
Financially• Co-payments and out-of-pocket• Deductibles and penalties
Life style• Habits and follow-up• Prevention
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Healthcare as a market Patient as a consumer Standardisation and competition
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é Focus on cost-efficiency
Financing based on pathology Pay for performance Gatekeeping Fading concepts of in- and out-
patient Concentration of funding
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éDevelopment of ICT
Electronic Medical Records Ownership and sharing information Integrated and Continuous care Business case
Focus on generic medicines Rating systems (NL = « Preference
policy ») Re-assessment of marketing and
refund policies
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é Growing need of healthcare professionals
Ageing « Feminisation » sector Geographical distribution Education and numerus clausus Mobility and braindrain
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é Changing Healthcare Settings
From « cure » to « care » From « instant » to « constant » From « treatment » to « prevention » From « institution » to « person » From « process » to « induvidu » From « come » to « get »
AIM
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é The New Role of Healthcare Mutuals
Payer and Provider
Director of care
Pay office
Engagement in healthcare management
Stee
ring
capa
city
Director of healthcare
Payer and provider
AIM
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éFuture challanges
Sustainability, solidarity and equity Transparency and information Productivity and performance Prevention and education Quality improvement
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é Basic Healthcare Packages
3 dimensions• Who is covered (persons)• What is covered (products & services)• How is it covered (financing)
How to evaluate How to decide
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Who?
What ?
How ?
Courtesy to Prof.Dr R. Busse
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Who?
What ?
How ?
What ?• New techologies• Political choices
Who? Universalsation
How
? P
rivatisation
Courtesy to Prof.Dr R. Busse
AIM
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Discussions started in 1980´s• New/rare diseases (UK, Scandinavia)• Waiting lists (NO, NL, UK)• System reforms (NL, IL)
2 approaches• Developing principles (NL, NO, SE, DK)• Recommend concrete services (UK, IL)