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The impact of global processes on health systems in Europe

Brief analytical summaries or syntheses #11 The impact of global processes on health systems in Europe Summary The relationship between globalization and health systems is a complex one, where both positive and negative influences are reported. This unsystematic literature review explores the impact of globalization on European health systems and emphasizes the need for national policy-makers and leaders to consider global processes when designing national health systems. Background The world is changing rapidly with increasing life expectancies and improving child survival rates. Globalization has contributed to economic growth. In addition to global economic integration, globalization entails the mobility of capital, goods, services and labour, and can be said to be part of an ideological process justifying neo-liberal economic policies. Globalization is also a dynamic process of global interconnectedness influenced by a number of driving and constraining forces such as technological developments, political influences, economic pressures, changing ideas, and greater awareness…

Re-orienting health systems : Towards modern, responsive and sustainable health promoting systems

Brief analytical summaries or syntheses #55 Re-orienting health systems Towards modern, responsive and sustainable health promoting systems Summary This position paper from EuroHealthNet is the culmination of a policy dialogue process with stakeholders, experts and European Union (EU) institutions to identify key contributions to sustainable health systems across Europe. The paper frames its findings in the context of the EU 2020 Europe strategy for continental growth. Background The sustainability of national health systems is a core concern of the European Member States, the European Commission, and the World Health Organisation. As early as 2001, the European Commission identified ‘financial viability’ as one of three long-term objectives for national health systems, along with accessibility and quality. Since then, the development of high-quality, accessible and sustainable services has been in the spotlight of different EU policy agendas social protection, public health, and economic and financial affairs. Initially, the issue was incorporated in…

Europe - Europe paying a heavy price for chronic diseases, finds new OECD-EC report

Better public health and prevention policies as well as more effective health care could save hundreds of thousands of lives and billions of euros each year in Europe, according to a new joint OECD/European Commission report. Besides the loss of lives and the human tragedy that this always entails, Health at a Glance: Europe 2016 estimates that the premature deaths of 550,000 working age people across European Union countries from chronic diseases, including heart attacks, strokes, diabetes and cancer, cost EU economies EUR 115 billion or 0.8% of GDP annually.

Health policy responses to the financial crisis in Europe

Brief analytical summaries or syntheses #47 Health policy responses to the financial crisis in Europe Summary This August 2012 report by the Health Evidence Network (HEN) identifies key challenges for European health policy makers in the wake of the ongoing financial crisis. The report focuses on responses to essential service cuts and interruptions in revenue streams, as well as on inefficiencies and exacerbations of adverse effects evident in national health systems. Background The global financial crisis that began in 2007 can be classified as a health system shock – that is, an unexpected occurrence originating outside the health system that has a large negative effect on the availability of health system resources or a large positive effect on the demand for health services. Economic shocks present policy-makers with three main challenges Health systems require predictable sources of revenue with which to plan investment, determine budgets and purchase goods and services.…

Europe - Building European reference networks in health care. Exploring concepts and national practices in the European Union

Under the European Directive on the application of patients’ rights in cross-border health care, the development of European reference networks was promoted as one of the prime areas for cross-border cooperation among Member States. These networks are meant to improve access to and provision of high-quality specialized health care to those patients who need it, and to act as focal points for medical training and research, information dissemination and evaluation, especially for rare diseases. This book examines the ways in which reference networks have developed in European countries, for what kind of medical conditions or interventions, the motivations behind their establishment, the regulatory and administrative processes involved, and the financial arrangements needed.

Governance for health in the 21st century : a study conducted for the WHO Regional Office for Europe

Brief analytical summaries or syntheses #27 Governance for health in the 21st century a study conducted for the WHO Regional Office for Europe Summary The WHO Regional Office for Europe recently presented conclusions from an in-depth study of current thinking and innovative practices in governance for health in the 21st century. The study recommends different ways that public authorities can strengthen health governance through collaboration. Background In this study, ‘governance for health’ is defined as the attempts of governments or other actors to steer communities, countries or groups of countries in the pursuit of health as integral to well-being through both a ‘whole-of-government’ and a ‘whole-of-society’ approach. It positions health and well-being as key features of what constitutes a successful society and a vibrant economy in the 21st century and grounds policies and approaches in values such as human rights and equity. Governance for health promotes joint action of health…

Europe — Launch of a two-year process that will shape Health 2020, the new European policy for health

In Andorra, the first meeting of the European Health Policy Forum of High-level Government Officials opened on 9 March 2011, to launch a two-year process that will shape Health 2020, the new European policy for health. Four working papers have been submitted for discussions: Developing the new European policy for health – Health 2020, Interim report on implementation of the Tallinn Charter, Strengthening Public Health Capacities and Services in Europe: A Framework for Action, and Assessing System Performance for Health Governance.

Europe - Special report on Healthy Cities in Europe launched

The Regional Office for Europe of the WHO published this special supplement to look at intersectoral governance for health and equity in European cities. It presents a collection of critical analyses and reflections that build on a five-year evaluation process incorporating data from 99 cities across the WHO European Region.

Europe - New policy briefs published for the Belgian European Union Presidency Ministerial Conference on the European Health Workforce

Two joint Health Evidence Network - European Observatory on Health Systems and Policies policy briefs and two policy summaries were prepared for the Belgian EU Presidency Ministerial Conference on ‘Investing in Europe’s health workforce of tomorrow: scope for innovation and collaboration’ (La Hulpe, September 9–10 2010): How to create conditions for adapting physicians’ skills to new needs and lifelong learning, how to create an attractive and supportive working environment for health professionals, assessing future health workforce needs, and using audit and feedback to health professionals to improve the quality and safety of health care.

Europe - Health professional mobility and health systems. Evidence from 17 European countries

Published in the journal European Observatory on Health Systems and Policies, this study presents research conducted within the framework of the European Commission’s Health PROMEtheus project. It gives a comprehensive analysis of mobility patterns, migration impacts on health systems, and their relevance for policy-making and responses across Europe.

Europe - European health report 2018

Published by the WHO, the 2018 edition of the European Health Report gives a snapshot of health across Europe as the continent progresses towards the goals of the WHO-mandated Health 2020 Program to ensure health and wellbeing for all. The report shows progress towards the goals of Health 2020, covers current European health policy, and examines health inequalities and areas of concern.

Europe - Performance of EU health care systems investigated in new study

A new European research project has been launched to evaluate the performance of European health care systems in terms of outcomes, quality, use of resources and costs. Financed by the European Union and coordinated at the National Institute for Health and Welfare (THL) in Finland, the EuroHOPE project (European Health Care Outcomes, Performance and Efficiency) will focus the evaluation on five key public health problems or diseases: acute myocardial infarction, stroke, hip fracture, breast cancer and low-birth-weight infants.

Europe - Unwarranted variations in health care performance across Europe: Lessons from the ECHO Project

Using evidence from the European Collaboration for Health-Care Optimization (ECHO) Project, the nine articles in this special issue of the European Journal of Public Health consider national variations in healthcare delivery within the European Union (EU). Articles describe variations in comorbidity measures, hospital efficiencies, avoidable hospitalizations, hip replacement surgery, coronary artery bypass surgery and caesarean section. Two papers discuss ECHO itself.

Europe - The European health report 2015

Published by the WHO, this report documents improvements in health throughout Europe and decreases in health inequalities between European countries, notably in life expectancy and infant mortality. However, absolute differences between countries remain large, especially for indicators linked to the social determinants of health. Europe has the world’s highest rates of alcohol consumption and tobacco smoking.

Europe - The Europeanization of Health Care Coverage Decisions. EU-Regulation, Policy Learning and Cooperation in Decision-Making

This German paper presents two cases of Europeanization in health policy, traditionally controlled by national governments and unaffected by European integration. The first case deals with how European Union (EU) transparency directives have forced member states to establish formal healthcare coverage decision-making procedures. The second case looks at health technology assessment and how the EU has successfully promoted the field.

Europe – The European Observatory on Health Systems and Policies launches new web platforms on health systems and financial crisis

The European Observatory on Health Systems and Policies has launched two web platforms to promote comparison and evidence-informed policies in health. The Health Systems and Policy Monitor (HSPM) tracks changes in European national health systems. A second platform, the Health and Financial Crisis Monitor (HFCM), collates evidence about the effects of the ongoing financial crisis on Europe’s health systems.

Europe - Strengthening general practice/family medicine in Europe—advice from professionals from 30 European countries

This study is based on a survey of medical teaching professionals from 30 European countries on how to strengthen general practice and family medicine (GP/FM). It finds substantial variations among GPs/FMs across Europe with regards to governance, workforce competence and performance, and academic standing. Respondents strongly agree that securing GP/FM as an academic teaching and research discipline is essential, as is cementing GP/FM’s position as a highly regarded specialty.

Europe - Global Health: European Commission calls on European Union to gear up on health actions

The European Commission has recently adopted proposals to enhance the EU's role in global health. The objective is to make Europe's contribution more effective so as to better accompany developing countries towards achieving health-related Millennium Development Goals (MDGs). The Commission presents four approaches to improving global health: establish a more democratic and coordinated global governance; push for a collective effort to promote universal coverage and access to health services to all; ensure better coherence between EU policies relating to health; improve coordination of EU research on global health and boost access in developing countries to new knowledge and treatments.

Europe - Healthcare privatisation in Europe. Mapping reforms

Privatisation de la santé en Europe. Un outil de classification des réformes This working paper prepared by researchers from the Centre d'économie de l'Université Paris Nord analyzes the privatization of healthcare that has occurred in many European countries over the past few decades. They characterized this privatization according to two criteria: the scope (financing and delivery of care) and the 'external' or 'internal' nature of privatization. The authors then empirically analyze privatization in the health systems of 14 European countries since 1980 and present a mapping of the privatization process.

Europe – Mental health problems costing Europe heavily

This OECD Europe report says greater efforts in the treatment of mental illness would improve the lives of millions of Europeans and contribute to strengthening the economy. The report estimates the total costs of mental ill health in Europe at over 600 billion euros ($900 billion Cdn), more than 4% of GDP.

Europe - How can voluntary cross-border collaboration in public procurement improve access to health technologies in Europe?

Produced by the WHO, this policy brief examines the legal framework put in place by the European Union (EU) to foster voluntary cross-border collaboration in the field of public procurement of health technologies, it looks at recent experiences and developments in cross-border collaboration across Europe and explores the challenges and opportunities these present.

Europe - Healthcare in your pocket: unlocking the potential of mHealth

On April 10, 2014, the European Commission launched a consultation on mobile health, asking for help in finding ways to enhance the health and wellbeing of Europeans with the use of mobile devices, such as mobile phones, tablets, patient monitoring and other wireless devices. A major ambition is to put the patient in control and improve the efficiency of health services. The European Commission is asking for input from all interested parties by July 3, 2014.

Europe - New report reveals need for more humane, personalized approach in European Region’s long-term institutions for adults with intellectual and psychosocial disabilities

The WHO released an assessment of quality of care for adults with intellectual/psychosocial disabilities in 75 institutions across 25 European countries. Only 25% of quality scores met international standards, meaning that long-term institutional care in Europe has significant room for improvement.

Europe - Economic crisis, health systems and health in Europe: impact and implications for policy

The European Observatory on Health Systems and Policies monitors the effects of the economic crisis on health systems and health. This report, undertaken jointly with the WHO Europe, analyses the impact of the crisis between 2008 and 2013 on government and household finances, spending on health, health coverage, health system performance and population health.

Europe - Reforming payment for health care in Europe to achieve better value

In Europe, funding cutbacks have prompted healthcare policies focusing on better value for money. This report from the Nuffield Trust examines European trends in payment reform in health care and their effect on payers, providers and policy-makers.

Europe - Public health in Europe during the austerity years

Released by the UK International Longevity Centre (ILC-UK), this report explores the relationship between European governments’ economic austerity policies and public health across Europe. Using cross-national data and evidence from individual countries, the report charts the evolution of austerity across the continent since the financial crisis of 2008, describes subsequent changes to health systems and health outcomes, and identifies channels through which austerity impacts on health.

Europe - EU health organisations call for action on health equity

Twenty-one European health organizations have issued a statement calling on European Union (EU) governments to recognize the central role that health equity plays in social market economies. The statement encourages the use of EU mechanisms like the European Structural and Investment Funds to address health inequalities.

Europe - A European blueprint for the deployment of telemedicine

Momentum, a European Union (EU) network created to advance the adoption of telemedicine in Europe, has released a deployment blueprint. It describes 18 critical success factors for telemedicine deployment, including context and indicators. Case studies are included.

Europe - Health spending in Europe falls for the first time in decades

This report from the OECD says health spending has fallen across the European Union for the first time since 1975. According to the report “Health at a Glance: Europe 2012,” health spending per capita fell by 0.6% in 2010 after an annual average growth rate of 4.6% between 2001 and 2009.

Europe - Better use of health data will transform the healthcare landscape, says expert report

The eHealth Task Force was established a year ago to advise the European Commission on how to unlock the potential of eHealth for safer, better and more efficient health care in Europe. Their report contains five recommendations beginning with the creation of a legal framework that provides Europeans confidence their data will be handled appropriately.

Europe - Re-orienting health systems: towards modern, responsive and sustainable health promoting systems

This position paper from EuroHealthNet is the culmination of a policy dialogue process with stakeholders, experts and European Union (EU) institutions to identify key contributions to sustainable health systems across Europe. The paper frames its findings in the context of the EU 2020 Europe strategy for continental growth.

Europe - Building resilient and innovative health systems

This issue of Eurohealth focuses on themes discussed at the recent European Health Forum Gastein 2013. The Forum explored innovative suggestions for health policy in Europe that respond to European values as well as market realities. Resilience, the ability to cope with internal and external shocks, emerged as a key theme.

Europe - A New Drive for Primary Care in Europe: Rethinking the Assessment Tools and Methodologies

Overseen by an expert panel convened by the European Union (EU), this report looks at tools used to assess performance in primary care. It explores indicators, methodologies, and quality assurance while seeking to understand the impact of performance assessment. It finds that Europe’s primary care performance assessment systems currently vary in strength and makes seven recommendations to embed performance assessment in policy processes.

Europe - The Long-Term Sustainability of European Health Care Systems

Europe’s healthcare systems need to secure economic and financial sustainability without undermining universal coverage. This Italian paper maintains that new regulatory supply and demand tools would improve the ways European health systems incentivize and reward patients. The authors also consider that rebalanced public-private funding mixes could assure sustainability, but would produce some increases in health inequities.

Europe - Health: driving forward the uptake of e-Health with a new network for European Co-operation

On December 22, 2011, the European Commission adopted a Decision establishing an eHealth Network, as foreseen by the Directive on Patients' Rights in Cross-border Healthcare. The Network will bring together the national authorities responsible for eHealth on a voluntary basis to work on common orientations for eHealth. The aim is to ensure EU-wide interoperability of electronic health systems and wider use of eHealth. The eHealth Network is expected to translate the results of numerous research projects and pilot projects into real-life accessible services for European citizens.

Europe - The changing national role in health system governance: a case-based study of 11 European countries and Australia

Conducted by the European Observatory on Health Systems and Policies, this study was undertaken to compile background material for the 2012 Swedish Governmental Inquiry on Health Care. Assessments of 11 European countries and Australia focus on changing national roles in health systems, and government efforts to reconfigure responsibilities for health policy, regulation and management.

