Denmark: health system review

This analysis of the Danish health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Population health in Denmark isgood and improving, with life expectancy above the European Union average but is, however, lagging behind the other Nordic countries. Denmark has a universal and tax-financed health system, providing coverage for acomprehensive package of health services. Notable exclusions to the benefits package include outpatient prescription drugs and adult dental care, which require co-payment and are the main causes of out-of-pocket spending. The hospital sector has been transformed during the past 15 years through a process of consolidating hospitals and the centralization of medical specialties. However, in recent years, there has been a move towards decentralization to increase the volume and quality of care provided outside hospitals in primary and local care settings. The Danish health care system is, to a very high degree, based on digital solutions that health care providers, citizens and institutions all use. Ensuring the availability of health care in all parts of Denmark is increasingly seen as a priority issue.Ensuring sufficient health workers, especially nurses, poses a significant challenge to the Danish health system’s sustainability and resilience. While a comprehensive package of policies has been put in place to increase thenumber of nurses being trained and retain those already working in the system, such measures need time to work. Addressing staffing shortages requires long-term action. Profound changes in working practices and workingenvironments will be required to ensure the sustainability of the health workforce and, by extension, the health system into the future.

Техническая справка по вопросам укрепления сестринских и акушерских кадров в целях улучшения показателей здравоохранения: что известно о расширении сестринских функций: фактические данные и уроки для внедрения

Во время пандемии COVID-19 руководители, определяющие политику, и широкая общественность признали важный вклад сестринских работников в борьбу с пандемией и непростые условия, в которых им приходилось работать. В результате в Европе и в мире повысилось внимание к стратегической роли сестринских кадров. Высшее сестринское образование способствует обеспечению безопасности пациентов и улучшению результатов для пациентов, групп населения и систем здравоохранения. Расширение сестринских функций определено в качестве одного из эффективных кадровых решений в области здравоохранения, которое позволяет улучшить доступ к медицинским услугам для недостаточно обслуживаемых и проживающих на отдаленных территориях групп населения и решить проблему нехватки персонала в учреждениях первичной медико-санитарной помощи, способствуя тем самым достижению всеобщего охвата услугами здравоохранения. В настоящей технической справке основное внимание уделено изложению механизмов, с помощью которых государства-члены Европейского региона расширяют сестринские функции, и описаны возможные пути содействия процессам реализации соответствующих программ.

Health and care data: approaches to data linkage for evidence-informed policy

An indispensable prerequisite for answering research questions in health services research is the availability and accessibility of comprehensive, high quality data. It can be assumed that health services research in the comingyears will be increasingly based on data linkage, i.e., the linking, or connecting, of several data sources based on suitable common key variables. A range of approaches to data collection, storage, linkage and availability exists across countries, particularly for secondary research purposes (i.e., the use of data initially collected for other purposes), such as health systems research. The main goal of this review is to develop an overview of, and gain insights into, current approaches to linking data sources in the context of health services research, with the view to inform policy, based on existing practices in high-income countries in Europe and beyond. In doing so, another objective is to provide lessons for countries looking for possible or alternative approaches to data linkage. Thirteen country case studies of data linkage approaches were selected and analyzed. Rather than being comprehensive, this review aimed to identify varied and potentially useful case studies to showcase different approaches to data linkage worldwide. A conceptual framework was developed to guide the selection and description of case studies. Information was first identified and collected from publicly available sources and a profile was then created for each country and each case study; these profiles were forwarded to appropriate country experts for validation and completion.

France: health system review

This review of the French health system analyses recent developments in health organization and governance, financing, healthcare provision, recent reforms and health system performance.Overall health status continues to improve in France, although geographic and socioeconomic inequalities in life expectancy persist. The health system combines a social health insurance model with an important role fortax-based revenues to finance healthcare. The health system provides universal coverage, with a broad benefits basket, but cost-sharing is required for all essential services. Private complementary insurance to cover these costs results in very low average out-of-pocket payments, although there are concerns regarding solidarity, financial redistribution and efficiency in the health system. The macroeconomic context in the last couple of years in the country has been affected by the COVID-19 pandemic, which resulted in subsequent increases of total health expenditure in France in 2020 (3.7%) and 2021 (9.8%).Healthcare provision continues to be highly fragmented in France, with a segmented approach to care organization and funding across primary, secondary and long-term care. Recent reforms aim to strengthen primarycare by encouraging multidisciplinary group practices, while public health efforts over the last decade have focused on boosting prevention strategies and tackling lifestyle risk factors, such as smoking and obesity with limited success. Continued challenges include ensuring the sustainability of the health workforce, particularly to secure adequate numbers of health professionals in medically underserved areas, such as rural and less affluent communities, and improving working conditions, remuneration and career prospects, especially for nurses, to support retention. The COVID-19 pandemic has brought to light some structural weaknesses within the French health system, but it has also provided opportunities for improving its sustainability. There has been a notable shift in the will to give more room to decision-making at the local level, involving healthcare professionals, and to find new ways of funding healthcare providers to encourage care coordination and integration.

