Policy context - EU level cooperation

European Commission, DG Health and Food Safety

Sylvain Giraud,

19 September 2018

To set the scene for today's discussion

• The Commission role in supporting the reforms of national

health systems

• EU Structural funds and Health

• The digitalisation of health and care

Supporting the reforms of national health systems

EU level

• Similar challenges – shared values and objectives• A common policy framework• Knowledge brokering – State of health in the EU• Coordination of economic policy – the European Semester• Cooperation mutual learning and EU support tools

Health systems across the EU need to adapt confronted with many challenges

• Ageing population: longer life expectancy but not "healthy life years"

• Burden of chronic diseases; lifestyle related and often preventable

• Higher expectations for patient-centred, effective and safe care

• Rapid development of new technologies; often costly• Greater movement of people (patients but also health

workforce)• Pressure on public expenditure.

Shared policy objectives follow the 2014 Commission Communication on:

EFFECTIVE,

RESILIENT health systems

ACCESSIBLE &

Principle 16Everyone has the right to timely access to affordable, preventive and curative health

care of good quality

• Building upon art 35 of the EU Charter of fundamental rights

• Access to good quality preventive health care and medical treatment is recognised as a fundamental

• principles in many national health systems in the EU

• Social scoreboard: indicators to monitor progress on the Pillar Principles

• Action at EU level (Cooperation, Legislation, Semester) and national level

WHAT IS THE "STATE OF HEALTH IN THE EU" CYCLE?

A concise package of factual, high-quality evidence

A two-year cycle at the service of policy makers, stakeholders and practitioners

In partnership with the OECD and EU Observatory for Health

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November 2016 November 2017 November 2017 First half of 2018

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The Country Health Profiles

1. Highlights

2. Health status

3. Risk Factors

4. Health System (description)

5. Performance of Health

System

5.1 Effectiveness

5.2 Accessibility

5.3 Resilience

6. Key Findings

5 takeaways from 28 healthcare systems

1. Focus on health promotion and disease prevention.

2. Step up primary care, to avoid unnecessary hospital admissions.

3. Provide incentives for health service providers to work together more effectively through integrated care.

4. Improve health workforce planning and forecasting, to address current and future challenges.

5. Invest in patient-centred data on health outcomes to increase knowledge.

Coordination of economic policy

The European Semester

EUROPEAN SEMESTER 2018

Public expenditure on health account to about 8% of GDP and 15% of all public expenditure

Health insurance and

healthcare support social

safety nets and active inclusion

strategies

Health of the population is a

productive factor

Health is an economic

sector providing

growth and jobs

CSRs 2018 (adopted 23 May)

• 12 MSs with health-related CSRs in 2018

• Consistency with policy principles

• Continuity : long-term and challenging nature of structural reforms of national health systems

• Focus on cost effectiveness and quality, sustainability and accessibility (coverage)

The Commission recommends

• Implementation of agreed reforms for better cost-effectiveness and accessibility of care in Cyprus, Slovenia and Finland.

• Improving fiscal sustainability and cost-effectivenessof health system in Austria, Malta Portugal and Ireland

• Investing in disease prevention in Lithuania

• Attention to workforce planning in Bulgaria and Slovakia.

• Reducing high out-of-pocket payments for patients in Bulgaria and Latvia

• Strengthening primary and outpatient care in Latvia, Lithuania and Romania.

Cooperation mutual learning EU support tools

The role of the European Union: A policy agenda for health systems

EU funds' investment in Health

• Overall analysis of the investments financed by ESIF in health

• Internal work with other services to channel ESIF support to health

• Support to Member States' health authorities to channel ESIF support to health

• The next MFF - post 2020

Overall analysis of the investments financed

by ESIF in health

in 2014-2020 more than 40 million people are expected to benefit from improved health services (Cohesion Data

Portal estimations)

ESIF Thematic Objectives

Research and InnovationClimate change adaptation,

risk prevention

ICT, incl.e-health

Competitiveness of SMEs

Low carbon economy

Environmental protection

and resource efficiency

Sustainable transport

Better public

administration

Education, training

and LLL

Social Inclusion,

incl.access to healthcare

Employment and mobility,

incl. AHA

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Internal work with other services to channel ESIF

support to health

Since the beginning of the preparations of the current

programming period (2009-2010) DG SANTE has been

involved in intra-Commission work with other services

(DG REGIO and DG EMPL) to channel ESIF support to

health

Internal work with other services to channel ESIF

support to health

• Commission Guide on ESIF support to health 2014-2020 providing policy

guidance for key priority areas of investment in health, pointing at suggested

lines of intervention eligible under the ESIF thematic objectives

• Ex Ante Conditionality ("ExAC") for health

setting requirements related to policy and strategic frameworks, regulatory

frameworks and administrative and institutional capacity that MS must fulfil to

be able to reactive fundings

• Mapping of the planned use of ESIF in health for the period 2014-2020

providing an overview of actions that Member States foresee supporting in

the field of health with ESIF

Access

➢ Addressing health inequalities between geographical areas and between social groups, in particular by ensuring access to healthcare;

➢ Supporting investments in health infrastructure and in new technologies (e-health) if they contribute to increased cost-efficiency and better access to care;

Healthy ageing

➢ Support the development of new ICT based solutions and services to address the needs of an ageing population and empower users to use them to remain active and independent for longer.