Europe - A comparative analysis of health policy performance in 43 European countries

This article from European Public Health assesses national variations in health policy and investigates the influence of local political, economic and social determinants. The article reviews the policies of 43 European countries on nutrition, child health, infectious diseases, hypertension, cancer screening, road safety, air pollution, and tobacco and alcohol use.

Europe - Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

The harmonization of European health systems has created a new need for tools that standardize information on medical care. Standards and coding systems are necessary for the incorporation of local data into evidence-informed policy. This report from the eDESDE-Long Term Care (LTC) project describes the development of a standardizing tool and coding tool for LTC services across Europe.

Europe - Health system performance assessment in the WHO European Region: which domains and indicators have been used by Member States for its measurement?

Health systems performance assessment (HSPA) varies across Europe. This WHO review summarizes 14 HSPA domains and 1,485 indicators used in European HSPA reports. All countries had indicators of service delivery and health outcomes. Other domains, such as safety, efficiency, coverage or responsiveness, were included in only 30% of the documents. The review concludes that further refinement of frameworks is warranted.

Europe - Boosting Investment in Social Infrastructure in Europe

Published by the European Union (EU), this report by the High-Level Task Force on Investing in Social Infrastructure in Europe looks at investments in social infrastructure such as health care, education, and affordable housing, and discusses the financing tools these require. The report formulates concrete recommendations aimed at enhancing current financing methods as well as future schemes and initiatives.

Europe - Commission steps up efforts to increase availability and boost healthcare data sharing

On April 25, the European Commission proposed measures to assure better access to, and reusability of, public sector data. These accompany a General Data Protection Regulation that will come into effect on May 25, 2018. The new measures include the creation of a European Open Science Cloud to improve access to scientific information; fostering cooperation to make better use of health data, including genomic data; and improving the interoperability of electronic health records to enable data to be shared across borders. The proposal will now go to European Parliament.

Europe - Home care across Europe: current structure and future challenges

This two-volume book published by EURHOMAP (Mapping Professional Home Care in Europe) compiles and analyzes results from a 2008 to 2010 study of the home care sector in 31 countries. The organization, financing, and provision of home care across Europe is addressed, along with system failures and unmet needs.

Europe - The European health report 2012

As part of its mandate to monitor the health of 900 million Europeans, the WHO issues this comprehensive continent-wide health report every three years. The 2012 report focuses on providing an evidence base for Health 2020, the European Union (EU) policy framework to improve health and wellbeing.

Europe - eHealth Action Plan 2012-2020 - Innovative healthcare for the 21st century

This European Commission report details challenges and opportunities for eHealth services in Europe and describes the continent’s new eHealth Action Plan, designed to address and remove barriers to European Union (EU) member state implementation and use of eHealth.

Europe - WHO European Region advances health on political and social agendas: Health 2020 progress report

In the two years since its launch, Health 2020 has become a vital resource for Member States, helping to bolster their health policies and decrease inequities. This first progress report reveals the accomplishments of Europe's governments and defines the WHO Europe vision for the future. Emphasis on reducing health inequalities, a focus on healthy cities, and measures to improve governance are among the advances described.

Europe - A cost/benefit analysis of self-care systems in the European Union

This European Union study explores the added value of self-care systems in Europe and assesses their economic and societal impacts. It provides evidence of the added value of self-care for five minor ailments (athlete’s foot, cold, cough, heartburn, urinary tract infection), analyzes costs and savings, and develops a strategy to disseminate benefits and best practices.

Europe - Building primary care in a changing Europe: case studies

In this report, the European Observatory on Health Systems and Policies presents structured case studies of primary care in 31 European countries. They establish the context of primary care, key governance and economic conditions, look at the workforce and at how primary care services are delivered, and assess the quality and efficiency of the different systems.

Europe – Health at a Glance: Europe 2010

This special edition of Health at a Glance focuses on health issues across the 27 European Union member states, three European Free Trade Association countries (Iceland, Norway and Switzerland) and Turkey. It gives readers a better understanding of the factors that affect the health of populations and the performance of health systems in these countries. Its 42 indicators present comparable data covering a wide range of topics, including health status, risk factors, health workforce and health expenditure.

Europe - Disparities in Regular Health Care Utilisation in Europe

Despite common recommendations and quasi universal health care coverage in all European countries, there are large differences in the utilisation patterns of different health services. Little comparative information is available on different types of health service utilisation and variations in utilisation patterns over a longer time span. The objective of this study is to compare and investigate individual and cross-country determinants of health care utilisation habits over the life span across European countries. The authors of the study found that while there is a general shift toward more regular and preventive care utilisation in all countries; there are still significant social inequalities between countries and cohorts. There is also evidence that once the individual effects have been isolated, cross-cohort and country differences in the prevalence of regular care use are partly associated with differences in welfare states interventions.

Europe - Assessing chronic disease management in European health systems: country reports

This book published by the European Observatory on Health Systems and Policies systematically examines efforts in 12 countries in Europe to redesign delivery systems to provide appropriate support to people with long-standing health problems. It compares approaches to chronic care and evaluates the outcomes of these initiatives.

Europe - Economic crisis, health systems and health in Europe: country experiences

Europe’s economic crisis has had a visible but varied impact on the continent’s national health systems. This new book maps responses to the crisis, providing detailed analysis of health system changes in nine countries and shorter overviews of another 47 countries. It draws on a study involving over 200 European health system experts and academic researchers.

Europe - Self-assessment tool for the evaluation of essential public health operations in the WHO European Region

Through a process of extensive consultation, the WHO Regional Office for Europe devised 10 essential public health operations (EPHOs) that define the field of modern public health for the Member States in the WHO European Region. This report provides a series of criteria that national public health officials can use to evaluate the delivery of the EPHOs in their particular settings and can contribute to the development of public health policies.

Europe - WHO/Europe launches new report on women’s health and well-being in Europe

The WHO has issued a report on European women’s health and wellbeing that shows the impact of gender-based inequalities interacting with social, economic and environmental determinants. The report focuses on how people-centred health systems can effectively respond to women’s needs throughout the life course.

Europe - Recruitment and Retention of the Health Workforce in Europe

Funded by the European Union (EU), this study of health workforce recruitment and retention in Europe includes a literature review, eight case studies, and recommendations for policy makers, managers and health professionals. The authors identify innovative solutions to the challenges of recruiting and retaining health staff.

Europe - Organization and financing of public health services in Europe

Published by the WHO, this book examines the financing and organization of public health services across Europe. Looking at nine European countries, it contains an in-depth analysis of the budgets, funding, and cost-effectiveness of public health services, which are often organized differently at national, regional and local levels. Case studies of campaigns responding to alcohol abuse, obesity and antimicrobial resistance are included.

Europe - From innovation to implementation – eHealth in the WHO European Region

This report describes the development of and emerging trends in electronic health (e-health) in the WHO European Region in 2016. Its content and key messages are based on data collected from the 2015 WHO Global eHealth Survey and the assistance of a number of key practitioners in the field. The report gives case examples to illustrate success stories in countries and the practical application of e-health in various settings. Together, the findings and analysis provided in this report offer a detailed insight into the development of e-health in Europe.

Europe - Health investments in the EU: mapping report showing use of European Structural and Investment Funds (ESIF) now available online

The European Union (EU) has released a report that shows how use of European Structural and Investment Funds (ESIF) are financing health sector investments by its 28 member states. The report presents information on each EU country’s expected use of ESIF in health care until 2020. Overall, most funding has been committed to healthcare access, followed by infrastructure spending.

Europe - Building primary care in a changing Europe

In this report, the European Observatory on Health Systems and Policies analyses how primary care is organised and delivered across European countries, looking at governance, financing and workforce aspects and the breadth of the service profiles. It describes wide national variations in terms of accessibility, continuity and coordination, and financial, workforce and technological challenges.

Europe - The European Semester 2018 from a health equity perspective

The European Semester cycle process is designed to help steer European Union (EU) Member State government fiscal policies. It is increasingly being used to review social protection systems funded through public budgets. This report analyzes recommendations of the 2018 edition from a health equity perspective. It explains how the process can support work on key determinants of health, health inequalities, and assuring care for vulnerable groups.

Europe - Assessing chronic disease management in European health systems: concepts and approaches

This report from the European Observatory of Health Systems and Policies explores approaches to chronic disease management across Europe. Drawing on 12 detailed country reports the study provides insights into the range of care models and the people involved in delivering these; payment mechanisms and service user access; and challenges faced by countries in the implementation and evaluation of these novel approaches.

Europe - What does Eurostat’s Labour Force Survey say about health and health inequalities in the European Union?

This publication presents extensive analysis of newly available data from the Labour Force Survey (LFS) of Eurostat (the statistical office of the European Union) to measure health and socioeconomic inequalities in health in 25 European countries over a period including 1983–2004 at most.

Europe - Health in the European Union: trends and analysis

Prepared for DG Employment, Social Affairs and Equal Opportunities of the European Commission, this reportinvestigates differences in health status within and between European countries. The relationship between living conditions, socio-economic factors and health is discussed and analyzed with the objective of stimulating a debate and policy action for creating a healthier and more equitable society.

Europe - Out-of-pocket payments in healthcare systems in the European Union

Analyzing the extent to which hospital care in 25 European Union (EU) countries is financed by out-of-pocket payments, this report relies on national and EU data to examine direct payment, cost sharing, and indirect payment schemes. A majority of the countries under study utilize forms of cost sharing, but different hospital financing strategies are also evident.

Europe - The other side of the coin: The privatization phenomenon and realization of public welfare in a Single European Health Care System? A sketch from the perspective of the economic theory of law

From Munich Personal RePEc Archive (MPRA), comes this paper exploring the privatization of public hospitals in Europe. Using methods from the economic theory of law, the paper looks at the extent to which governments may be losing influence over public welfare.

Europe - Hospitals 2020. Hospitals of the future, healthcare of the future

Drawing on the June 2015 conference of the European Hospital and Healthcare Federation held in Warsaw, this report on hospital management in 15 European Union (EU) countries discusses innovations in patient care, clinical work, nursing, human resources, information systems, drug management, laboratory operations, finances, quality control and patient involvement. Information on each of the 15 countries is included.

Europe - The changing role of nursing

Four articles in this issue of the journal EuroHealth assess nursing in the 28 European Union (EU) countries, where regulations on the free movement and qualifications of nurses within the European Union affect clinical and managerial practices at the national level. The articles consider EU policies on nursing education, certification and migration.

Europe - Physical activity strategy for the WHO European Region 2016–2025

The physical activity strategy aims to inspire governments and stakeholders to work towards increasing the level of physical activity among all citizens of the European Region by: promoting physical activity and reducing sedentary behaviours; ensuring an enabling environment that supports physical activity through engaging and safe built environments, accessible public spaces and infrastructure; providing equal opportunities for physical activity regardless of gender, age, income, education, ethnicity or disability; and removing barriers to and facilitating physical activity

Europe - Public Consultation on Health and Care in the Digital Single Market

This consultation investigates the need for policy measures that will promote digital innovation for better health and care in Europe. It is seeking views on cross-border access to and management of personal health data, joint European exploitation of digital infrastructure, and measures to support interaction between patients and providers. Citizens, patient organisations, health and care professionals, public authorities, researchers, industries, investors and users of digital health tools are invited to respond to the consultation by October 12 2017.

Europe - Governing Public hospitals

This special issue of EuroHealth, the quarterly of the European Observatory on Health Systems and Policies, focuses on public hospital governance across Europe. It features such topics as hospital autonomy in Spain, pay-for-performance in Macedonia, and innovative governance in Norway.

Europe - Health diplomacy: European perspectives

Health diplomacy is central to health governance at global and regional levels, and integral to foreign policy in many countries. This book published by the WHO presents case studies of health diplomacy in action in Europe. Chapters review road safety in Russia; experience with integrated health diplomacy in Malta and Switzerland; and efforts by the Balkan countries to improve capacity.

Europe - WHO Europe launches new action plan for noncommunicable diseases

In September 2016, the WHO launched a new action plan for noncommunicable diseases (NCDs) in Europe that outlines actions to reduce the burden of NCDs, improve quality of life, and make healthy life expectancy more equitable. Along with early detection of NCDs, the plan advocates the use of marketing restrictions to promote healthy eating.

Europe - Health ministers adopt European policy for health and well-being

In September 2012, the WHO announced the adoption of Health 2020, a comprehensive policy designed to protect and promote the health of Europe’s 900 million inhabitants. The policy targets regional health inequities, shrinking public service expenditures, and the growing burden of non-communicable disease.

Europe - Voluntary health insurance in Europe: country experience

Published by the WHO, this 160-page book contains short, structured profiles of markets for voluntary health insurance (VHI) in 34 European countries. Each profile, written by local experts, identifies gaps in publicly financed health coverage, describes the role VHI plays, outlines how the market for VHI operates, summarizes public policy towards VHI, and highlights national debates and challenges.

Europe - Performance of Long-Term Care Systems in Europe

This paper, published by the Centre for European Policy Studies, summarises the results and discusses the policy implications of the evaluation of long-term care (LTC) systems carried out in the ANCIEN project. An overall evaluation was carried out for four representative countries: Germany, the Netherlands, Spain and Poland. The role of the state in funding and organising LTC versus individual responsibilities is one of the most important differences among countries.

Europe – Efficiency and Health Care

The September issue of EuroHealth explores the possibilities and challenges of developing a workable model of efficiency in European health systems. Articles highlight reforms in the Netherlands and Portugal as well as providing a Europe-wide perspective.

Europe - Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries

Using institutional theory and an analysis of healthcare quality practices in 10 hospitals in five European countries, this British paper explores pressures to improve quality and constrain spending. How hospitals responded to these challenges was dependent on managerial competence and stability, and the coherence of demands from external institutions.

Europe - So What? Strategies across Europe to assess quality of care

Prepared by a European Union (EU) Expert Group, this report shares examples of best practices in healthcare quality assessment implemented by EU countries and analyses them to draw general conclusions for policy development. The report presents a list of methodologies developed to support national policy-makers but does not compare quality of care across countries, regions or healthcare providers.

Europe - Measuring efficiency in health care

Efficiency measures are vital for assessing the performance of health systems. This issue of the Eurohealth Observer features two articles that explore issues related to measuring the performance of European health systems. One article identifies the causes of inefficiencies in the continent’s health systems, while the other examines the challenges of using European cross-country comparisons of efficiency to inform national health policy.

Europe - Priorities for health systems strengthening in the WHO European Region

In this issue, the European Observatory on Health Systems and Policies explores how Member States are strengthening their health systems. Articles look at priorities for strengthening people-centred health systems; moving towards universal health coverage; enhancing the health workforce; ensuring equitable access to cost-effective medicines and technology; and improving health information systems.

Europe - Key findings of consultation on monitoring noncommunicable diseases released

The WHO Regional Office for Europe reports key findings from a web-based consultation to determine European Member States’ capacity to monitor proposed voluntary targets and global indicators. It found universal capacity to report on mortality, high capacity to monitor four behavioural risk factors (tobacco, alcohol, diet and physical inactivity) and lower capacity to monitor factors such as overweight and high blood pressure.

