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.

Отчет о результатах консультаций с государствами-членами, организациями-партнерами и негосударственными структурами по созданию Платформы обеспечения доступа к новым лекарственным средствам: январь – февраль 2023 г.: резюме

Европейская программа работы ВОЗ на 2020–2025 гг. «Совместные действия для улучшения здоровья жителей Европы» (ЕПР) выдвигает на передний план важность обеспечения социально справедливого и устойчивого доступа к качественным лекарственным средствам для достижения всеобщего охвата услугами здравоохранения и Целей в области устойчивого развития (ЦУР). Вопросы доступа к лекарственным средствам и изделиям медицинского назначения неизбежно возникают на стыке постановки трех задач ЦУР, а именно: ЦУР 3 – содействовать повышению уровня здоровья и благополучия; ЦУР 9 – развивать промышленность и инфраструктуру и поощрять инновации; и ЦУР 17 – активизировать партнерства ради достижения поставленных Целей.

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.

Case studies of health system recovery in Ukraine: focus on the role of the private sector

On 24th February 2022, the Russian Federation launched a full-scale invasion of Ukraine, resulting insubstantial civilian casualties, the displacement of millions of people, and widespread destruction of socialand economic infrastructure. Despite immense pressures and ongoing attacks on healthcare, the healthsystem in areas under the control of the Government of Ukraine has demonstrated resilience, maintainedits functionality and it already undertaking efforts to rebuild and recover. This report documents fourcase studies of current modalities related to health system recovery in Ukraine and the role played bythe private sector and other nongovernmental actors in this process. The report is intended to shedlight on some of the important roles being played by different nongovernmental actors in the recoveryand early rebuilding processes, outlining possibilities for future scale-up, critical issues to be addressedfurther and potential partnerships to be formed, in the attempt to “build back better” – creating a healthsystem that progresses towards universal health coverage for the population of Ukraine.

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.

Report of consultations with Member States, partner organizations and non-State actors on Access to Novel Medicines Platform: January–February 2023

At the 72nd session of the WHO Regional Committee for Europe in Tel Aviv, Israel, in September 2022, the WHO Regional Office for Europe, in agreement with Member States, issued a statement of intent to act as a neutral convenor for the establishment of a platform for collaboration, to agree on solutions and improve patient access to novel high-cost medicines. The Access to Novel Medicines Platform (NMP) will enable Member States, non-State actors and other partners to coordinate, collaborate, prioritize and align efforts to deliver solutions to improve access for patients. The strategic aims, terms of reference and areas of work for the NMP were drafted and refined in three virtual consultations in January and February 2023. The diversity of the markets was noted, as were specific issues for low- and middle-income countries and small markets, as well as challenges with markets for antimicrobials. This report summarizes the key points raised and suggestions for action proposed during the consultations.

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.

Czechia: health system summary, 2023

This Health system summary is based on the Czechia: Health System Review published in 2023 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.