Health promotion & disease prevention

➢ Promote health promotion and early intervention programmes for people from groups with increased vulnerability for mental disorders;

➢ Strengthen ambulatory services and primary care, while increasing care coordination, to reduce unnecessary visits to specialists/hospitals, including via prevention and monitoring including telemedicine and telecare solutions.

Available at: http://ec.europa.eu/health/health_structural_funds/docs/esif_guide_en.pdf

Commission guideon health investments through ESIF

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Support to Member States' health authorities to

channel ESIF support to health

1rst project (2013-2015)

aimed to provide assistance to relevant authorities in EU Member States inthe programming period 2014-2020 and support effective implementationof ESIF actions in the health sector

Outputs:

• Mapping of the planned use of ESIF in health for the period 2014-2020

• series of practical tools and guidelines,

• practical support through visits to 12 countries

• 2 thematic workshops

Project outputs

➢ Guide for effective investments in health under ESIF

➢ Technical toolkit

➢ Dissemination 1 – ‘Roll-out’ to MS

➢ Dissemination 2 – Website

➢ Mapping Report on the use of ESIF in health

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"Effective use of ESIF for health investments in the programming period 2014-2020"

"Effective use of European Structural and Investment Funds for health investments in the programming period 2014-2020"

http://esifforhealth.eu/Mapping_report.htm

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Scope of investments 2007-2013:

- Health infrastructure

- Health promotion and disease prevention

- Education of medical staff

- E-health

- Medical R&D

- Public administration and health services

- Workplace health & safety

- Health tourism

Overview of the Mapping results

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Scope of investments 2014-2020:

- Deinstitutionalisation and community-based care

- Active and Healthy Ageing

- Improving access & quality of health care services

- Health promotion and disease prevention

- Education of medical staff

- E-health

- Medical R&D

- Public administration and health services

- Workplace health & safety

- Health tourism

- Risk prevention and disaster preparedness

Support to Member States' health authorities to

channel ESIF support to health

2nd project (ongoing 2016-2018)

➢Objective: to further develop capacities of the relevant actors inEU Member States and regions to support the effective andconsistent implementation of ESIF for health, to supportcapacity buildings in Member States through knowledge sharing,developing and promoting exchange of information and goodpractices among interested Member States

Outputs of 2nd project

▪ Thematic mapping ▪ Inventory of projects▪ Geographic mapping: 28 Country fact-sheets▪ Series of workshops▪ Overall analysis of ESIF support to health investments

MultiannualFinancial Framework 2021-2027

A BUDGET FOR EUROPE'S PRIORITIES

Simplification, transparency and flexibility

Source: European Commission

RESEARCH, INNOVATION and DIGITAL

1.3%

❑ Building on the success of

the EU’s past flagship

research and innovation

programmes, the

Commission proposes to

increase investment in

research-innovation and

digital by allocating €118.3

billion for the future MFF.

Source: European Commission

❑ The Commission proposes to create a new Digital Europe

programme with an overall budget of €9.2 billion to shape and

support the digital transformation of Europe’s society and economy.

Examples:

• Artificial intelligence

• Super-computing

• Investing in Europeans' digital skill

• Developing very high capacity digital networks

• Joining forces against cyberattacks

❑ The digital strand of the Connecting Europe Facility has a budget of

€3 billion which will finance digital connectivity infrastructure.

DIGITAL TRANSFORMATION

Source: European Commission

Inside the EU

INVESTMENT Streamlining tools to promote investment: InvestEU Fund

REGIONAL DEVELOPMENT AND COHESION

❑ A strengthened link with the European Semester

❑ A simplified framework and less red tape for the beneficiaries

of the funds

❑ A more tailored approach to regional development

Source: European Commission

STRONGER LINK WITH THE EUROPEAN SEMESTER OF ECONOMIC POLICY COORDINATION

coordination and

complementarity of financing

from cohesion policy funds

and the new Reform Support

Programme

roadmap for the short,

mid- and long-term

planning and monitoring

of investments

technical and financial

support for reforms at

national level

Cohesion Policy objectives

▪PO 1: a smarter Europe…▪PO 2: a greener Europe…▪PO 3: a more connected Europe...▪PO 4: a more social Europe…▪PO 5: a Europe closer to citizens…

▪ All ESF+ specific objectives fall under PO 4 : “a more social Europe, implementing the European Pillar of Social Rights”

▪ Investments in health and long-term care may be envisaged both under PO1 and PO4.