Europe - Developing a New Understanding of Enabling Health and Wellbeing in Europe – Harmonising Health and Social Care Delivery and Informatics Support to Ensure Holistic Care

Although social care and informal care are essential to improving health and preventing health problems, especially in an aging population, there are still large gaps of knowledge in how best to organise this, and how best to combine it with health care. This position paper from the European Science Foundation aims to present the vision of a new paradigm of integrated care support for citizens’ health through technology-linked social and health care, and identify common ground between consumer, professional and government bodies.

Europe - Special Collection. Project INTEGRATE: Lessons for Policy, Management and Implementation of Integrated Care in Europe

Project INTEGRATE was a 2012-2016 research project investigating the leadership, management and delivery of integrated care in Europe. This collection provides some of the papers published by researchers involved, and focuses on work undertaken in the project’s final phases that examined factors in integrated care design, management, and policy. It includes case studies of care integration in four countries.

Europe - Fiscal Federalism and European Health System Decentralization: A Perspective

How does fiscal decentralisation affect the organization of a health system? This paper from the London School of Economics addresses the effects of fiscal and health care decentralization in Europe, and reviews key questions on health system design. The authors argue that efficiency improvements after decentralization depend on fiscal design.

Europe - Commission diagnoses the state of health in the EU

The European Commission has published 28 country health profiles of member-states of the European Union (EU). The EU country profiles consider population health and risk factors while assessing the effectiveness, accessibility and resilience of national health systems. Many EU member states are increasingly focusing on primary care, health promotion, and disease prevention.

Europe – The European health report 2012: charting the way to well-being

This report describes both the overall improvements in health in the WHO European Region and their uneven distribution within and between countries. It breaks new ground by helping both to define well-being and to map the way towards achieving it.

Europe - Health policy responses to the financial crisis in Europe

This August 2012 report by the Health Evidence Network (HEN) identifies key challenges for European health policy makers in the wake of the ongoing financial crisis. The report focuses on responses to essential service cuts and interruptions in revenue streams, as well as on inefficiencies and exacerbations of adverse effects evident in national health systems.

Europe - Everything you always wanted to know about European Union health policies but were afraid to ask

Published by the WHO, this 146-page book describes health policies enacted by the European Union (EU). The book focuses on four aspects of EU health policy: institutions, processes and powers related to health; health actions taken under EU mandates; non-health actions affecting health and health systems; and the impacts of EU financial governance on health.

Europe - BLOCKS: tools and methodologies to assess integrated care in Europe

Released by the EU Expert Group on Health Systems Performance Assessment, this report summarizes tools and methodologies to assess integrated care in Europe. It discusses interrelated system levers for the effective design and implementation of integrated care frameworks that relate to politics, governance, stakeholder engagement, organizational change, leadership, workforce education and training, patient empowerment, infrastructure, financing, monitoring and evaluation.

Europe - Strategic investments for the future of healthcare

This report summarizes a seminar organized by the EU to promote innovative large-scale strategic investment in Europe’s health sector. The report champions the use of EU financial instruments, such as the European Fund for Strategic Investments, to help absorb financial risk, and calls for network building across the public and private sectors to pursue partnered investments in health.

Europe - Reducing inequalities in health and health care

This special issue of EuroHealth features 10 articles on the dimensions of health and care inequalities in Europe. Articles discuss the challenge of reducing inequalities in the prevention of infectious disease and the regulation of health behaviour. Initiatives addressing specific populations at risk, such as Europe’s Roma peoples, are described.

Europe - Health and safety at work: Strategic Framework sets out EU objectives for 2014-2020

In this document, the European Commission sets out a plan to better protect workers in the European Union from work-related accidents and disease. Three major challenges are to improve implementation of existing health and safety rules, improve the prevention of work-related diseases, and take account of the aging of the workforce.

Europe - New European code prescribes 12 ways to prevent cancer

Avoiding tobacco, alcohol and excessive sunlight, maintaining a healthy weight and being active are among 12 ways to prevent cancer prescribed by the new Code Against Cancer developed by the European branch of the WHO. The Code recommends participating in preventative measures and screening for bowel, breast and cervical cancer.

Europe - Mental Health and Integration. Provision for Supporting People With Mental Illness: A Comparison Of 30 European Countries

Intelligence Unit (EIU) created this Mental Health Integration Index comparing mental health services and treatment in 30 European countries. It considers medical service provision, human rights, stigma, quality of life, housing and employment, along with other factors. The index is accompanied by interviews with experts and a literature review.

Europe - Euro Health Consumer Index, 2014

Published by a Swedish firm, this report employs 48 indicators to rate the user-friendliness of national healthcare systems in 35 European countries. In 2014, Switzerland ranks first and the Netherlands second. Overall, the report says European healthcare continues to produce better results in spite of austerity measures. Survival rates for heart disease, stroke and cancer are all increasing.

Europe - Challenges and opportunities in improving access to medicines through efficient public procurement in the WHO European Region

This report by the WHO examines methods used by European countries to improve efficiency in the procurement of medicines. It describes schemes to minimize low-value repetitive purchases, increase economies of scale and reduce transactional costs. Other instruments to leverage improved efficiency are discussed, such as clinical formularies and the use of generic or biosimilar products.

Europe - ‘The Choice Agenda’ in European Health Systems: The Role of ‘Middle Class Demands’

Written by two professors at the London School of Economics (LSE), this paper explores the political and economic drivers of ongoing provider choice reforms in eight European national health systems. The paper concludes the reforms are linked to efficiency improvements tied to fiscal restraint and high costs, as well as demands from middle class consumers unsatisfied with health care.

Europe – Cost-Containment Policies in Hospital Expenditure in the European Union

This European Union study suggests that the reorganization and rationalization of care is a major factor in hospital cost containment, especially in institutions with high bed densities. It notes the difficulty of gauging the impact of tools to improve performance via structural changes.

Europe - Intersectoral action for health – Experiences from small countries in the WHO European Region

Intersectoral action can play a crucial role in addressing public health challenges. This WHO report shows how eight small European countries, with populations of less than one million, used intersectoral action to address a diverse set of health needs. Sectors involved were agriculture, education, family affairs, interior, labour, justice, sports and tourism.

Europe - Health at a Glance: Europe 2014

Published by the OECD, this book presents indicators related to health status, access to care, quality of care, and health financing, expenditure and resources in 35 European countries. Key indicators reflect the new availability of comparable data in the areas of non-medical determinants of health and access to care.

Europe - Public health: Commission stresses need for greater effectiveness, accessibility and resilience for EU’s health systems

On April 4, 2014, the European Commission laid out an agenda for making Europe's health systems fit to face current challenges and pressures and meet expectations for high quality care. It provides methods and tools to help achieve greater health system effectiveness, accessibility and resilience.

Europe - eHealth in the EU: what's the diagnosis?

The European Commission undertook a broad survey of eHealth use in acute care hospitals and among GPs in member countries. Use is climbing but still only 60% of GPs were using eHealth tools in 2013. Denmark, Estonia, Sweden and Finland are top performers in hospital uptake, with rates over 60%. The Netherlands, Denmark and the UK have rates over 80% in digitising patient health records. However, many barriers remain to adopting eHealth, preventing more important usage. Only 10% of GPs use online consultations and only 9% of hospitals in Europe allow patients access to their own medical records.

International - Slow growth in health spending but Europe lags behind

Many European countries saw further reductions in health spending in 2013, according to OECD Health Statistics 2015. Health spending continued to shrink in Greece, Italy and Portugal in 2013. Most countries in the European Union reported real per capita health spending below the levels of 2009. Outside of Europe, health spending has been growing at around 2.5% per year since 2010.

Europe - Implementing a Health 2020 vision: governance for health in the 21st century. Making it happen

This report from the WHO Regional Office for Europe outlines how whole-of-government and whole-of-society approaches can achieve real health outcomes. The report reviews a range of specific policies and programmes from the European Region and elsewhere, highlights the lessons learned, and provides valuable guidance in pursuing this agenda of good governance for health.

Europe - European Vacancy Monitor highlights growing job opportunities in healthcare sector

The European Commission finds that employment in the EU healthcare sector has grown almost 2% annually between 2008 and 2012. This is attributed to the combined effects of an ageing population, advances in technology and treatments, people expecting higher quality service and greater emphasis on preventative care. In 2012 almost one million people were hired to work in health care.

Europe - Comparative efficiency of health systems, corrected for selected lifestyle factors

Funded by the European Union (EU), the MACELI (Macro Cost Effectiveness corrected for Lifestyle) Project investigates the cost-effectiveness of European health systems and the impact of lifestyle factors such as smoking, obesity, and alcohol consumption. The report provides better insight into the different mechanisms through which lifestyle affects health system efficiency.

Europe - More investment in health promotion and primary prevention is needed to reduce the burden of chronic diseases across Europe, says a report published by the J-A CHRODIS

A new report on 14 European countries by Joint Action on Addressing Chronic Diseases and Healthy Aging across the Life Cycle (JA-CHRODIS) shows that gaps and needs in health promotion and primary prevention are similar between countries. Most gaps and needs relate to funding, capacity development, evaluation, monitoring and research.

Europe - Health 2020 policy framework and strategy

In 2012, the WHO Regional Committee for Europe approved Health 2020 in two forms. This publication gives both. The shorter policy framework provides European politicians and policy-makers with Health 2020’s main values and principles, and key strategic advice to support action for health and well-being. The longer policy framework and strategy give more detail in terms of evidence and practice.

Europe - Report on health inequalities in the European Union

In 2009, the European Commission adopted a communication on ‘Solidarity in health: reducing health inequalities in the EU" and introduced measures to support action by Member States and stakeholders, along with EU policies. The report describes the main actions the Commission has taken and examines trends in health inequalities since 2000 with a focus on recent years.

Europe - Competition among health care providers - Investigating policy options in the European Union

The European Union (EU) Expert Panel on Effective Investments in Health (EXPH) issued this report examining competition among healthcare providers as a way to improve the efficient use of resources. The report recognizes the importance of patient choice, saying it works best when patients can easily assess the quality of services.

Europe - How can structured cooperation between countries address health workforce challenges related to highly specialized health care?

This policy paper by the WHO draws on the experience of different cross-border collaborations in specialized health care to address health workforce challenges in European countries. It identifies factors that enable or block structured cooperation, describes the institutional framework in place, and examines policy implications for the European Union (EU).

Europe - Strengthening health system accountability: a WHO European Region multi-country study

This WHO report summarizes European countries' experience with strengthening health system accountability in the context of the momentum created by the Tallinn Charter of 2008 and the Health 2020 policy framework of 2012. Countries have set rigorous goals and are measuring and reviewing health systems' performance, taking significant steps to improve health system accountability.

Europe - EU Action Plan on Childhood Obesity 2014-2020

Childhood obesity has tripled across Europe since the 1980s. This plan developed by the European Union (EU) sets out priority areas for action and includes measures to keep track of progress across EU member states. Priority actions include restricting advertising to children and promoting physical fitness and healthier environments.

Europe - Mental health policy in Eastern Europe: a comparative analysis of seven mental health systems

In this study, Czech researchers compare mental health policies in seven formerly Communist Eastern European countries: Bulgaria, the Czech Republic, Hungary, Moldova, Poland, Romania and Slovakia. The study looks at overall healthcare financing, mental health services, and purchasing and policy measures. None of the countries observed has a separate mental healthcare budget.

Europe - Integrating care for people with multimorbidity: what does the evidence tell us?

The European Union (EU) ICARE4EU project was created to investigate new approaches to integrated care for the 50 million people in Europe with multimorbidity, a number expected to rise significantly in the future. Five policy briefs share the project findings related to integrated care design, applicability, effective implementation, financing mechanisms and the role of eHealth.

Europe - E-learning courses on commercialising research in the health sector

Three e-learning courses teaching health researchers how to commercialize findings have been developed by the Health-2-Market Project funded by the European Union (EU). Created at Europe’s top business schools, the free-of-charge courses focus on three issues: entrepreneurship and business planning; business ventures and marketing; and intellectual property and ethics. The e-learning materials can be accessed at any time by signing up.

Europe - Private health insurance companies in six European countries

This report describes the role of private insurance companies in health coverage in Europe, looking at six countries: France, Germany, the Netherlands, Switzerland, Spain and the United Kingdom. These countries have basic and compulsory health coverage, but some entrust the management of this coverage to private insurers. There are significant government constraints on these markets, and these are found to exhibit trends toward concentration.

Europe - Report shows progress towards Health 2020 targets

The WHO reports that Europe is moving towards the WHO Health 2020 goals. Forty-three European countries have now aligned national policies with Health 2020 priorities and defined targets and indicators. Health 2020 focuses on health inequities and their social determinants to improve health and well-being.

Europe - Governing public hospitals. Reform strategies and the movement towards institutional autonomy

This study by researchers at the WHO explores major developments in the governance of public hospitals in Europe and looks at their implications for national and European health policy. Individual hospitals have been given varying degrees of semi-autonomy within the public sector and empowered to make key strategic, financial and clinical decisions themselves. The study includes an in-depth assessment of eight different country models of semi-autonomy.

Europe - Health Expenditure, GDP Growth and the Financial Crisis: A Panel Data Analysis for OECD European Countries

This study analyses the dynamics of GDP and health expenditure for 25 European countries from 1993 to 2015. Although the study concludes that the growth dynamics of health expenditure did not change significantly during the financial crisis of 2008 and subsequent recession, it finds that deterioration in population health during the period goes beyond the effect on health spending of economic growth.

Europe - Heath Policy in Europe: Contemporary Dilemmas & Challenges

This book is an effort to describe and critically analyse the recent experience of various European countries and discuss the dilemmas and challenges that confront health policy and policy-makers in this period of time and geopolitical setting, providing concrete evidence from various countries. Specific chapters address issues in Germany, Sweden, the United Kingdom, Croatia, the Republic of Macedonia, Serbia, Greece, Turkey, and Palestine, with an additional comparative study of the situation in the market-dominated health care system in the United States.

Recentralization tendencies within healthcare services: Implementation of a new idea ?

Brief analytical summaries or syntheses #9 Recentralization tendencies within healthcare services Implementation of a new idea? Summary Decentralization has been a widespread trend in European health sectors for many years. More recently, however, a new set of reforms is observable, implying ambitions to regain lost control. This paper by Renate Minas, Associate professor of Social Work at Stockholm University in Sweden, looks at what this general trend toward recentralization is about and what happens when reforms promoting recentralization are implemented in different national contexts. The establishment of regional health authorities in Norway and regional hospital agencies in France are used as examples to analyze the spread of recentralization reforms. Background General context of health care Health care is a highly political area, subject to intense negotiations on the distribution of power and resources between the institutions responsible for financing, planning and delivering health services. Pressures to control spending and increase…

Europe - Inequalities in utilisation of general practitioner and specialist services in 9 European countries

This study published in BMC Health Services Research describes educational inequalities among patient populations using GP and specialist medical services in nine national European health care systems. The study found that better educated people use medical specialists more often than less educated people in every nation except Holland.

Europe - Synopsis Report Consultation: Transformation Health and Care in the Digital Single Market

In 2017, the European Union (EU) announced a digital health and care strategy based on three pillars: citizen access to their health records, a supportive data infrastructure, and patient-centred interoperability of healthcare data. This report provides an analysis of consultation activities connected to the strategy that involved online surveys and questionnaires answered by respondents across Europe. Results showed strong support for the EU actions.

