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.

How does Switzerland’s health sector contribute to the economy? Health and the economy: a series of country snapshots

Health matters. The health sector is an important and innovative industry, as well as a source of stable employment for many people. Health systems support active and productive populations, reduce inequities and poverty and promote social cohesion. A strong health system makes good economic sense and underpins the overall sustainable development agenda. Countries around the world are grappling with the health, economic and fiscal implications of the COVID-19 pandemic. As they begin to recover from the crisis, difficult decisions will need to be made about how to allocate scarce resources. These snapshots share valuable evidence for policy-makers on how investing in health sectors and health systems helps to achieve national economic objectives.

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.

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.

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.

Sweden: health system summary, 2023

This Health system summary is based on the Sweden 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.

Commercial determinants of non-communicable diseases: the imperative for a systems approach

The increasing burden of non-communicable diseases (NCDs) challenges conventional approaches to public health. The struggle to curb preventable NCDs persists due to narrow reductionist biomedical paradigms and the influence of corporate actors in shaping unhealthy environments, a concept known as the commercial determinants of health. This phenomenon, amplified by globalisation, affects health through various factors. To promote global well-being, commercial entities must be incentivised to shift from profit-driven models to socially and environmentally responsible practices. This shift demands adherence to regulations preventing harm and support for public health policies, urging a systemic understanding of NCDs as outcomes of complex systems.

25 years of collaboration between EUPHA and the Observatory

The European Observatory on Health Systems and Policies was founded in 1998 at a time of transition, from communism in Eastern Europe and to new means of paying for and delivering healthcare everywhere. Since then, Europe has confronted both longstanding challenges and new ones, including wars, the financial crisis, the COVID-19 pandemic, and climate change. The Observatory and the European Public Health Association (EUPHA) have collaborated to address these public health challenges. Looking ahead, there is much to be done together to transform health systems and achieve the Sustainable Development Goals.

Launching a public debate on the European Union’s future health priorities: how do we keep health on the political agenda beyond 2024?

In 2024, European citizens will vote for a new European Parliament. The ongoing political cycle has coincided with a health crisis that has reshaped the European Union’s policies and opened a window of opportunity for health and health systems. There is now a unique opportunity to assess past achievements and consider future goals in the field of health. The European Observatory on Health Systems and Policies, in agreement with the EC Directorate General for Health and Food Safety (DG SANTE), has launched a public debate. This initiative invites input from different stakeholders and the public to inform future EU health priorities. The article highlights key events and milestones planned within this public discourse.

Transitioning to more sustainable food systems that support health equity and wellbeing

There is now overwhelming evidence that current food systems are not sustainable, due to their detrimental impact on the environment, food-related health concerns, rise in chronic diseases and socio-economic impacts. At the institutional level, the seriousness of the situation has been acknowledged, but policies are still not sufficiently effective to resolve the challenge. We consider the over-reliance on and limits of the ‘business as usual’ approach, such as self-regulation by industry and focusing on changing individual behaviours in an unsustainable food environment. Instead, coordinated and systemic policies are needed that normalise sustainable and healthy food choice and practices for the whole population.

Leaving no one behind: prioritising digital health equity across the WHO European Region

The 2023 World Health Organization (WHO) report on digital health for the WHO European Region demonstrates the accelerated progress in the adoption of digital health technologies (DHT) in recent years. However, there are growing concerns about the digital divide resulting from inequitable access and utilisation of DHT, particularly among older people and marginalised communities. This article sheds light on the advancements made by WHO Europe Member States and underscores the necessity to ensure access to devices and stable internet connection, as well as promoting digital literacy and user engagement, to overcome this digital divide.

Building the future one health workforce

A ‘new normal’ in public health and healthcare has arisen with socioeconomic shifts, technological developments, political strife, climate change, environmental degradation, and COVID-19. Challenges cannot be solved by one discipline or profession alone, but requires multiple sectors coming together, combining knowledge, expertise and methods. One Health is an integrated epidemiological and economic approach aiming to sustainably optimise the health of people, animals and ecosystem. This article reflects on the roles of Association of Schools of Public Health in the European Region (ASPHER) and European Health Management Association (EHMA) and the concrete steps needed to address skills for One Health.

EU joint actions 2.0: A booster for health in the EU?

Since 2008, the Joint Action (JA) mechanism in the EU Health Programme has been promoting collaboration among Member States. This article assesses whether it is well-equipped to strengthen European collaboration in the post-COVID world and suggest ways in which the Commission can further improve this instrument. They can have a significant impact on health policies in the EU, yet challenges remain related to sustainability, administrative burden, and co financing structure. In order to contribute to the EU Health Union, we believe they need to become more politically driven, outcome-focused, and contribute to a comprehensive long-term vision regarding the role of health in the EU.