Finland: Health system summary, 2023

This Health system summary is based on the Finland: Health System Review published in 2019 in the Health Systems in Transition (HiT) series, and is significantly updated by the authors, including relevant reform updates highlighted by the Health Systems and Policies Monitor (HSPM) (www.hspm.org).For this edition, key data have been updated to those available in December 2022, unless otherwise stated. Health system summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of healthcare. They also provide insights into key reforms and the varied challenges testing the performance of the health system.

Кыргызстан: обзор системы здравоохранения

В предлагаемом анализе системы здравоохранения Кыргызстана рассматриваются процессы, происходящие в ее организации и стратегическом руководстве и предоставлении услуг, реформыздравоохранения и показатели функционирования системы здравоохранения. В стране действует система обязательного медицинского страхования, при которой Фонд обязательного медицинского страхования(ФОМС) при Министерстве здравоохранения выступает в качестве единого государственного плательщика, оплачивающего почти все услуги больниц и поставщиков первичной медико-санитарной помощи.Пакет медицинских услуг, покрываемых из государственных средств, определяется в Программе государственных гарантий по обеспечению граждан медико-санитарной помощью (ПГГ). Однако многие услуги требуют соплатежей, а в 2019 г. только 69% населения были охвачены обязательным медицинским страхованием. Показатель подушевых расходов на здравоохранение является одним из самых низких вЕвропейском регионе ВОЗ, что объясняется небольшим ВВП страны на душу населения. На долю личных расходов, почти целиком принимающих форму платежей из собственных средств и включающих неформальные платежи, в 2019 г. приходилось 46,3% расходов на здравоохранение. Финансовую защиту подрывают низкие уровни государственных расходов на здравоохранение, и это приводит к тому, что люди, пользующиеся услугами здравоохранения, сталкиваются с финансовыми трудностями. Несмотря на то, что в стране хорошо развита сеть медицинских учреждений, географическое распределение медицинских работников неравномерно и в целом наблюдается нехватка семейных врачей. Сохраняются трудности в доступе к медицинским услугам, и эти трудности усугубила пандемия COVID-19. Хотя в последние годыбыли достигнуты улучшения, инфекционные и неинфекционные заболевания по-прежнему представляют большую проблему, а ожидаемая продолжительность жизни до пандемии COVID-19 была одной из самыхнизких в Европейском регионе ВОЗ.

Звіт про діяльність Бюро ВООЗ в Україні за 2022 р.

У цьому звіті представлено огляд діяльності Бюро Всесвітньої організації охорони здоров’я (ВООЗ) в Україніпротягом 2022 р. Попри вкрай негативний вплив війни на здоров’я населення, Бюро ВООЗ в Україніпродовжувало працювати відповідно до своїх основних повноважень. ВООЗ надавала підтримку урядуУкраїни у реагуванні на надзвичайну ситуацію у сфері охорони здоров’я відповідно до Стратегічного плануреагування ВООЗ і продовжувала реалізацію поточних пріоритетних завдань, викладених у Тринадцятійзагальній програмі роботи на 2019–2023 рр., Європейській програмі роботи на 2020–2025 рр., а такожДворічній угоді про співробітництво на 2022–2023 рр., підписаній із урядом України. Це включало стримуванняпандемії COVID-19 та подальшу підтримку процесу реформування системи охорони здоров’я, що триває з2015 р. У цьому звіті окреслено досягнення Бюро ВООЗ в Україні протягом 2022 р. у контексті впливу війнина життя, здоров’я та добробут українців.