Europe - 20 Years of Health System Reforms in Europe: What’s New?

Appearing in the periodical Eurohealth, this article looks at the changing agenda of heath reform in Europe over the last two decades. While reforms implemented 20 years ago focused on improving efficiency, more recent reforms have concentrated on improving quality, strengthening primary care services, and promoting integrated care. Examples are given of this shift with regard to payment mechanisms, primary care, and hospitals.

Europe - Tools and Methodologies for Assessing the Performance of Primary Care

Assembled by an expert panel convened by the European Union, this report on tools and methodologies for assessing primary care performance identifies 10 main organizational domains in primary care, including care coordination and integration, and proposes indicators that could be used for comparative assessment. Procedural steps required for establishment of a performance assessment system are explored, and recent experiences from European countries are considered.

Europe - Hospital payment systems in Europe

This issue of Euro Observer focuses on Hospital payment systems in Europe. Country case studies come from Germany, the Netherlands and Finland.

Europe — The impact of global processes on health systems in Europe

The relationship between globalization and health systems is a complex one, where both positive and negative influences are reported. This paper explores the impact of globalization on European health systems and emphasizes the need for national policy-makers and leaders to consider global processes when designing national health systems.

Governing public hospitals. Reform strategies and the movement towards institutional autonomy

Brief analytical summaries or syntheses #33 Governing public hospitals. Reform strategies and the movement towards institutional autonomy Summary This study by researchers at the World Health Organization (WHO) explores major developments in the governance of public hospitals in Europe and looks at their implications for national and European health policy. Individual hospitals have been given varying degrees of semi-autonomy within the public sector and have been empowered to make key strategic, financial and clinical decisions themselves. The study includes an in-depth assessment of eight different country models of semi-autonomy. Background For hospital governance to be effective, it must incorporate two powerful and well-developed lines of health sector logic on the one hand, national health policy and objectives; on the other, operational hospital management. One sphere is political, the other technical. One is subjective and value-based, the other is objective, with performance that can be measured both clinically and financially. The…

Europe - Social Security and Health Services in EU Law: Towards Convergence or Divergence in Competition State Aids and Free Movement?

This working paper, published in March 2011 by the Robert Schuman Centre for Advanced Studies (RSCAS) in Florence, looks at the regulation of social security and health care in European Union (EU) law and the quest for balance between conflicting interests. It discusses state and market issues, European social and mobility rights, the distribution of competencies, and EU states’ autonomy over redistribution within their borders.

Europe - Service Integration across Sectors in Europe: Literature and Practice

This paper presents a preliminary review of service integration across sectors in Europe, between social services, health, employment and education. The review shows that integration may be either tailored to a particular target group or designed for communities in general. Systems to monitor integration are not yet adequately developed and further study is needed to understand the processes involved in cross-sector service integration.

Europe — Digital Agenda: European Commission seeks views on improving healthcare by applying ICT (eHealth)

The European Commission is seeking citizens' and other interested parties' views on how the EU can help to deliver widespread benefits to the quality and efficiency of healthcare by applying information and communication technologies (ICT) (so-called 'eHealth'). The online public consultation runs until 25 May. The answers will feed into the preparation of the eHealth Action Plan 2012-2020 that the Commission is due to present before the end of 2011.

Europe - Organization and financing of public health services in Europe: country reports (2018)

Describing the public health services of nine European countries, this study explores organization and financing along with training and workforce concerns. Covering England, France, Germany, Italy, the Netherlands, Slovenia, Sweden, Poland and Moldova, the study illustrates two different approaches to public health services: integration with curative health services (as in Slovenia or Sweden), or organization and provision through a separate parallel structure (Moldova and Poland).

Europe — The Crisis, Hospitals and Healthcare

HOPE, the European Hospital and Healthcare Federation, has been looking for the past year at the direct and indirect effects of the crisis on the European health systems. Its results are now available with the publication The Crisis, Hospitals and Healthcare. This comparative report details impacts and measures taken, on hospital and healthcare services, on healthcare professionals and on patients and citizens.

Europe — eHealth survey shows most hospitals online but telemedicine services not fully deployed

More than 90% of European hospitals are connected to broadband, 80% have electronic patient record systems, but only 4% of hospitals grant patients online access to their electronic records, according to the results of a survey conducted for the European Commission.

Europe — Cross-border health care in the European Union. Mapping and analysing practices and policies

Cross-border health care is a growing phenomenon in the European Union. This book explores this trend, looks at the legal framework and examines the legal uncertainties surrounding rights, access, reimbursement, quality and safety. The information and analysis presented mark an important step in the continuing debate on a legal framework for cross-border health care and will be of considerable use to policy-makers and those with an interest in key aspects of cross-border health care.

Europe - Governance for health in the 21st century: a study conducted for the WHO Regional Office for Europe

Published in August 2011, this study of contemporary European health governance conducted for the WHO defines a ‘whole of society approach’ to health governance that requires synergistic policies supported by many mechanisms enabling collaboration across the health sector and beyond. The study states that public health agencies are ideally placed for partnerships and joint actions.

Europe - Medical human resources planning in Europe: A literature review of the forecasting models

This paper aims to analyze models used in Europe to anticipate supply of and demand for physicians. It finds that quantitative forecasting of physician needs is limited to healthcare consumption and rarely considers overall needs and service targets. Horizon scanning enables an evaluation of the changes in supply and demand in an uncertain future, and post-hoc analysis is rarely implemented, but potentially valuable.

Europe - Culture and reform of mental health care in central and eastern Europe

This report builds on a workshop held in the Czech Republic by the WHO in October 2017. It aims to improve understanding of cultural aspects that impact and drive mental healthcare reform in central and Eastern Europe. The report outlines the key points and recommendations made by participants in relation to this objective.

Europe - Medicines Reimbursement Policies in Europe

This WHO report reviews reimbursement policies for medicines across Europe, finding that while most countries provide coverage for inpatients, outpatients usually pay a share of a medicine's price, imposing a significant financial burden for those with lower incomes. The report identifies ways to make medicines more affordable, including priority setting, consideration of vulnerable populations, regular evaluations, and strategic policy measures.

Europe - Toolkit to help European Region move towards sustainable health workforce now available online

A toolkit designed to raise awareness that the health workforce is an essential investment in universal health coverage is now available online. Produced by the WHO in collaboration with European experts, the toolkit is framed around four strategic objectives: education and performance, planning and investment, capacity building, and analysis and monitoring.

Europe - Poverty and social exclusion in the WHO European Region: health systems respond

In 22 case studies from across the WHO European Region, and three background papers on Roma, migrants and children, this publication focuses on how health systems can meet the needs of populations that are experiencing poverty and social exclusion, and thus at greater risk of being deprived of their right to health.

Europe - Comparing public and private providers: a scoping review of hospital services in Europe

Authored by two Finnish academics, this scoping review of 24 prior studies (17 on economic issues and six on quality of care) compares the performance of 5,500 public and private hospitals in Europe. Public hospitals were most frequently found to have better economic performances and quality of care than private hospitals. Private for-profit hospitals performed worse on these measures than private non-profit hospitals.

Europe - Inequalities in access to healthcare - A study of national policies

Exploring inequalities in access to health care in European countries, this European Union (EU) report shows that important inequities persist both between and within countries. Sizeable vulnerable populations, especially women, minorities and the poor, continue to face multiple hurdles to accessing care and obtaining quality care. The report makes 20 recommendations concerning service availability, health coverage and insurance, system financing and initiatives for vulnerable populations.

Europe - Policies to limit marketing of unhealthy foods to children fall short of protecting their health and rights

A report from the WHO finds that European policies to limit the marketing of high fat, salt and sugar (HFSS) foods to children are not working, partly because of the proliferation of media promotional platforms. Around half of Europe’s 53 countries limit marketing of HFSS foods to children.

Europe - Health system performance assessment – Integrated Care Assessment

Commissioned by the European Union (EU), this study reviews integrated care performance in the 28 EU countries and tests a performance assessment framework. Analyzing 71 integrated care policies and 550 initiatives, the review finds that the characteristics, depth and breadth of IC penetration vary considerably across Europe. The study's Integrated Care Performance Assessment Framework contains 58 indicators to track integrated care outcomes and patient experiences.

Europe - Embedding a cultural contexts of health approach across the WHO European Region

In 2015, the WHO acknowledged the significant role of cultural contexts (including value systems, traditions and beliefs) in shaping health outcomes, and implemented a Cultural Context of Health (CCH) project in Europe to study the issue. Supported by an expert group, the WHO is now clarifying CCH concepts. This report summarizes the fourth meeting of the CCH expert group held in April 2018.

Europe - Projecting future health care expenditure at European level: drivers, methodology and main result

To assess correctly the demography-related risks facing public finances in the EU over the next couple of decades and establish adequate policy responses to the demographic, social and economic developments, it is essential to devise a reliable method to estimate future health care expenditure. To tackle this issue, the European Commission and the Economic Policy Committee projected future public health care expenditure in all EU Member States over the period 2007-2060. A unique internationally comparable database has been established and a model built allowing to project health care spending in a common, coherent framework of macroeconomic variables.

Europe - Access to healthcare in times of crisis

Drawing from 31 case studies and nine country studies, this European Union (EU) report explores the effect of the 2008 economic crisis on access to health care in EU countries. It presents examples of measures taken by governments and providers to maintain access, and describes newly vulnerable social groups, notably migrants and young families, affected by the crisis.

Europe - Health, health systems and the crisis in six countries

These case studies published by the WHO examine the impact of the 2008 financial crisis on health systems and health in six European countries: Estonia, Greece, Ireland, Latvia, Lithuania and Portugal. The case studies examine how severe fiscal pressures on post-2008 health budgets have pushed policy makers to respond differently.

Europe - Costs of unsafe care and costeffectiveness of patient safety programmes

This European Union (EU) study investigates the costs of unsafe care and the cost-effectiveness of patient safety programs. It finds that up to 17% of EU patients experience adverse events, up to half of which are preventable, at a cost of €21 billion. Calculating the return on investment for two safety programs suggests EU-wide savings of €300 million for a program to reduce adverse events and €6 billion for an electronic medication ordering system.

Europe - What is the experience of decentralized hospital governance in Europe?

Published by the WHO, this brief explores experience with decentralized hospital governance in 10 European countries (Denmark, England, Finland, France, Germany, Italy, Netherlands, Scotland, Spain and Sweden). It finds examples of systems with decentralized hospital governance collaborating to overcome equity and efficiency concerns, but notes that the importance of institutional and political contexts makes it difficult to transfer successful models from one country to another.

Europe - EXPH (EXpert Panel on effective ways of investing in Health), Opinion on Assessing the impact of digital transformation of health services

Offering the views of a European Union (EU)-commissioned expert panel, this document analyzes the impact of the digital transformation of health service. It establishes evaluation parameters, categories and methodologies, while analyzing government decision-making and implementation. The document discusses data sources and broader considerations (cybersecurity, privacy, and market power), and provides detailed recommendations.

Europe - Avoidable deaths in 2013. One death out of three in the EU could have been avoided in the light of current medical knowledge and technology

Eurostat, the statistical office of the European Union (EU), has published a report showing that 33.7% of total deaths in the EU in 2013 could have been avoided with better access to medical knowledge and technology. Heart attacks accounted for 32% of avoidable deaths, followed by stroke, colorectal cancers, breast cancers, hypertensive diseases and pneumonia.

Europe - Toolkit for assessing health system capacity to manage large influxes of refugees, asylum-seekers and migrants

In recent years, Europe has seen a marked increase in arrivals of refugees, asylum-seekers, and migrants. This toolkit for assessing health system capacity to manage large influxes of people was developed by the WHO to support national ministries of health across the continent. It discusses access, standards of care, administrative support, funding, public health, and health inequities.

Europe - 2015 Euro Health Consumer Index

The Euro Health Consumer Index 2015 ranks consumer satisfaction with healthcare systems in 35 European countries. Its rankings show the Netherlands as the country with the best healthcare system, followed by Switzerland. The Index also indicates that survival rates of heart disease, stroke, and cancer continue to increase.

Europe - Euro health consumer index 2016

Published annually since 2005, the Euro Health Consumer Index (EHCI) assesses the performance of healthcare systems in 35 European countries. The 2016 EHCI compares systems on 48 indicators, covering areas such as patient rights, access, treatment outcomes, range of services, prevention and use of pharmaceuticals.

Europe - Health behaviours and incentives

This issue of the Eurohealth Observer looks at health-related behaviours and incentives in Europe. An overview article discusses the use of insights from behavioural science to nudge populations into making positive changes towards healthier lifestyles. Four articles follow on inequalities and health behaviours; the effectiveness and ethics of health incentives; and the ongoing debate over incentives in the Netherlands.

Europe - Patient safety: progress made, more needed

A patient safety package published on June 19, 2014, by the European Commission highlights how the Commission and EU countries are addressing the challenge of patient safety, progress made since 2012 and barriers to overcome to further improve patient safety. Systems are being put in place for patients to report adverse effects, but progress must still be made in patient empowerment and the education and training of healthcare workers.

Decentralization in health care

Brief analytical summaries or syntheses #18 Decentralization in health care Summary The Spring issue of Euro Observer looks at decentralization as a governance tool in health care. Case studies on Norway, Spain and the United Kingdom (U.K.) highlight how decentralized arrangements work in practice in these countries. Background A common challenge across most countries in Europe is finding the appropriate level for the making and implementation of policy and administration, particularly in health care. Many countries have decentralized, recentralized and then decentralized again in an ongoing cycle, searching the right balance of efficiency and responsiveness in their health care system. Looking at the arguments for and against, in many cases the same reasons are used to justify movement in opposite directions. This issue of Euro Observer looks at whether decentralization is purely a politically driven phenomenon or the wrong instrument used for the right objective. The debate about decentralization is…

Europe - What is the evidence on the economic impacts of integrated care?

This policy summary from the European Observatory of Health Systems and Policies reviews the existing evidence on the economic impact of integrated care approaches. The authors find weak evidence on cost-effectiveness and suggest that the concept itself is ill-defined, making assessment difficult.

Europe — Health Systems Governance in Europe: The Role of EU Law and Policy

The study looks into different areas of EU policy and law-making that have an impact on national healthcare systems. It provides policy-makers with a compelling and rigorous analysis of the real and potential impacts of EU integration on the organisation of healthcare provision and the protection of public health, highlighting the need to balance economic and social imperatives.

Europe - Person-centred care in Europe: a cross-country comparison of health system performance, strategies and structures

Published by the Picker Institute, an international charity based in England, this policy briefing compares patient or person-centred care within healthcare systems in the UK, Germany, Italy, Spain and the Netherlands. The briefing considers health system performance, strategies and structures, along with the cost-effectiveness of national person-centred care schemes.

Europe — Public consultation on the possible revision of Directive 89/105/EEC on the transparency of measures regulating the pricing and reimbursement of medicines

The European Commission is initiating a process of review of the “Transparency Directive” (89/105/EEC). In this framework, it is seeking the views of interested parties to determine how the existing EU rules on the transparency of pricing and reimbursement procedures for medicines may be modernised.

