Brussels, 21 February 2013 Innovating Public Health Policy in times of the financial & economic crisis in the WHO European Region Hans Kluge Director, Health Systems and Public Health
The WHO policy Health 2020 and instruments Main health system policy responses WHO work with Member States in response to the crisis
WHO Health Policy Framework Health 2020 Investing in health through a life-course approach and empowering people Tackling Europe s major health challenges of NCDs and communicable diseases Strengthening people centered health systems Creating resilient communities and supportive environments Universal health coverage is the basis for action in these four priority areas
Tallinn Charter: Strengthening health systems noone should become poor due to ill health
What is Universal Health Coverage? All people have access to needed health services (incl. prevention, promotion, treatment & rehabilitation) of sufficient quality The use of services does not expose any user (or his/her family members) to undue financial hardship
The health effects of financial & economic crisis Main health system policy responses Messages for policy makers
Policy responses up to end 2010 LOWER INPUT PRICES to cut costs, particularly in spending on hospital services and pharmaceuticals, by negotiating lower prices and switching to generic medicines Health personnel SALARIES were reduced, frozen, or the rate of increase reduced. In some cases these were acrossthe-board cuts, in other cases targeted
Protecting public spending for health during the crisis: some options 1. Those who accumulated savings have room to maneuver 2. Those who balanced the budget and reduced government debts during the years of economic growth can opt for deficit financing 3. Those who failed to do the above are in a more vulnerable position when the crisis hits, but can still avoid adverse effects on health and equity by giving higher priority to health It is a matter of choice in public policy and can have a direct effect on UHC
Health systems are important in mitigating the effects of the crisis Further deep cuts in health sector spending in coming years, may force staffing levels to be further reviewed Boosting employment is a high policy priority within EU at present Within EU27, the health sector accounts for approx 10% GDP - more than financial services or retail sector. Significant employment impact
The health effects of financial & economic crisis Main health system policy responses WHO s main work with member states in response to the crisis
Analytical work to update and synthesize the evidence (for example on out-of-pocket spending) Azerbaijan 70,00 Georgia Tajikistan Albania 60,00 Armenia Out-of-pocket as % total health spending 50,00 Moldova Uzbekistan Bulgaria 40,00 30,00 20,00 10,00 Kazakhstan Latvia Serbia Russian Federation Malta Slovakia Israel Lithuania Hungary Portugal Romania Poland Estonia Spain Turkey Czech Republic Slovenia Iceland Ireland Switzerland Belgium Sweden Germany United Kingdom France Denmark Netherlands 19 mn people face catastrophic and 7 mn people face impoverishing expenditures Influenced by a number of factors including health financing policy Norway R² = 0,707 0,00 0,00 1.000,00 2.000,00 3.000,00 4.000,00 5.000,00 6.000,00 Government health spending per capita int $ Source: WHO estimates for 2010, countries with population > 600,000
Close engagement with Member States Health System Responses to the Financial Crisis in Ireland: Options and Responses in a European Context 2012, Dublin, Ireland Health and Social Values in times of financial crisis at the FT-hosted event Shaping the Future of Healthcare in Greece 2012, Athens, Greece
Continual focus on improving efficiency Eliminate ineffective and inappropriate services Improve rational use of medicines Allocate more to public health, primary and outpatient specialist care at the expense of hospital care Invest in infrastructure that is less costly to run invest to save Cut the volume of least cost-effective services
People die from preventable and treatable diseases (mostly cardiovascular in productive ages) 100% 90% 80% 70% 60% Deaths 50% 40% 30% 20% 10% 0% European Region EU-15 EU-12 CIS Country groups Circulatory system Malignant neoplasms External causes Infectious disease Respiratory system Other causes
Policy dialogue and knowledge brokering - closer cooperation between health and finance Ministries OECD /WHO Joint Meeting on Financial Sustainability of Health Systems 2012, Tallinn, Estonia
WHO High-Level Technical Meeting Health systems in times of global economic crisis: an update of the situation in the WHO European Region 17-18, April, 2013 Oslo, Norway WHO working closely with European Observatory on Health Systems & Policies generating evidence of impact on health systems, health, and policy responses Bringing together health and fiscal policy makers from across European Region. Multilateral organisations also. Recommendations to be tabled at Regional Committee 63 in September 2013
Timeline of key WHO Europe activities for 2013 Ministerial conference on NCDs Ashgabat Dec 5 th Anniversary of Tallinn Charter Oct 35 th Anniversary of Alma-Ata Nov Oslo Conference on health systems in times of global economic crisis April