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.

Norway's Healthcare Communities are set up to build bridges between hospitals and primary care

In 2012, the Coordination Reform was introduced inNorway to improve coordination between municipalities that organise primary care and the central government that organises specialised care. In 2020, a local governance reform is being implemented, and some municipalities and regions are being merged into larger entities. “Healthcare Communities”, a new partnership between hospitals and their surrounding municipalities, are being established to improve planning and development of services, as well as contribute to national planning. However, improving coordination between primary and specialist services may prove challenging, notably due to the way in which they are governed.

Integrating primary care and public health

There are many calls for improved integration between primary care and public health, but also sizeable obstacles to achieving this, such as differences in the ways the two sectors are organised and financed, as well as differences in education, culture and approach. This article, based on a new Observatory policy brief, describes the types of interventions that come into consideration, the principles that should be followed, and the factors that can facilitate successful collaboration. While there is no universal template that can be followed by all countries, improved integration promises to yield substantial benefits to patients and wider populations.

Serbia: health system review

This analysis of the Serbian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the Serbian population has improved over the last decade. Life expectancy at birth increased slightly in recent years, but it remains, for example, around 5 years below the average across European Union countries. Some favourable trends have been observed in health status and morbidity rates, including a decrease in the incidence of tuberculosis, but population ageing means that chronic conditions and long-standing disabilityare increasing. The state exercises a strong governance role in Serbia’s social healthinsurance system. Recent efforts have increased centralization by transferring ownership of buildings and equipment to the national level. The health insurance system provides coverage for almost the entire population (98%). Even though the system is comprehensive and universal, with free access to publicly provided health services, there are inequities in access to primary careand certain population groups (such as the most socially and economically disadvantaged, the uninsured, and the Roma) often experience problems in accessing care. The uneven distribution of health professionals across the country and shortages in some specialities also exacerbate accessibility problems. High out-of-pocket payments, amounting to over 40% of totalexpenditure on health, contribute to relatively high levels of self-reported unmet need for medical care. Health care provision is characterized by the role of the “chosen doctor” in primary health care centres, who acts as a gatekeeper in the system. Recent public health efforts have focused on improving access to preventive health services, in particular, for vulnerable groups. Health system reforms since 2012 have focused on improving infrastructure and technology, and on implementing an integrated health information system. However, the country lacks a transparent and comprehensive system for assessing the benefits of health care investments and determining how to pay for them.

Eurohealth: priorities for health systems strengthening in the WHO European Region

This issue of Eurohealth looks at how Member States across the European Region are strengthening their health systems in line with the strategic document “Priorities for healthsystems strengthening in the WHO European Region 2015–2020: walking the talk on people centredness”. The strategic document guides countries on how to implement the values outlined in two health systems charters – the Ljubljana Charter on Reforming Health Care inEurope and The Tallinn Charter: Health Systems for Health and Wealth. Introduction - Introducing the 20th Ljubljana Charter anniversary issue, Priorities for strengthening people-centred health systems; People-centred population health management in Germany, Developing integrated health and social care models in Scotland, Transforming the model of care for treating TB in the Republic of Armenia; Universal health coverage and the economic crisis in Europe, Generating evidence for UHC; A people-centred system approach in Wales, Building public health leadership skills in the Republic of Kazakhstan, Transforming health professional education and training in Malta, Addressing health workforce outflow in Hungary; Centralizing procurement of medicines to save costs for Denmark, Improving access to essential medicines in the Republic of Moldova; Improving the mortality information system in Portugal, Evidence-informed policy-making in Slovenia, the European Observatory on Health Systems and Policies: knowledge brokering for health systems strengthening; and Publications.

Pharmaceutical policy in China: challenges and opportunities for reform

China has a complex pharmaceutical system that is currently undergoing significant reforms. This book provides a comprehensive overview of China's pharmaceutical system and covers key topics such as drug approvals and quality regulation, expenditure trends, pricing and reimbursement, irrational prescribing, traditional Chinese medicine, industrial policy, and the role of hospitals, primary care, and pharmacies.

What do we know about the strengths and weakness of different policy mechanisms to influence health behaviour in the population?

With health care systems under increasing pressure the development of a well defined and effective public health strategy has never been more important. Many health problems are potentially avoidable and governments have long had tools at their disposal to influence population health and change individual behaviours, directed both ‘upstream’ at some of the underlying causes of poor health, as well as at ‘downstream’ challenges when poor health behaviours are already manifest. But how effective are these different actions? This policy summary briefly maps out what is known about some of these mechanisms, including approaches that have come to recent prominence from behavioural economics and psychology. Combinations of taxation, legislation and health information remain the core components of any strategy to influence behavioural change. There remain many unanswered questions on how best to design new innovative interventions that can complement, and in some instances augment, these well established mechanisms.

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

This policy summary reviews the existing evidence on the economic impact of integrated care approaches. Whereas it is generally accepted that integrated care models have a positive effect on the quality of care, health outcomes and patient satisfaction, it is less clear how cost effective they are. As the evidence-base in this field is rather weak, the authors suggest that we may have to revisit our understanding of the concept and our expectations in terms of its assessment. Integrated care should rather be seen as a complex strategy to innovate and implement long-lasting change in the way services in the health and social-care sectors are delivered. This policy summary is based on a report for the European Commission to inform the discussions of the EU’s Reflection process on modern, responsive and sustainable health systems on the objective of integrated care models and better hospital management.

Cross-border health care in Europe

Patient mobility is high on the political agenda in the EU, with increasing numbers of people crossing European borders. Issues relating to health professional mobility have received less attention, yet this is an important policy issue for the EU considering the scale of and reliance on professional mobility between countries, and existing variations in educational and professional standards. How are health systems in Europe responding to patient and professional mobility, and what are the implications for access and quality of health services? Is greater coordination needed, or do calls for increasing integration reflect a political agenda for increasingly competitive markets in health care? Recent legislative changes which clarify patient entitlements to cross-border care will have important impacts on national and EU-wide health policies. This policy summary provides a review of the current state of issues relating to cross-border health care in Europe. It combines a literature search with evidence gathered by the Evaluating Care Across Borders (European Union Cross Border Care Collaboration) Project to provide an update on the 2005 ‘Policy Brief on Cross-Border Health Care in the European Union’.

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

The rising burden of chronic illness, in particular the rapid increase in the number of people with multiple health problems, is a challenge to health systems globally. Associated premature mortality and reduced physical functioning, along with higher use of health services and related costs, are among the key concerns faced by policy-makers and practitioners. There is a clear need to redesign delivery systems in order to better meet the needs created by chronic conditions, moving from the traditional, acute and episodic model of care to one that better coordinates professionals and institutions and actively engages service users and their carers. Many countries have begun this process but it has been difficult to reach conclusions about the best approach to take: care models are highly context-dependent and scientifically rigorous evaluations have been lacking. Assessing chronic disease management in European health systems explores some of the key issues, ranging from interpreting the evidence base to assessing the policy context for, and approaches to, chronic disease management across Europe. Drawing on 12 detailed country reports (available in a second volume Assessing chronic disease management in European health systems: 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. This book builds on the findings of the DISMEVAL project (Developing and validating DISease Management EVALuation methods for European health care systems), led by RAND Europe and funded under the European Union’s (EU) Seventh Framework Programme (FP7) (Agreement no. 223277).