Europe — Remote patient monitoring and treatment can improve care provision

According to the study “Strategic Intelligence Monitor on Personal Health Systems (SIMPHS): Market Structure and Innovation Dynamics”, telemedicine can help make a difference in the face of an increasingly heavy burden of demand for service in the health sector. In an ageing Europe, where more and more citizens live with chronic diseases, it can prove very useful.

Europe - Delivering hospital services: A greater role for the private sector?

Produced by the EU, this report examines the provision of private hospital services in Europe. It maps the extent of private provision, examines the drivers for increased private provision, and presents the views of different stakeholders. The report also analyses the implications of private provision for the public sector, and for the efficiency, accessibility and quality of services.

Europe - Country-by-country profiles on national health situation relaunched

The WHO is launching a series of publications providing analyses of health situations in European countries. Written in collaboration with ministries of health, the series will be based on the WHO’s Health 2020 indicators, and will provide insights into national health system performance.

Europe - Mental health, human rights and standards of care

Published by the WHO, this report rates the quality of care and protection of human rights in mental health institutions in 20 European countries. The objective of the report is to address gaps in knowledge about these institutions and identify deficiencies in care standards through the lens of the United Nations Convention on the Rights of Persons with Disabilities.

Europe - Public reporting in health and long-term care to facilitate provider choice

Public reporting is a term used to describe the publication of information and reports on the quality of health care and long-term care providers. This WHO summary looks at public reporting in Europe, examining national contexts, reporting system design and policy issues and implications.

Europe - Typology of health policy reforms and framework for evaluating reform effects

This report from the European Commission's Expert Panel on Effective Ways of Investing in Health develops a typology of reforms that can be used to assess the impact and progress on areas such as coverage, equity, efficiency, quality and sustainability.

Europe - Practice conditions of family physicians in 5 European countries

In response to the passage, over the last several years, of regulations intended to organize the supply of general practitioners in France, the Observatoire national de la démographie des professions de santé undertook this study on the practice conditions of family doctors in France. The study is accompanied by a publication of case studies from different countries: Germany, Belgium, Spain, Netherlands and United Kingdom.

Europe — Health Care Developments in EU Member States. Regressing Trends and Institutional Similarity?

The purpose of this paper is to perform a diachronical cross-national analysis of health care services. Contrary to previous claims, the authors of this study find that European health care systems are not particularly hit by retrenchment and convergence is absent in key health care dimensions, namely coverage, financing and provision.

Europe - Scaling up projects and initiatives for better health: from concepts to practice

Scaling up means expanding or replicating innovative pilot or small-scale projects to reach more people and broaden an intervention’s effectiveness. Using a literature review and results from a survey of policymakers and experts in 10 European countries, this WHO booklet and toolkit addresses the practical challenges of public and private scaling-up activities within national health systems.

Austria - Austria Health system review, 2018

Published by the European Observatory on Health Systems and Policies, this snapshot of Austria’s health system in 2018 highlights recent reforms to improve governance, increase healthy life expectancy, and improve quality and efficiency of service delivery. Overall, Austria has one of the most effective health systems in Europe, with coverage, access, patient satisfaction and mortality rates significantly better than the European Union average.

Europe – European Commission publishes Eurobarometer on Mental Health

A poll released to mark World Mental Health Day reveals that during the 12 months preceding the survey, 15% of respondents across EU Member States sought professional help for psychological or emotional problems and 7% took antidepressants, mostly for depression or anxiety. According to the results, there is still stigma attached to mental disorders, with 22% of those surveyed saying they would find it difficult to speak to a person with a "significant mental disorder".

Europe - How do we ensure that innovation in health service delivery and organization is implemented, sustained and spread?

This WHO policy note reviews frameworks and factors supporting the successful introduction of innovation in health service organization and delivery. It illustrates these factors using examples of service innovations in European countries and describes the successful implementation, sustainability and spread of innovation in terms of health outcomes, administrative efficiency, cost-effectiveness, and user experience.

Europe - Health Systems Perspectives – A new European Observatory on Health Systems and Policies/BMJ collaboration

Health Systems Perspectives is a new occasional series published in the BMJ based on Observatory work. The series focuses specifically on developments in the European Union and the EU health policy agenda.

Europe - Evidence on financing and budgeting mechanisms to support intersectoral actions between health, education, social welfare and labour sectors

Intersectoral collaboration between health and welfare, education or labour sectors can influence the social determinants of health. Funding such collaboration is difficult as these sectors are subject to different regulatory structures. This review examines 51 documents from 12 European countries that describe use of various financial mechanisms to facilitate collaboration for health promotion involving at least two of these sectors.

Europe - The case for investing in public health: the strengthening public health services and capacity

Europe’s economic crisis has led to increased demand and reduced resources for health sectors. This WHO report outlines quick returns from public health interventions that promote healthy employment, housing, mental health, physical activity and nutrition. The report gives examples of interventions that can bring quick returns and approaches that promise longer-term gains.

Europe - Efficiency estimates of health care systems in the EU

This paper estimates the relative efficiency of European Union (EU) healthcare systems. Results show that average EU life expectancy could be increased by 1.8 years if lower performing systems moved to the highest efficiency levels. Belgium, Cyprus, Spain, France, Luxembourg, Sweden and the Netherlands consistently score among the top seven performers.

Europe - One place, one budget? Approaches to pooling resources for public service transformation

One approach to breaking down government silos has been to pool budgets to curtail inefficient multiple funding streams. This RAND Corporation report examines the experiences of nine European local government initiatives to pool budgets for services such as health and social care, vocational training, and public asset management.

Europe - Promoting better integration of health information systems: best practices and challenges

Produced by the WHO, this report addresses current trends in the 28 member states of the European Union (EU) around the integration of health information systems. To understand what better integration means from a pragmatic perspective, experts from 13 EU countries were interviewed and their views were combined with findings from a literature search.

Europe - Taking a participatory approach to development and better health. Examples from the Regions for Health Network

Released by the WHO, this report documents participatory approaches to development and health improvement taken by health systems with regional jurisdictions in four European countries. Case studies provide details of participatory health approaches in the regions of Skåne (Sweden), Trento (Italy), Andalusia (Spain), and Wales (UK).

Europe - European Observatory on Health Systems and Policies. New template for writing HiTs

The Observatory announces the launch of a new and improved template for the Health system profile (HiT) series. HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. They are produced by country experts in collaboration with the Observatory staff. The HiT template is designed to guide the writing of HiTs by setting out key questions, definitions and examples needed to compile a country profile of the health system.

Europe - Will population ageing spell the end of the welfare state? A review of evidence and policy options

Released by the European Observatory on Health Systems and Policies, this briefing reviews evidence on health and long-term care costs associated with aging populations to better understand escalating cost pressures due to changing demographics. It focuses on selected policy areas that either support the health and activity of older people or reinforce sustainable care systems more broadly in the context of population aging.

Europe - Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability

Prepared by the European Union (EU) Directorate for Economic and Financial Affairs, this report investigates policy challenges for the healthcare and long-term care sectors within the 28 member countries of the EU. It examines options on how to contain spending pressures through efficiency gains to ensure fiscally sustainable access to quality services.

Europe - How to make sense of health system efficiency comparisons?

Improving health system efficiency is a compelling policy goal, especially in systems facing serious resource constraints. This policy brief from the European Observatory on Health Systems and Policies proposes an analytic framework for understanding and interpreting the most common healthcare efficiency indicators.

Europe - Output and productivity growth in the healthcare sector: a study of four European countries

Funded by the European Union (EU), this study created indicators to study the performance of healthcare service sectors in four countries (UK, Spain, Hungary, and Germany). Separate sets of indicators provide information on market and non-market services while describing trends in growth and productivity. The authors also develop experimental indicators covering insurance, collective services, and research sector output.

Europe - Investment for health and well-being: a review of the social return on investment from public health policies to support implementing the Sustainable Development Goals by building on Health 2020

Based on a scoping review, this WHO report concludes that Europe's current public health investment policies and practices are unsustainable and carry high social, economic, and environmental costs. Instead, it advocates investment in policies based on values and evidence that contribute to social, economic and environmental sustainability. Investing for health and wellbeing is a driver and enabler of sustainable development.

Europe - Crises and reforms from a health perspective

This special issue of the IRES journal illustrates the importance of taking health seriously as a criterion for evaluating societies. The articles explore the effects of austerity policies on health services in Europe, the methodical dismantling of Greek healthcare institutions, the effects of unemployment, managerial reforms in healthcare institutions, and much more.

Europe - Benchmarking Access to Healthcare in the EU

This report from an expert panel in the European Union (EU) proposes a series of quantitative and qualitative benchmarks for assessing progress in reducing unmet need for health care. It also explores use of EU funds to improve access. Relying on the Survey of Income and Living Conditions (SILC), the report draws attention to the relatively high rates of unmet need in some EU countries.

Europe - Joint meeting of experts on targets and indicators for health and well-being in Health 2020

This report results from a February 2013 meeting of European experts convened by the WHO to discuss targets and indicators for health and wellbeing in the framework of Health 2020. Meeting delegates ratified a definition of wellbeing and reviewed research data and guidelines on tools and indicators for wellbeing.

Europe - New Action Plan agreed for innovative cross-border healthcare

European Union (EU) health ministers attending the May 2013 EU Ministerial eHealth Conference in Dublin agreed on a new ehealth action plan and Declaration on eHealth. These aim to prioritize the use of cross-border health information and communications technology (ICT) within the EU.

Europe - Leapfrogging health systems responses to noncommunicable diseases

This special edition of EuroHealth features two articles on ways to buttress and speed up European health system response to non-communicable diseases (NCDs). One article proposes policy responses to NCDs, while the other concentrates on interventions involving rapid adoption of innovation. Both articles explore areas that play an important role in tackling chronic conditions: public health, primary care, the health workforce, and information technology.

Europe - Identifying targets and indicators for monitoring Health 2020: results of regional consultation published

Following a web-based consultation with input from 30 Member States, this report presents revised indicators to measure progress in reaching the six Health 2020 targets. They and the proposed monitoring framework will be presented and submitted for approval to the sixty-third session of the WHO Regional Committee for Europe later this month.

Europe - Strengthening the measurement framework

The adoption of Health 2020, the European policy framework for health and wellbeing, marked a shift towards a values-based approach to health that has since proved complex to measure and report on. In response, the WHO convened an expert group to investigate ways to enhance Health 2020 monitoring and reporting. This report outlines recommendations made by the expert group.

Europe - Competition policy in five European countries. What can be learned for health policy in England?

This Health Foundation working paper is the final report of a project that produced case studies of competition policies in France, Portugal, Germany, The Netherlands and Norway. It finds that patient choice policies are increasingly common, that the process to determine hospital tariffs differs across countries, and that introducing GP competition is controversial.

Europe - Evidence on mechanisms and tools for use of health information for decision-making

Published by WHO Europe, this report describes tools and mechanisms to increase the use of health information in policy development. It describes synthesis methods, information packaging, and tools for using surveillance data and modelling. The dissemination and communication tools discussed include health information-sharing platforms and social media.

Europe - Euro health consumer index 2012

Published by the Health Consumer Powerhouse, the sixth edition of the Euro Health Consumer Index offers a performance-related comparison of 34 national healthcare systems across Europe. This year’s report says user-friendliness has become a major quality performance driver.

Europe - Headline Indicators for Structured Monitoring of Health System Performance in Europe

Published by EuroHealth, this article proposes using a prioritized set of indicators identified from 43 health system performance assessments (HSPA) to inform comparative analysis of policy impacts. The set of 95 indicators were assessed for relevance to HSPA domains of access, efficiency, equity and quality of care. Indicators to monitor performance on key public health objectives in were identified.

Europe - Health Systems, Health, Wealth and Societal Well-being

This book by the European Observatory on Health Systems and Policies is a compilation of studies arguing that health systems are not a drag on resources but a means to improve societal health to achieve economic growth. The book’s 18 authors take a multidisciplinary look at interdependencies between health and wealth.

Europe - Austerity and health: the impact in the UK and Europe

Government austerity measures have enormous social impact, including on health. This review evaluates the evidence of austerity’s health impacts using two mechanisms: a ‘social risk effect’ of catalogued socio-economic risk factors, and a ‘healthcare effect’ viewed through analysis of service cuts, reductions in coverage, and restrictions on access to care.

Europe - Social investment: Commission urges Member States to focus on growth and social cohesion

This Communication from the European Commission, issued on February 20, 2013, calls on Member States to prioritise social investment and modernise their welfare states, including a more efficient and effective use of social budgets. It states that social investment today will help to prevent Member States having to pay much higher financial and social bills tomorrow.

Europe - Health system performance assessment. Reporting and Communicating. Practical guide for policy makers

Published by the European Union (EU), this paper is for policymakers conducting health system performance assessments and provides practical tips and advice on ways to effectively report and communicate their findings. Four steps in the process are described: defining performance assessment goals, identifying target audiences, determining methodology, and implementing monitoring to provide evaluation and effective feedback. Examples are provided for each step.

Europe - Commission proposes faster access to medicines for patients

On March 1, 2012, the European Commission proposed to streamline and reduce the duration of national decisions on pricing and reimbursement of medicines. In future, such decisions should be taken within 120 days for innovative medicines, and within 30 days for generic medicinal products instead of the current delay of 180 days. The Commission also proposes strong enforcement measures in case the decisions do not comply with the time limits, as these are often exceeded by Member States.

Europe - Euro health consumer index 2017

The 2017 edition of the Euro Health Consumer Index (EHCI) has been released, assessing the performance of healthcare systems in 35 European countries. The EHCI analyzes national health care on 46 indicators, looking into areas such as patient rights and information, access to care, treatment outcomes, range and reach of services, and use of pharmaceuticals.

Europe - Strengthening health-system emergency preparedness. Toolkit for assessing health-system capacity for crisis management

In preparing for health crises, health systems face the prospect of multiple hazards, limited resources for dealing with them and high expectations of their performance. With the European Commission Directorate-General for Health and Consumers, the WHO Regional Office has developed a toolkit to assess health-system capacity for managing crises. Pilot tested in several countries since 2007, it helps countries assess the capacity of their health systems to respond to various threats and identify gaps.

UK — Assessing Welfare Effects of the European Choice Agenda: The case of health care in the United Kingdom

Choice and competition policies in public services are popular reform strategies in the member states of the European Union (EU). This paper discusses choice policies in European countries and uses the case of choice in health care in the UK to assess the welfare effects of choice and competition. The results indicate positive effects of choice, particularly for middle class individuals.

Europe - Euro Health Consumer Index 2013

The Euro Health Consumer Index (EHCI) is produced annually by the Health Consumer Powerhouse to report on European healthcare systems from the perspective of consumers and patients. The EHCI offers reality checks for policy makers, empowerment to consumers, and an opportunity for stakeholders to highlight weak and strong aspects of health care.

Europe - Promoting health, preventing disease: is there an economic case?

This report from the European Observatory of Health Systems and Policies presents the evidence for interventions that address risk factors to health. Many such actions are delivered outside the health sector. Most interventions bring long-term cost benefits, making efforts aimed at children more cost-effective than others.

Europe - A European Flavour for Medicare. Learning from experiments in Switzerland and Sweden

This paper published by the MacDonald-Laurier Institute compares Canada’s healthcare system with Sweden and Switzerland, two countries in the middle of the public/private spectrum whose health systems rank high internationally. The paper also describes how the UK government in the 1990s sold Britons on market reforms to the National Health Service (NHS).