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ERDF to support investment in health and in particular

(…) ensuring equal access to health care through developing infrastructure,

including primary care(…)

The ESF+ components

Total Budget: €101 174 000 000

Investment for Jobs and Growth: €100 000 000 000 of which- Transnational cooperation €200 000 000- Outermost regions: €400 000 000

Employment and social Innovation and Health strands: € 1 174 000 000- EaSI €761 000 000- Health €413 000 000

Specific objectives of the ESF+

EU Pillar of Social

Rights

(i) improving access to employment(ii) modernising labour market(iii) Promoting women’s labour market participation, work/life balance, childcare, working environment, adaptation to change, active and healthy ageing(iv) Improving quality of education and training systems(v) Promoting equal access to education and training and lifelong learning, (vi) active inclusion (vii) integration of third country nationals and marginalised

communities e.g. Roma; (ix) access to services; social protection healthcare systems and

long term care

(x) people at risk of poverty including / most deprived and children;(xi) addressing material deprivation

yy) Health promotion

Horizontal principles

Gender equality

Equal opps

Non discrimination

Contribution to "Smarter Europe"“Greener Europe”

Structural funds to support• reforms of health systems

• improving accessibility, effectiveness and resilience of healthcare systems

• equal access to affordable, accessible, sustainable and high-quality healthcare with a view to reducing health inequalities

• Investment strategies, which consider together human capital needs, innovative technologies and new care delivery models

– strengthened primary care;

– integration of care; transition from residential care to independent living community-based services

– patient empowerment structures and new patient pathways;

– planning and training of of the health workforce;

– increased capacity to measure quality and outcomes

– Health promotion and disease prevention

Structural funds to support

Increase access to e-health tools for data sharing, support to health decision and monitoring of outcome, and e-services to promote e-inclusion

Possibilities for investing in digital health infrastructure

• ESF+ / health strand

• Connecting Europe Facility

• Digital Europe Programme

• European Regional Development Fund (ERDF

• InvestEU Programme

Commission Communication of 25 April3 Priority areas on digitising Health and Care

• Progressive exchange of e-prescriptions and patient summaries

across EU Member States

• Increased interoperability of Electronic Health Records

• Commission Recommendation on exchange format for EHR

Pillar 1:

Citizens' access and sharing of their data

• Decentralised European Infrastructure to federate access to health data

• Voluntary participation of Member states

• 1 Mio genomes Declaration signed by 16 Member States

• Pilot actions for rare and infectious diseases, and real world data

Connected health data to advance research, prevention and personalized health and care

Pillar 2:

• Facilitate the wide deployment of digitally-enabled services

• Promote common principles for validating and certifying health technology

• Capacity building and technical assistance for health authorities

• Mobilising investment to support large-scale implementation of digitally enabled,

integrated, person-centred care models

Digital tools to foster citizen empowerment and person-centred care

Pillar 3:

Cooperation on eHealth

Article 14 of Directive2011/24/EU

Support and co-operation and exchange ofinformation amongst Member States within a

voluntary network connecting national authorities for eHealth

Cooperation on eHealthArticle 14 of Directive 2011/24/EUObjectives

– Delivering sustainable economic and social benefits of European eHealth systems and services and interoperable applications,

– Achieve high level of trust and security, enhancing continuity of care and ensuring access to safe and high-quality healthcare

– Draw up guidelines on data included in patients’ summaries and effective methods for medical data in public health and research

– Common identification and authentication measure to facilitatetransferability of data in cross-border healthcare

eHealth Network

• eHealth Network was set up pursuant to Article 14.3– Implementing Decision 2011/890/EU of 22 December

2011 providing the rules for the establishment, the management and the functioning of the eHealth Network

• All Member States decided to join, as well as Norway• Meets twice a year• Multi-annual work programme running for 3 years

– The one for the period 2018-21 adopted in November 2017

– Supported by Joint Actions (currently the 3rd)

DeliveredGuidelines

• Patient summary guideline

• ePrescriptions guideline

• Organisational framework of eHealth National Contact

Points

• Governance model for eHealth Digital Service

Infrastructure

• How to assess Member States‘ readyness to go live

Works on– Technical, semantical and legal interoperability of heath data– Setting up the eHealth Digital Service Infrastructure

Achievementsof the eHealth Network

Setting up the eHealth DSI

A digital service infrastructure connectinghealthcare providers across Member States

– Enabling health data exchange between service providers

– Implementing the guidelines adopted by eHealth Network

– Voluntary cooperation like the eHealth Network