Primary health care transformation in Spain: current challenges and opportunities: primary health care policy paper series

In Spain, primary health care (PHC) has played an important role in achieving good health outcomes among the population. Since the turn of the 21st century, PHC has shown signs of fragility. In the aftermath of the coronavirus disease (COVID-19) pandemic, the PHC system in Spain is at a crossroads, also driven by changes in demography, population health-care needs and expectations and innovation. This case study has two overarching aims. First, to inform and support the dialogue among actors in Spain’s health-care system about how to move forward and strengthen PHC; and second, to provide a snapshot of the PHC model of care in Spain to an international audience. To achieve these aims, this case study focuses on providing a comprehensive analysis of the current state of the PHC system, how it is performing and how the providers and decision-makers perceive the key challenges and opportunities. The case study concludes with a set of recommendations to enhance the development and sustainability of PHC in the broader health-care system in Spain.

Scaling primary health care through networks and other models: primary health care policy paper series

Fulfilling the Astana vision for primary care as the foundation for population health will require a step change in the way primary care is organized and delivered. There is huge variation in primary care organizations – from solo clinics to city wide health centres – and no single blueprint for the future. But across the WHO European Region there is growing experience of team-based, services delivered through networks and larger primary care organizations. This paper draws on a pragmatic review of available evidence, case studies in five countries and workshops with primary care experts to describe different forms of networking, collaboration, and organizational change in primary care, identifying potential benefits that can accrue and highlighting potential pitfalls. Opportunities include teamworking, extending digital technology; improving access; integrating with other services and opportunities to develop premises and build organizational development capacity. Risks include reduced continuity and professional disengagement. The paper describes policy levers to encourage new ways of working and sets out a three-stage, practical approach to guide policy-makers aiming to encourage large-scale primary care organization that better meet the needs of population.

Sweden: health system review

The Health Systems in Transition (HiT) country reports provide an analytical description of each health system and of reform initiatives in progress or under development. They aim to provide relevant comparative information to support policy-makers and analysts in the development of health systems and reforms in the countries of the WHO European Region and beyond. The HiTs are building blocks that can be used: to learn in detail about different approaches to the financing, organization and delivery of health services; to describe accurately the process, content and implementation of health reform programmes; to highlight common challenges and areas that require more in-depth analysis; and to provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policy-makers and analysts in countries of the WHO European Region. This analysis of the Swedish health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. This series is an ongoing initiative and material is updated at regular intervals.

WHO Country Office in Ukraine, 2022 report

This report provides an overview of the operations and activities of the WHO Country Office in Ukraine during 2022. Despite the acute health impacts of the war in Ukraine, WHO’s Country Office continued its work according to its core mandate. WHO supported the Government of Ukraine to manage the health emergency according to the WHO Strategic Response Plan and pursued existing priorities set out in WHO’s Thirteenth General Programme of Work 2019–2023, the European Programme of Work 2020–2025 and the Biennial Collaborative Agreement 2022–2023 signed with the Government of Ukraine. This included containing the COVID-19 pandemic and continuing to support the health reform process that had been ongoing since 2015. The report presents the achievements of the WHO Country Office in Ukraine during 2022, in the context of the impacts of the war on the lives, health and well-being of Ukrainians.

Germany: health system summary, 2022

This Health system summary is based on the Germany: Health System Review published in 2020 in the Health Systems in Transition (HiT) series, and relevant reform updates highlighted by the Health Systems and Policies Monitor (HSPM) (www.hspm.org). For this edition, key data have been updated to those available in July 2022 to keep information as current as possible. Health system summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide insights into key reforms and the varied challenges testing the performance of the health system.

Italy: health system summary, 2022

This Health system summary is based on the Italy: Health System Review published in 2022 in the Health Systems in Transition (HiT) series. Health system summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide insights into key reforms and the varied challenges testing the performance of the health system.

Estonia: health system summary, 2022

This Health system summary is based on the Estonia: Health System Review published in 2018 in the Health Systems in Transition (HiT) series, and is significantly updated, including data, policy developments and relevant reforms as highlighted by the Health Systems and Policies Monitor (HSPM) (www.hspm.org). For this edition, key data have been updated to those available in July 2022 unless otherwise stated. Health system summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide insights into key reforms and the varied challenges testing the performance of the health system.

Austria: health system summary, 2022

This Health system summary is based on the Austria: Health System Review published in 2018 in the Health Systems in Transition (HiT) series, and relevant reform updates highlighted by the Health Systems and Policies Monitor (HSPM) (www.hspm.org). For this edition, key data have been updated to those available in July 2022 to keep information as current as possible. Health system summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide insights into key reforms and the varied challenges testing the performance of the health system.