Europe - Building resilience: a key pillar of Health 2020 and the Sustainable Development Goals – Examples from the WHO Small Countries Initiative

Strengthening resilience is central to Health 2020, the WHO European policy framework for health and well-being. This publication explains the concept of resilience and its implications for health at three levels (individual, community and system/society). It presents knowledge gained from three countries participating in the WHO Small Countries Initiative (Iceland, Malta and San Marino).

Europe - Governance for health equity in the WHO European Region

This report from the WHO analyzes why policies and interventions to address social health determinants and health inequities succeed or fail. It discusses features of governance and systems for service delivery that increase success in reducing inequities, and presents a checklist for health equity governance.

Europe - Varieties of Health Care Devolution: “Systems or Federacies”?

Some European countries have devolved healthcare services to subnational units. This paper examines broad trends in two types of devolution: a federacy model, where only a few territories obtain healthcare responsibilities (seen in the UK), and a systems model, where the whole health system is devolved to subnational units (such as in Spain). Findings suggest that the systems model gives rise to significant policy interdependence.

Europe - Culture matters: using a cultural contexts of health approach to enhance policy-making

Published by the WHO, this policy brief explores the three key public health areas of nutrition, migration and the environment. It demonstrates how cultural awareness is central to understanding health, wellbeing, and the development of effective and equitable health policies. The brief argues that public health policy-making should apply research from the humanities and social sciences.

Europe - Using Evidence. What works? A discussion paper

Identifying 354 uptake models from the research literature, this paper notes that an entire industry now helps identify ways to link research to practice in many fields, especially healthcare. The paper discusses the literature’s most effective strategies to increase appropriate uptake of research evidence in health care and includes over 50 examples and case studies.

Europe - A resource for developing an evidence synthesis report for policy-making

This 50th edition of the Health Evidence Network (HEN) Synthesis Reports summarizes the best available global findings on public health questions from peer-reviewed and grey literature, and proposes general directions, strategies and actions for consideration. The resource has been developed to outline key approaches, methods and considerations supporting the systematic use of the best available evidence for public health policymaking.

Europe - Evidence synthesis for health policy and systems: a methods guide

This guide to methods for synthesizing evidence from health policy and systems research examines quantitative, qualitative and mixed method synthesis strategies. It also provides practical guidance for engaging decision-makers in evidence synthesis and fostering the uptake of findings in policy and practice. Suggestions are included for framing a synthesis question, assessing context-sensitive evidence, understanding complexity, addressing health equity, and selecting appropriate synthesis approaches.

Europe - Health and inequality in health in the Nordic countries

Comparing population health, access to health care, and inequalities in the five Nordic countries (Iceland, Norway, Denmark, Sweden and Finland), Germany and the UK, this 2002-2012 study found that Nordic countries lead in access, services, and population health, and have fewer health inequalities. Sweden rated first among the Nordic countries while low-income citizens experienced the best health and care in Iceland.

Europe - WHO report shows urban green spaces deliver multiple health benefits

Urban green spaces reduce morbidity and mortality in city residents by providing relaxation, supporting physical activity, and reducing exposure to air pollutants, noise, and excessive heat. This WHO report summarizes evidence of health benefits, discusses pathways to health, and evaluates health-relevant indicators of urban green space. An example of a green space accessibility indicator and methodological tool kit is provided.

International - The private healthcare market and the sustainability of an innovative community nurses programme based on social entrepreneurship - CoNSENSo project

CoNSENSo is a European Union (EU) project to develop a community nursing model to support active aging in Europe’s remote mountain areas. The sustainability of the approach relies on social entrepreneurship in the healthcare market. This research, undertaken in Italy’s Piedmont region, highlights conditions for successful implementation, and finds that the private supply of healthcare services can support active aging in mountain areas.

Europe - Understanding the Drivers of Organisational Capacity

Conducted by the RAND Corporation, this study aims to improve the ability of organizations to measure capacity and harness organizational culture to optimize performance. Based on interviews and a literature review, the study analyzes the dimensions of organizational capacity, explores how organizational culture and communication interact with capacity building, and paves the way for future development of a diagnostic tool for organizational capacity assessment.

Europe - Health system efficiency: How to make measurement matter for policy and management

In this 242-page book, five authors explore efficiency measurement in health systems and offer insights into the pitfalls and potential associated with various measurement techniques. The authors use examples from various countries to examine how policy-makers and healthcare managers use efficiency measurement and suggest ways to make better use of efficiency measurement in the future.

Europe - Key policies for addressing the social determinants of health and health inequities

Evidence indicates that four areas (early child development, employment, security and the living environment) have the greatest effect on social determinants of health and health inequities. This WHO briefing identifies practical policy options for action that focus on early childhood education and care; child poverty; labour market programs; working conditions; social cash transfers; and regulatory mechanisms to improve air quality.

Europe - Making the economic case for investing in health systems. What is the evidence that health systems advance economic and fiscal objectives?

Intended to counter the idea that the expense of public health systems hinders the achievement of other governmental fiscal objectives, this WHO briefing argues instead that health systems play an increasingly important role in national economies. The authors marshal evidence from a wide variety of sources, including the financial sector, to support health system policy-makers engaged in governmental debates about public spending.

Europe - Urban green space interventions and health: A review of impacts and effectiveness. Full report (2017)

Published by the WHO, this report on interventions to establish urban green spaces summarizes evidence of their health benefits, particularly for individuals of lower socioeconomic status. The report evaluates health-relevant indicators of urban green space and concludes that interventions are most effective when coupled with a promotional social engagement/participation element to reach target groups.

International - Peer Review in Slovenia: Long-term care – the problem of sustainable financing

Slovenia is preparing a major reform of its fragmented long-term care (LTC) system and is introducing long-term care insurance. A Peer Review held in Ljubljana on November 18 and 19, 2014, brought 12 Member States and stakeholders together to discuss how to ensure adequate and sustainable financing of LTC. This report, published by the European Commission, presents results of the meeting.

Europe - Monitoring framework agreed to assess progress on NCDs

In November 2012, member states of the WHO agreed on a global monitoring framework to prevent and control non-communicable diseases, including cancer, diabetes, heart disease and chronic lung conditions. The new framework focuses efforts to address these diseases and assess progress in reducing associated illness and death.

International - Health: the high cost of diabetes

Across OECD countries some 83 million people suffer from diabetes. On current trends, that will rise to almost 100 million by 2030. Speaking at the European Diabetes Leadership Forum in Copenhagen, OECD Deputy Director General Yves Leterme said, “Preventing and treating diabetes and its complications costs about €90 billion annually in Europe alone.

Health system performance comparison: an agenda for policy, information and research

Brief analytical summaries or syntheses #44 Health system performance comparison an agenda for policy, information and research Summary This WHO policy brief calls for more international comparisons of health system performance. It describes the methodology of international comparative studies, key domain comparators, and cites the benefits of international comparison in policy influence and as a source of evidence. Background This policy brief seeks to summarize the current “state of the art” of health system comparison, identifying data and methodological issues and exploring the current interface between evidence and practice. It also draws out the priorities for future work on performance comparison, in the development of measurement instruments, analytic methodology, and assessment of evidence on performance. It concludes by presenting key lessons and future priorities policy-makers should take into account. Analysis and results Comparing key domains of performance Population health measures often take a broad perspective, which captures the effect of…

Financial sustainability and affordability of health care systems. Lessons from OECD countries

Brief analytical summaries or syntheses #46 Financial sustainability and affordability of health care systems. Lessons from OECD countries Summary This presentation by Mark Pearson, head of the Health Division at the OECD, reviews how health spending has been affected during the economic crisis in various countries. the author makes some recommendations on how policy should react. The presentation was delivered at the International Conference of Social Security Actuaries and Statisticians that took place in Berlin from May 30 to June 1, 2012. Background The problem facing many European health systems is one of fiscal unsustainability. Claims that health spending is good value for money compared to many other things that people purchase are beside the point. Fiscal sustainability needs to be restored in the short term and once this is done, there will still remain the longer-term challenge of ensuring economic sustainability, which requires a different agenda of policies –…

Europe - The Evolution of Healthcare managers' role: a comparison France/United Kingdom

This study on nurses’ job satisfaction from the University of Lyon compares the expanding roles of healthcare managers in France and the UK. It concludes that the evolution of the healthcare manager role has negative consequences for workplace relations and staff retention in both countries, and suggests research into new modes of leadership.

International - DISMEVAL Developing and validating disease management evaluation methods for European healthcare systems: Final report

This RAND Corporation technical report documents the overall findings of the work carried out within the DISMEVAL project that reviewed current approaches to chronic care and explored the policy context for chronic disease management in European countries. It also sought to test and validate different evaluation methods using data from disease management interventions in six countries.

Russian Federation – Health System Review.
Health systems in transition, 2011

Brief analytical summaries or syntheses #37 Russian Federation – Health System Review. Health systems in transition, 2011 Summary The WHO produces health system profiles (HiTs), which are country-based reports providing a detailed description of health systems and policy initiatives. This HiT on the delivery of health care in Russia examines different approaches to the organization, financing and delivery of health services in that country, along with the roles of main local actors. Background At independence from the Soviet Union in 1991, the Russian health system inherited an extensive, centralized Semashko system, but was quick to reform health financing by adopting a mandatory health insurance (MHI) model in 1993. While the health system has evolved and changed significantly since the early 1990s, the legacy of having been a highly centralized system focused on universal access to basic care remains. High energy prices on world markets have ensured greater macroeconomic stability, a…

Spain - The search for low-cost integrated healthcare: the Alzira model – from the region of Valencia

European health care systems all face similar challenges: ageing populations, rising costs, and increasing demand. This report by the European Office of Britain’s National Health Service (NHS) looks at the Alzira Model of Spain’s Valencia region, which has taken a pioneering approach to the provision of health care through public-private partnerships.

Canada - Better Value for Money in Healthcare: European Lessons for Canada

This commentary from the C.D. Howe Institute says Canadian health care would benefit from a serious look at European countries’ efforts to align incentives within their health systems to encourage better performance. Health systems in the U.K. and Netherlands have conducted reforms to attain greater value for money while continuing to adhere to equity principles similar to Canada’s.

Europe – Health. Comparative analysis of public spending in France and Germany

Santé. Analyse comparative de la dépense publique en France et en Allemagne If France brought its public health expenditure per capita down to German levels, it would save 7.2 billion euros a year. This report describes a French system that is running on empty and, while it offers efficient care now, will not be able to respond to future challenges such as population aging. The comparative approach with Germany proposed by the author offers a vision of the magnitude of effort required to produce reform. The comparison with Germany is justified by population size and by its comparable quality of care.

Europe - Decomposing the productivity differences between hospitals in the Nordic countries

This Norwegian study collected Scandinavian hospital data on operating costs and patient discharges and broke down productivity levels into technical/scale efficiencies and country-specific results. The study found small differences in scale and technical efficiencies between countries alongside larger differences in country-level production possibilities.

International - Incentives for telehealthcare deployment that support integrated care: a comparative analysis across eight European countries

This Spanish study investigated 31 telehealth initiatives across eight European countries to identify factors that promoted the use of telehealth applications to support integrated care. The study found a trend towards greater uptake in the presence of outcomes-based and bundled payment schemes, but sees a need to design more effective incentive models.

International - Getting better: improving health system outcomes in Europe and Central Asia

Instead of catching up with their Western neighbours, many countries in Eastern and Central Europe have been falling behind. This report from the World Bank identifies three key agendas for achieving more rapid convergence with the world's best-performing health systems. First is to strengthen public health and primary care interventions to help achieve the 'cardiovascular revolution' that has taken place in the west in recent decades. Second is to improve healthcare financing and the use of resources. The third agenda relates to broader institutional arrangements.

Responding to the challenge of financial sustainability in Estonia’s health system : one year on

Brief analytical summaries or syntheses #29 Responding to the challenge of financial sustainability in Estonia’s health system one year on Summary This WHO follow-up report looks at changes in Estonian health care financing one year after a comprehensive WHO analysis. It reviews developments in four areas where policy recommendations had been made. Background Health system financial sustainability has always been a central health policy issue, but the recent financial crisis has forced it to the top of the policy agenda the world over. With the aim of supporting a financially sustainable, high-performing health system, this report assesses health financing policy in Estonia. It looks at how well placed current financing policy is to enable goal attainment in the medium-to-long term (to 2030) and identifies ways to strengthen financing policy. The report is the result of a year-long process of stakeholder consultations and expert analysis initiated by the Ministry of Social…

Europe - How can telehealth help in the provision of integrated care?

This policy brief is divided in four parts: 1. Health policy context and current use of telehealth, 2. What do we know about the benefits and effectiveness of telehealth? 3. Policy options to help foster use of telehealth as a support to integrated care systems, 4. Identifying alternative ways of bringing about change.

Germany - The organizational‐institutional transformation of the German Healthcare System: mixing rescaling, privatization, and managerialism

Since the early 1990s, European public health care systems experience dynamic transformation processes. Health care systems have come under the pressure of strong financial constraints, indicating the end of the “golden age” of welfare state policy. Thus, the most important issue at hand is cost control. Various tools have been employed in order to contain rising costs. The broad range of different reform measures can be categorized into three major reform types, namely privatization, managerialization and rescaling, e.g. the reshaping of the distribution of decision‐making authority. In all European health care systems – albeit in different forms and with differing degrees – market mechanisms have been implemented in health care financing as well as in health care provision. The following case study assesses the impact of the regulatory changes on the German health care system.

Europe — Chronic diseases. A clinical and managerial challenge

The HOPE exchange programme has reached in 2010 its 29th edition. Participants of HOPE Exchange Programme 2010 were invited to explore and report to their colleagues about the best practices implemented in their hosting countries to tackle chronic diseases and improve well-being of chronic patients. The present report has the specific objective of presenting the content and findings of the HOPE Agora 2010.

Europe — (Re)centralizing tendencies within Health Care Services. Implementation of a new idea?

Decentralization has been for many years a widespread trend in health care sectors throughout Europe. Yet, more recently, a new host of reforms is observable implying an ambition of some states to regain lost control. What is the general trend of (re) centralisation about and what happens when reforms promoting (re) centralisation are translated in different national contexts; e.g. in what way contextual factors modify a general trend? The establishment of regional health authorities in Norway and regional hospital agencies in France will be used as examples to analyze the spreading and transformation of (re)centralisation.

Italy - EU integration and health systems: challenges and opportunities for patients, professionals and policy-makers

The Observatory Venice Summer School brings together high-level policy-makers in a stimulating environment. Organized by the European Observatory on Health Systems and Policies and one of its partners, the Veneto Region of Italy. it draws on their experiences of promoting evidence-based policy-making and of providing a unique platform for European health policy debate in action. The Summer School will take place in Venice on July 25-31, 2010.

Canada - Euro-Canada Health Consumer Index 2010

This is the third annual Euro-Canada Health Consumer Index (ECHCI). The ECHCI is an international comparison of healthcare system performance in 34 countries. All 27 European Union member states are examined, along with Norway, Switzerland, Croatia, FYR Macedonia, Iceland, Albania and Canada. For the third straight year, the Netherlands finishes in first place in the ECHCI, earning 857 out of 1,000 possible points.

