Transcript GODIŠNJA KONFERENCIJA 2006

“HEALTH CARE REFORMS
IN SEE COUNTRIES-
The Trade Union Perspective”
The 1st Summer School and Discussion
Forum of the PERC
Budapest, 1-3 September 2008
____________________________________________
Enisa Salimović, ITUC-PERC SEE Office Sarajevo
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Reform of health care system is
one of the most important
reforms in each country
1. Health is one of the main human rights
for fulfilling all other human rights. Every
human beeing has right to enjoy the
highest possible standards of health, what
made it possible for decent life of each
individual
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There are 3 main models of
health care system financing
1.
So called Model of social insurance/
Bismark/ in many continental
countries, and in the SEE. Financing
from obligatory contributions, which
employers and workers need to pay
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2.
3.
Model of national health insurance/
England, Sweden, Canada-financing
from the taxes
Liberal-market model / Americaworkers and their families are insured
in the private insurance companies
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These three models
started to overlap
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Principles for managing
change
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Develop health policy
Listen to citizen’s voice and choice
Reshape health care delivery
Reorient human resources for health
care
Strengthen management
Learn from experience
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Major reform strategies:
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Restructuring
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Splitting of purchaser – provider roles
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Separation policy / financing functions from operational functions
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Reorientation of service delivery
Decentralization
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Deconcentration; delegation; devolution; privatization
Privatization
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of ownership; responsibility; service provision; finance
Introduction of market mechanisms
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Reform objectives:
•
Efficiency
Quality
Equity
Responsiveness
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Sustainability
•
•
•
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Fundamental principels
Within the European context,
health care systems need to be
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Driven by values
Targeted on health
Centred on people
Focused on quality
Based on sound financing
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Activities for TUs so far:
ETUI and ITUC-PERC organized two
events:
1.
Zagreb / April 2007/ and
2.
Brussels / December 2007/
SEE TU Network for helath reforms has
been set up
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The following topics were
discussed:
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SEE Health network, past, present, future
Social health insurance and mutual health
associations in Belgium
Reforms and their impact on health personnel
Issues affecting the Sustainability of Health financing
in SEE
SEE Reform Policies- a view from the West, Belgian
system of health care
Health financing reforms in Hungary
The migration of labour force from health systems in
Romania
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Socail reforms started in all
Balkan countries
Five countries of the Western Balkans:
Serbia, BiH, Croatia, Montenegro and
Macedonia have a common history and a
similar starting base
Reforms in three phases:
 Initial changes, 1990 -91
 Interruption / due to wars
 Speed continuation of reforms, from1996
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Caracteristic of social transformation
in the Balkan countries:
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Reforms of health care system started
paralelly with other social reforms
International Financial institutions,
particularly the World Bank, make strong
influence on these processes
National trade unions, are practically
eliminated from the strategic decisions on the
reforms and the selection of solution variants.
Governments are implementing reforms
without consenzus with other social partners
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There are some main issues to
be discussed:
1.
2.
3.
4.
Future model of Health care
system
Public healthcare
Quality of healthcare
Financing
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There are concerns about financial
sustainability of the present
system…. / According to the WB
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Financial sustainability
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Relatively high payroll taxes for Social Health Insurance
High dependency ratio (paying as non-paying
beneficiaries)
Insurance benefit package not defined
Fiscal pressure caused by insurance arrears and need
to pay for care of uninsured population
Lack of coordinated investment planning in high-cost
infrastructure and technology
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… as well as efficiency and
equity
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Efficiency
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No strategic purchasing to improve provider performance
Overcapacities and low productivity in hospital sector
Advances in medical technology, inter alia, will generate
pressures for higher spending
Price distortion for specialist care leading to more high-cost
services
Inefficient pharmaceutical procurement
Equity
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Inequity in utilization and financing caused by out-of-pocket
payments
Widespread informal payment charged by health workers
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High insurance contribution rates put
pressure on labor markets and result in
low collection rates
In % of gross wage
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15
14
14
12.5
12
9.2
10
8
8
6
5.3
6
4
2
0
Bulgaria
Croatia
Macedonia
Romania
Turkey
(2007)
Austria
France
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High income inequality within
countries makes it difficult to reach
adequate financing for health
Gini Index, 2002/3
50
43.6
45
40
34.5
35
30
26.2 26.9
36.0
37.7
39.0
31.1
29.2 30.0
28.2 28.4 29.1
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Steps on the way forward
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TU need to be active partner in the process of reforms / Social
dialogue for consensus building
TUs need to be realistic
Need to integrate health workforce aspects into reform policiesindustrial democracy in the sector
Issues to be followed: trends in employment in the health
sector, the financing and quality of the health care systempublic finansing; privatization; patient’s contributions; under
funding; accessibility; quality of services; safety and health at
work
Challenge for authorities:
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Successful reforms balance health workforce interests
with population interests and service performance
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What is the trade union
perspective:
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The social dialog should be diverted from a
formal procedure into real
Trade union organizations and employers
should be encouraged by the national and
European institutions to increase their
administrative and expert capacity
There is also a need for better cooperation
/exchange of information, expertise and
practices/ among the national confederations
at sub-region level
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Thank you for your atention!
I wish you a good health !
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