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.

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.

Building capacity and identifying appropriate support: How can the EU contribute to securing resources for health systems?

European health systems face increasing challenges and demands, while striving to provide high-quality care. The European Union (EU) offers support to complement national efforts, but accessing and utilising it can be challenging for Member States. Austria, Belgium, and Slovenia are collaborating on a multi-country project supported by the EU’s Technical Support Instrument, to create an EU Health Resources Hub. This advisory service aims to help Member States access EU funding instruments for their health needs. This article discusses the project’s goals and early learnings, offering insights that could inform future health funding opportunities and policies in Europe.

Trust and transformation: five policy briefs in support of the Tallinn conference

Today’s Tallinn Conference affirms the values of the Tallinn Charter (2008) and builds on the tradition of inclusive dialogue with all health system stakeholders fostered in the 2013 and 2018 anniversary meetings. It echoes their commitments to solidarity, equity and participation and adopts the themes of trust and transformation as central to building resilient and sustainable health systems for the future. The European Observatory on Health Systems and Policies has generated evidence to inform each of the Tallinn meetings: evidence on the dynamic relationship between health systems and economic development; on the benefits of health systems strengthening and all-of-government and all-of-society approaches; and on how to include, invest and innovate. For the 2023 conference, it has produced a suite of five policy briefs in support of the key themes of trust and transformation.

Ninth high-level meeting of the Small Countries Initiative: advancing health and well-being: Luxembourg, 10–12 May 2023

The Ninth High-level Meeting of the Small Countries Initiative (SCI) brought together ministers of health and secretaries of state from the 11 countries of the Initiative in Luxembourg on 10–12 May 2023. Small country perspectives, challenges and needs emerged on the following themes: advancing health, equity and well-being; preventing and providing a quality response to noncommunicable diseases; access to medicines; improving mental health at the community level; advancing human resources for health; and leveraging digital health transformation. Participants also celebrated International Nursing Day on 12 May. Globalization of the SCI was proposed for consideration by the Government of Malta. The meeting was an opportunity to share progress in implementing the Roadmap towards better health in small countries in the WHO European Region, 2022–2025, and to address the challenges of small countries in the Region and beyond. Ministers of health from other WHO regions and other small countries within the European Region also attended and provided insights and perspectives.

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.

Eighth high-level meeting of the Small Countries Initiative: Bečići (Budva), Montenegro, 2–3 June 2022: towards better health and well-being in the small countries in the WHO European Region: meeting report

The Small Countries Initiative (SCI) is a WHO Regional Office for Europe platform that enables countries with populations of 2 million and less to work together on sharing experiences in addressing common issues with the aim of improving health in the WHO European Region and beyond. SCI’s annual high-level meetings provide a forum for countries to come together, report on progress and plan future joint activities. The Eighth high-level meeting of the SCI, entitled “Towards better heath and well-being in the small countries in the WHO European Region”, took place in Bečići (Budva), Montenegro, on 2–3 June 2022, the first in-person meeting of the Initiative since 2019. It brought the 11 member countries together, along with other partners, to discuss how to strengthen health-system preparedness and response, mobilize financial and human resources, and strengthen health and well-being through sustainable tourism. The “Roadmap towards better health in small countries of the WHO European Region, 2022–2025” and the Montenegro Statement were adopted during the meeting. While placing health at the centre of sustainable tourism, the countries made concrete commitments to better addressing uncertainty, emergency response and recovery, financial hardship, and the lack of human resources for health.