International - Economic Transition and Health Care Reform: The Experience of Europe and Central Asia

This paper exploits the staggered adoption of major concurrent health reforms in countries in Europe and Central Asia after 1990 to estimate their impact on public health expenditure, utilization, and avoidable deaths. While the health systems all derived from the same paradigm under central planning, they have since introduced changes to policies regarding cost-sharing, provider payment, financing, and the rationalization of hospital infrastructure.

Europe - Measuring and managing performance

This issue of Eurohealth focuses on performance monitoring to maintain high quality health services. Also covered are the topics of user fees in the Czech Republic; private sector providers in England; barriers to physician workforce development in Uzbekistan; and providing a solid evidence base for policy makers through the ECHI initiative.

International - Chronic Disease Management Matrix 2010. Results of a survey in ten European countries

Although the greatest threat to population health today comes from chronic diseases such as cancer, COPD, cardiovascular disease and depression, there has been little institutional response to these threats from national healthcare systems. This European survey conducted in 2010 assesses the situation in 10 countries, first establishing criteria for relevant Chronic Disease Management Programs (DMPs), and then investigating health systems’ implementation of DMPs on a national, regional or local basis.

International — Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature

The aim of this review was twofold: firstly, to gain insight into the scientific and professional literature describing the extent to and the ways in which nurse prescribing has been realised or is being introduced in Western European and Anglo-Saxon countries; secondly, to identify possible mechanisms underlying the introduction and organisation of nurse prescribing on the basis of Abbott's theory on the division of professional labour.

Europe - Putting our own house in order: examples of health-system action on socially determined health inequalities

This publication will give policy advisers, policy entrepreneurs and those who work in health systems a better understanding of the keys to taking action on socially determined health inequalities. It shows how to systematically generate and use evidence-informed options for action from a selection of case studies. It also contains a checklist of generic principles that can be put into practice or used to review existing examples of health-system actions and that can assist in designing and developing a tailored policy response. The publication illustrates the wide range of actual and potential actions that the health system can take to “put its own house in order”: ensuring equity of access to health services and improving the investment in and approach to working with other sectors so that the health system is instrumental in creating the conditions for health for all groups in the population.

Europe — Medical Technology and the Production of Health Care

This paper investigates the factors that determine differences across OECD countries in health outcomes, using data on life expectancy at age 65, over the period 1960 to 2007.

Europe — Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects

In a world where there is increasing demand for the performance of health providers to be measured, there is a need for a more strategic vision of the role that performance measurement can play in securing health system improvement. This volume, first published in 2009 and now free to download, meets this need by presenting the opportunities and challenges associated with performance measurement in a framework that is clear and easy to understand.

International - Health spending starts to rise but remains weak in Europe, says OECD

Released on June 30, 2014, this latest OECD report shows that health spending has started to rise again after stagnating or even falling in many OECD countries during the financial crisis, but that the pace of growth remains well below pre-crisis rates, especially in Europe. Overall health spending accounted for 9.3% of GDP on average across OECD countries in 2012. Mexico has very strong growth in health spending, at 8.5%, as it works toward universal coverage and access to health care.

Canada - Rethinking Canada’s Unbalanced Mix of Public and Private Healthcare: Insights from Abroad

This commentary from the CD Howe Institute asserts that Canada’s public-private healthcare mix is unbalanced compared to European countries and blames the restrictions imposed on the private financing of hospital and physician care. The author describes how European health systems without similar restrictions devote a larger share of public resources to drugs and long-term care.

Switzerland – Switzerland: Health system review. Health Systems in Transition, 2015

The European Observatory on Health Systems and Policies presents a look at the health system in Switzerland, where life expectancy is the second highest in Europe. It examines efforts since 2000 to improve the country's mandatory health insurance program, and discusses challenges in lowering healthcare spending as a percentage of GDP and reducing the burden of out-of-pocket costs on lower income households.

Europe - Health Statistics for the Nordic Countries 2015

Published annually, the 2015 edition of Health Statistics for the Nordic Countries (Scandinavia, Finland, Iceland and Greenland) presents data on population trends, illness, hospital treatment and causes of death. Descriptions of the structure and resources of Nordic countries' health sectors are provided. Trends towards integrated and community services are evident.

Europe - Weekend Mortality on the Continent. The cases of Germany and France

Increases in mortality over weekends in the UK are attributed to lower clinical staffing, urgent medical needs and more complex surgeries. This study by British researchers investigates whether mortality goes up at weekends in Germany and France. It finds a weak weekend effect in Germany, but cannot establish one in France because of a lack of data.

Europe - Promoting Health, Preventing Disease: The economic case

Available for download, this book by British and French authors provides an economic perspective on health promotion and chronic disease prevention, and gives a rationale for assessing the economic case for action. It provides a review of the international evidence base for public health interventions that addresses effectiveness, implementation costs, impacts on health expenditures, and wider economic consequences.

Europe - Healthcare Reform in Italy and Spain: Do these tax-financed, decentralised systems facilitate better reform implementation than in the NHS?

Like Britain’s National Health Service (NHS), Italy and Spain have tax-financed and decentralized healthcare systems and have recently undergone reforms prompted by austerity. This UK report investigates the effects of each country’s reforms on healthcare outcomes, primary care, and core values. It finds that health outcomes are poorer in the UK and that primary health care in Italy and Spain remains more efficient, equitable and decentralized.

Europe - New procurement model can increase the impact of health and social care services

A new procurement model to increase the impact of health and social care services has been developed in Scandinavia. Tested in Finland’s health system, the VABPRO Nordic value-based model helps public providers improve outcomes by reconfiguring services around user needs. Value and outcome are recent concepts in Scandinavian care systems that previously focused on resources, production and output.

Europe - Smart governance for health and well-being: the evidence

Governance for health describes the attempts of governments and other actors to steer communities, whole countries or even groups of countries in the pursuit of health as integral to well-being. This study tracks recent innovations to address the priority determinants of health and categorizes them into five strategic approaches to smart governance for health. It relates the emergence of joint action by the health and non-health sectors, public and private actors and citizens, all of which have increasing roles to play in achieving seminal changes in 21st-century societies.

Europe — Decentralization in health care

The new Spring issue of Euro Observer looks at decentralization as a governance tool in health care. Case studies on Norway, Spain and the United Kingdom highlight how decentralized arrangements work in practice in these countries.

Portugal - Portugal: Health system review. 2011

This European Observatory Country Profile provides a detailed description of the health system and of policy initiatives in progress or under development in Portugal. It shows a population that enjoys good health and increasing life expectancy, a health system that has not undergone any major changes on the financing side since the early 1990s, and a steady growth in public health expenditure. The system is financed largely through taxation, but co-payments have been increasing, primarily for pharmaceuticals. Recent measures have aimed to improve performance.

International - International profiles of health care systems

This publication from the Commonwealth Fund presents overviews of health care systems in nine European countries, Japan, Australia, Canada, and the U.S. Each overview covers insurance, financing, organization, quality of care, health disparities, efficiency and integration, information technology usage, use of evidence-based practice, cost containment, and reform and innovation. Summary tables provide data on key characteristics and performance indicators.

The Netherlands - Health System in Transition, 2016

Produced by the WHO, this review looks at the current state of health care in the Netherlands. While the country has some of Europe's highest per capita health expenditures, costs are slowing considerably following of the introduction of managed system competition and universal social health insurance. Out-of-pocket payments are low from an international perspective, and healthcare quality remains high.

Austria - Public Health in Austria. An analysis of the status of public health

Published by the European Observatory on Health Systems and Policies and carried out by the London School of Economics on behalf of the Austrian government, this report argues that orienting health policy solely towards the health care sector is too limiting. It highlights areas of public health in which Austria is lagging and offers recommendations for improvement.

UK - Improving Efficiency and Resource Allocation in Future Cancer Care

This report examines evidence regarding cancer care efficiencies and resource allocation in nine European countries in order to draw lessons for UK oncology services. It provides an overview of the costs of cancer, the health burden and resources devoted to cancer care, and offers case studies of where efficiencies can be made across the NHS system.

Canada - Research Synthesis on Health Financing Models: The Potential for Social Insurance in Canada

Coverage by the various provincial plans for services not mandated by the Canada Health Act is uneven, raising equity concerns. The social insurance (SI) model has been suggested as a way to raise revenue to improve access to non-CHA services. This study begins with a description of how SI functions in four European countries and addresses a number of crucial questions about the SI model’s impact on risk sharing, delivery systems, jobs and income growth and cost control.

Germany - Informing the development of a resource allocation framework in the German healthcare system

This report provides the National Association of Statutory Health Insurance Physicians in Germany with an overview of quality indicators and approaches that are currently used for ‘high stakes’ assessment in a range of countries in Europe and elsewhere and so inform the development of the quality component of a proposed national resource allocation framework in the German statutory healthcare system.

International - Better Health. A Shared Challenge for Hospitals and Primary Health Care

This report from HOPE (European Hospital and Healthcare Federation) discusses the findings of this year’s congress, HOPE Agora 2011, held in Turku, Finland on June 20 and 21, 2011. Findings are presented on the congress’s central themes: rational reforms, locally implemented patterns, role changes for health professionals, and home care.

International - Framework for assessing, improving and enhancing health service planning

This report aims to contribute to policy learning across countries from the diversity of healthcare planning approaches in Europe and elsewhere through developing and validating a framework for assessing, improving and enhancing healthcare planning. It identifies a set of criteria within three broad themes: "Vision", "Governance" and "Intelligence", which were then tested empirically through an in-depth analysis of four countries, using a case study approach: Germany, Austria, Canada (Ontario) and New Zealand.

International - Declaration of Astana charts course to achieve universal health coverage, 40 years since declaration on primary health care in Alma-Ata

On October 26, 2018, at a WHO conference in Astana, Kazakhstan, 150 countries agreed to a new global commitment to primary health care for all. The Declaration of Astana reaffirms a historic 1978 declaration in which world leaders first committed to primary healthcare at a WHO conference in the Kazakh city of Alma-Ata.

Netherlands - The Netherlands: Health system review. Health Systems in Transition

The Health System in Transition’s (HiT) profile on the Netherlands was co-produced by the European Observatory on Health Systems and Policies and NIVEL, Netherlands Institute for Health Services Research. The report examines the organisation’s financing and delivery of health services and the role of the main actors in the health system.

Europe - Scandinavian long-term care financing

The Scandinavian systems (Denmark, Norway and Sweden) for financing long-term care are remarkably similar. The institutional setup is almost identical in the three countries: the local government carries the main responsibility for funding and provision of long-term care, and the national government defines general goals and principles for the locally provided services. These general goals and principles are also very similar between the countries. Differences between the three countries are notably only in the emphasis of different types of services, or in details concerning the design of schemes for user charges.

Italy - The Veneto model – a regional approach to tackling global and European health challenges, 2016

This WHO report addresses health policy and practice in the northern Veneto region of Italy around the city of Venice. The report examines how Veneto promotes and provides health and social care with an emphasis on community and home care, and describes how the region’s autonomous healthcare system was developed.

Republic of Korea: Health system review. Health Systems in Transition, 2009

This paper produced by the European Observatory on Health Systems and Policies focuses on major health care reforms carried out in the last (ten)10 years. These include the integration of existing health insurance funds into a single insurer system in 2000 and the incremental expansion of the benefit package.

International - WHO calls for global action on diabetes

The WHO released its first Global report on diabetes on April 7, 2016. It states that the number of adults living with diabetes worldwide has almost quadrupled since 1980, to 422 million, with prevalence rates in some European countries of up to 14%. The new report calls upon governments to ensure that people are able to make healthy choices and that health systems are able to diagnose, treat and care for people with diabetes. It encourages us all as individuals to eat healthily, be physically active, and avoid excessive weight gain.

Europe - Preferences for Health Insurance in Germany and the Netherlands – A Tale of Two Countries

This paper seeks to answer two questions. Are preferences of German and Dutch consumers similar or dissimilar with regard to attributes of health insurance? Did the information campaign launched by the Dutch government in the context of the 2006 reform have an effect?

Belgium - Model for the Organization and Reimbursement of Psychological and Orthopedagogical Care in Belgium

Based on an analysis of mental health care and reimbursement in selected European countries, and a review of mental health services in Belgium, this report discusses the possible introduction of psychotherapy into the reimbursement package of Belgium’s national health insurance. A financing model is included.

International - A New Resource for Exploring Health Care around the World

This website presents profiles of healthcare systems in 18 countries in Europe, North America, and Asia, along with Australia. Readers can compare health system organization and insurance, financing, quality, coordination, efficiency, integration, information technology use, evidence-based practice, cost containment and recent reforms and innovations.

International - Implementing Health Financing Reform. Lessons from countries in transition

This book analyses health financing reforms in central and Eastern Europe, the Caucasus, and central Asia. Reforms are analysed first from a functional perspective, focusing on revenue collection, pooling, purchasing and benefit entitlements. Subsequent chapters analyse particular financing reform topics including: financing of capital costs; links between reforms and the wider public finance system; financing of public health services; voluntary health insurance; informal payments; and accountability in financing institutions.

UK - Clinical and service integration. The route to improved outcomes

This report summarises relevant evidence about high-profile integrated systems in the United States, such as Kaiser Permanente and Geisinger Health System and outlines examples of integrated care in North America and Europe. It also explores the range of approaches to improving co-ordination for individual patients and carers. The report focuses on examples that are most relevant to the NHS in England in the context of the coalition government's programme. The authors of the study hope that it will help inform the future direction of reform.

Spain - Spain. Health system review

This review of Spain’s health system finds that public healthcare spending (71% of total health spending) is once again on the rise, further strengthening the primary care sector. While structural measures are needed to improve resource allocation, technical efficiencies, and the provision of patient-centred care, life expectancy in Spain continues to be the highest in the European Union (EU).

International - The association between social exclusion or inclusion and health in EU and OECD countries: a systematic review

Social exclusion (SE), the inability to participate fully in society, is one of the driving forces of health inequalities. Evidence on the subject is pertinent but scarce. This review systematically summarizes 22 studies examining the association between the multidimensional concepts of SE, social inclusion (SI), and health among adults in European Union (EU) and OECD countries.

International - Spending cuts on health care in countries badly affected by the economic crisis impede access to care

This report, published by INSEE in France, examines the impact of the economic crisis begun in 2008, which caused a reversal in health spending trends that, in the 30 years before the crisis, grew fairly consistently in most European countries. The report finds that in some countries, measures implemented after the crisis have reduced access to care, and especially to medicines. Although life expectancy has not declined, life expectancy in good health has declined in Greece and Italy.

Belgium - Performance of The Belgian Health System - Report 2015

Using 106 indicators, this report on Belgium’s healthcare system from 2008 to 2013 lists the system’s strengths and weaknesses, and recommends future priorities for performance improvement. Overall, Belgians are satisfied with their health care, and 78% consider themselves healthy. In terms of quality of care, the country is slightly above the European average.

Switzerland - Health 2020: 10 priorities for 2016

The Swiss government has announced its top 10 health priorities for 2016 in line with the European Union (EU) Health 2020 framework. The measures include a strategy for the prevention of non-communicable diseases and the launch of consultations on modifying health insurance to introduce a reference price system.

France: Health system review. Health Systems in Transition, 2015

Assessing the current performance of France’s healthcare system, this review notes that, while the French population has a good level of health, the overall picture is mixed. Rising healthcare costs along with large-scale health inequalities across socioeconomic and geographical groups are increasingly problematic. Public financing of healthcare expenditure is nearly the highest in Europe.

International - Nurses’ Reports on Hospital Care in Five Countries

A new study of more than 43,000 nurses practicing in more than 700 hospitals in five countries indicates that fundamental problems in the design of work are widespread in hospitals in Europe and North America. Its findings further suggest that major workforce management problems in hospitals must be corrected to ensure acceptable quality of care and an adequate nurse workforce for the future.

Luxembourg - The HiT in brief review for Luxembourg reveals some room for efficiency gains

Published by the WHO, this review of health care in Luxembourg says performance in terms of high life expectancy, low infant mortality, and low out-of-pocket payments is better than the European Union (EU) average. Long lengths of stay combined with low occupancy rates signal possibilities for efficiency gains in the hospital sector.

International - Health systems in times of global economic crisis: an update of the situation in the WHO European Region. Report

This report was produced from a follow-up, held in April 2013, to an original meeting in 2009 on health and the financial crisis. The meeting reviewed the impact of the economic crisis on health and health systems, and focused on three themes: reinforcing equity, solidarity and universal coverage; and coping mechanisms, with a focus on efficiency and health system resilience. Policy recommendations were prepared for consideration by member states.

International - A roadmap for comparing readmission policies with application to Denmark, England and the United States

Reducing unnecessary hospital readmissions can improve quality and save costs. This paper by a group of European researchers reviews readmission policies in Denmark, England, Germany and the US Medicare system. It finds that readmission policies vary widely and develops a comparative roadmap to evaluate ways for countries to adopt each other’s policies.

Canada - Canada should not allow two-tiered practicing for medically-necessary services

Comparing Canada with European nations that operate two-tiered health systems with both public and private care, this paper argues that Canada should not allow a two-tiered approach to medically necessary services. It says doing so will weaken healthcare outcomes in the public system as practitioners migrate to the private sector, leaving publicly-funded services with longer wait times and reduced quality.

Italy - Budget cuts and regional disparities increase the pressure on the Italian health system

Part of a series reviewing European health systems, this report on Italy discusses the country’s ability to reduce health care costs while accommodating increased demand. Belt-tightening responses to Italy’s fiscal crisis have exacerbated inequities across regions. Gaps in service provision and variations in health system performance persist.

Ireland - National Cancer Strategy 2017 -2026

Following significant progress over the last 10 years, Ireland is determined to make further strides in cancer control such that survival rates reach the top quartile of European countries by 2026. Prevention is a cornerstone, along with integration across primary, acute and social care with enhanced leadership from the National Cancer Control Programme. The strategy describes measures intended to reduce the cancer burden, provide optimal care, and maximize patient involvement and quality of life.

Canada - Integrated Funding: Connecting the Silos for the Healthcare We Need

According to this article from the C.D. Howe Institute, healthcare delivery silos are impeding Canada’s ability to adapt to changing demands. The article points to experiences in the US and Europe with integrated payment models that distribute funding envelopes across providers. The authors consider this the best way to reduce healthcare costs and increase efficiency and effectiveness.

Germany - Comparison of Public, Non-Profit and Private Hospitals

Originally presented at a conference called ‘Market or Government’, this paper examines how Germany’s public, non-profit and private hospitals exercise their function and make decisions. Based on interviews with key informants, the study took place in a context where the economic crisis in Europe limited the resources available in public institutions and where inequities in services between regions and providers were growing.

UK - Top industry influencers reveal what healthcare excellence means to them

Interviewing public healthcare administrators and charity and industry executives, the Picker Institute Europe recently asked prominent UK health sector leaders what care excellence means to them. Healthcare quality, patient-centred decision-making, increased community care and better funding top the responses from the nine interviewees.

International - Health spending continues to stagnate, says OECD

After falling sharply in 2010, health spending remained flat across OECD countries in 2011 as the economic crisis continued to have an impact, particularly in those European countries hardest hit by the crisis, according to OECD Health Data 2013. While health spending grew on average by close to 5% year-on-year from 2000 to 2009, this has since been followed by a sluggish growth of around 0.5% in 2010 and 2011. Current expenditure on health (i.e., excluding capital expenditure) grew by 0.7% in both years. Preliminary figures for some countries suggest a continuation of this trend in 2012.

International - We must take better care of the elderly, say OECD and the European Commission

The number of people over 80 will double by 2050 rising from 3.9% of the population to 9.1% in 2050 across OECD countries and from 4.7% to 11.3% across 27 EU members. Estimates are that up to half of them will need help to cope with their daily needs. Yet even today governments are struggling to deliver high-quality care to elderly people with reduced physical and mental abilities, says a new OECD/EC report, A good life in old age?. Most countries have legislation to prevent abuse, including encouraging public disclosure of specific cases, complaint mechanisms and an ombudsman to deal with concerns. However very few countries systematically measure whether long-term care is safe, effective, and meets the needs of care recipients.

Germany - Causes of regional variation in healthcare utilization in Germany

Healthcare utilization varies widely between regions in Germany. This study examines patient migration to see how much of the variation in German ambulatory care use can be attributed to demand and supply factors. Based on administrative data, the authors find that regional variation is overwhelmingly explained by patient characteristics. These results contrast with previous findings for other European countries.

International - Trends in health systems in the former Soviet countries

Based on health system reviews from the European Observatory on Health Systems and Policies, this 217-page book analyzes health system reform in 12 countries that were previously part of the Soviet Union. The book reviews the reorganization, financing, and provision of health services in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. A large section is devoted to Russia.

International - Improving detection and treatment would cut cancer death rates significantly, says OECD

The report by the OECD was prepared with the support of the European Commission and builds on earlier WHO research. It finds that earlier detection and better treatment for cancer would cut death rates from the disease by around a third, saving the lives of nearly a million people in the developed world every year. Improving care standards, cutting waiting times and spending resources more effectively are key steps to save many lives.

Australia - Telehealth in primary health care settings within Australia and internationally

This Policy Issue Review from Australia’s Primary Health Care Research and Information Service (PHC RIS) examines the evidence on telehealth models in Australia, Europe, and North America. It focuses on real-time video consultations involving patients, primary health care providers and specialists.

International - OECD urges countries to harmonise clinical trial regulations to boost medical research and save lives

This policy guidance from the OECD recognizes that increasingly complex and inconsistent clinical trial regulations are causing delays, raising costs and leading to a decline in the number of international trials conducted by academics for non-commercial purposes. In the European Union alone, the number of applications for clinical trials fell by 25% between 2007 and 2011. The OECD calls on its member governments to harmonise their clinical trial approval processes.

International - Caring For Quality in Health. Lessons Learnt from 15 Reviews of Health Care Quality

Between 2012 and 2016, the OECD conducted a series of reviews looking at policies and institutions design to measure and improve healthcare quality in 15 OECD countries, primarily in Europe. The findings presented in this final synthesis report identify common challenges, responses, and leading edge practices to delivering value for money in health care.

Europe – Is migration the solution to staff shortages in the health care sector?

La migration : la solution aux pénuries de personnel dans le secteur des soins et de la santé ? The King Baudouin Foundation seeks to develop a clear framework on migration and integration in Belgium. This report discusses, in particular, the international recruitment of health workers to meet the growing needs in this sector. The report looks closely at the phenomenon of foreign-born health care workers, identifies how many are currently in Belgium, their country of origin, how they arrived at their jobs, and the impact of their departure on their country of origin.

Germany - The private sector within a public health care system: the German example

In Europe, where public financing is as prevalent as in Canada, if not more so, the private for-profit sector has an extensive role to play in delivering service. The German experience shows that private sector involvement and the search for profit, contrary to widespread fears, are correlated with better quality care and can improve the efficiency of low-performance establishments.

The Netherlands - Dutch Health Care Performance Report 2014

The 2014 edition of this annual report on Dutch health care gives high overall marks for access and quality. However, variations in elder and nursing home care due to insufficient staffing are evident. The Netherlands continues to be Europe’s fourth highest spender on health care, largely because of long-term care costs.

UK - Atlas of Social Innovation – New Practices for a Better Future

Part of a European Union project, the Atlas of Social Innovation offers a comprehensive overview of this multifaceted concept and contains 62 articles compiled by 25 international partners. The Atlas offers new insights into various types of social innovation in different regions and policy areas, including health and social care.

International - Paying for “End-of-Life” Drugs in Australia, Germany, and the United Kingdom: Balancing Policy, Pragmatism, and Societal Values

This edition of Issues in International Health Policy analyses British, German, Australian and American policies on the coverage of costly life-extending medicines. For Europe and Australia, the challenge is to pay for medicines through publicly-funded systems without undermining core principles. In the U.S., the goal is to ensure the sustainability of Medicare and the private insurance market without restricting choice.

A review of telehealth in Scotland

Brief analytical summaries or syntheses #30 A review of telehealth in Scotland Summary This government review, prepared for Scotland’s Auditor General, focuses on National Health Service (NHS) telehealth initiatives that deliver care to patients. It determines that, targeted appropriately, telehealth has the potential to help NHS boards deliver clinical services more efficiently and effectively. Background The use of technology in the NHS has the potential to improve the quality, delivery and efficiency of healthcare services. Telehealth is the provision of healthcare to patients at a distance using a range of technologies, such as mobile phones, internet services, digital televisions, video-conferencing and self-monitoring equipment. Telehealth can offer a number of potential benefits to patients and NHS boards, such as reducing the need to travel to outpatient clinics, providing a quicker diagnosis, and avoiding referrals to hospital for diagnosis or treatment. It also has the potential to help NHS boards deliver clinical…

UK - Recovering the cost of NHS treatment for overseas visitors

This report details work done by the Department of Health to help the National Health Service (NHS) increase the amount charged and recovered for treating overseas visitors. The British government hopes to recover up to £500 million for treating overseas visitors by 2018. A new immigration health surcharge for students and migrants from outside the European Economic Area (EEA) generated £164 million in 2015.

Improving estimates of exports and imports of health services and goods under the SHA framework

Brief analytical summaries or syntheses #31 Improving estimates of exports and imports of health services and goods under the SHA framework Summary This document is the final report of an OECD project that responds to increasing demand for statistics on the trade in health care goods and services. The report provides clear concepts, definitions and guidelines for the production of reliable, timely and comparable estimates of imports and exports of health services and goods within a standard health accounting framework. Background Trade in health services, and its best-known component, medical tourism, has attracted a great deal of media attention in recent years. This creates the impression that a large part of the population is regularly seeking health care abroad or buying pharmaceuticals over the internet from foreign providers. The apparent growth in such imports and exports has been fuelled by a number of factors. Technological advances in information systems and…

Canada - Public Health Observatories: Learning From our World neighbours

In November 2008, seven representatives from Canada’s Public Health Observatory (PHO) community attended the “Health Observatories: Learning from Our World Neighbours, 2008” meetings hosted by the London Public Health Observatory, in London and Newcastle, England. The purpose of the tour was twofold: to understand in greater depth Public Health Observatories; and, through sharing Canada’s PHO progress to date, explore the possibility of establishing an Observatory network between Canada’s nascent Association of Population Health Observatories (CaNPHO), the United Kingdom’s established Association of Public Health Observatories (APHO), and APHO’s European partners. The document provides an overview of England’s Public Health and Theme-based Observatories, as well as the UK’s Association of Public Health Observatories (APHO). The document also briefly profiles the Canadian Public Health Observatories and technologies showcased during the tour.

Denmark – Denmark: Health system review. Health Systems in Transition, 2012

Published by the European Observatory on Health Systems and Policies, this country profile provides a detailed description of Denmark’s health system and policy initiatives. The report describes the institutional framework, process, content, and implementation of Danish healthcare policy reform.

UK - Population health systems. Going beyond integrated care

The expansion of integrated care has been a central part of health service reform in Britain. This paper points out that integrated care and public health pathways rarely coincide and calls for a national strategy to coordinate efforts. The paper contains examples from other European countries.

Sweden – Health System Review

Brief analytical summaries or syntheses #43 Sweden – Health System Review Summary Published by the European Observatory on Health Systems and Policies, this report regards Sweden’s health system in detail. It describes the institutional framework, process, content, and implementation of Swedish health policies, highlighting challenges and areas that require further analysis. Background Sweden is a monarchy with a parliamentary form of government. The size of the population is about 9.4 million inhabitants and more than 80% of the population lives in urban areas. The GDP per capita, measured as purchasing power parity (PPP, current international US$), amounted to Swedish krona (SEK) 37 775 (€4200) in 2010. Life expectancy in Sweden is among the highest in the world. Diseases of the circulatory system are the leading cause of mortality, accounting for about 40% of all deaths in 2009. The second largest cause of death is cancer. There are three independent government…

UK - New HiTs (Health Systems in Transition) health system reviews for the United Kingdom (Northern Ireland, Scotland, and Wales) have just been released

In November 2012, the European Observatory on Health Systems and Policies released Health Systems in Transition (HiT) reviews for British health systems in Northern Ireland, Scotland and Wales. HiT health system reviews are country or region-based reports providing a detailed description of local health system reforms and policy initiatives.

Canada – Canada: Health system review. Health Systems in Transition, 2013

The new HiT (Health Systems in Transition) health system review for Canada has just been released by the European Observatory on Health Systems and Policies. HiT health system reviews are country or region-based reports providing a detailed description of local health system reforms and policy initiatives.

Belgium – Performance of the Belgium’s health care system. 2012 Report

This report prepared by the Centre fédéral d’expertise des soins de santé (KCE) studied the performance of the Belgian healthcare system. Results were compared with those of 14 other European countries. On the positive side are the rate of vaccination among children, 5-year survival after breast cancer or colon, the relationship with the GP, the increasing use of cheap drugs. Screening for breast and colon cancer, as well as the monitoring of diabetic patients, remain to be improved.

Denmark - Primary Care Review of Denmark

Produced by the OECD, this review of Denmark’s primary care system says high-quality care is not always delivered. Rates of avoidable hospitalization are higher than in the rest of Scandinavia, and Denmark is one of the few European countries with no means of monitoring primary care performance. Patients also have no access to their health records.

Canada - Healthcare in Quebec: more money in, fewer services out

A new publication from the Centre for Productivity and Prosperity compares best practices in healthcare management in Quebec and six European countries. It finds that while Quebec spends more on healthcare than the rest of Canada and these other countries, the province not only provides fewer services than elsewhere, but has fewer doctors and less equipment.

Italy - Veneto Region, Italy: Health system review. Health Systems in Transition. 2012

This health system profile from the European Observatory on Health Systems and Policies examines different approaches to the organization, financing and delivery of health services and the role of the main actors in the health system of this region of Italy.

Sweden - Sweden: Health system review. Health Systems in Transition, 2012

Published by the European Observatory on Health Systems and Policies, this report regards Sweden’s health system in detail. It describes the institutional framework, process, content, and implementation of Swedish health policies, highlighting challenges and areas that require further analysis.

UK - National evaluation of the Department of Health's integrated care pilots

This document, prepared by RAND Europe and Ernst & Young in collaboration with the University of Cambridge, is the final output of an evaluation of the 16 Department of Health Integrated Care Pilots (ICPs) in the UK. It provides an account of the evaluation activities conducted, the data collected and the analyses completed.