UEHP presents its Board Members
PRINCIPAUTÉ DE MONACO
Guy Nervo, treasurer and Deputy Chairman of the Cardio-Thoracic Centre of Monaco
How would you summarize the place of the private healthcare sector in your country?
Private hospitalisation is above all complementary to the only public hospital in the Principality of Monaco, the Princess Grace Hospital. Three private establishments complete the health offer, the Cardio-Thoracic Centre (CCM) of which I am the Deputy Chairman, the Monegasque Institute of Sports Medicine and a dialysis centre. In cardiology, the public hospital deals with medical cardiology and rhythmology and the CCM deals with exploration and interventional cardiology, cardiac surgery and all vascular pathology. In Monaco we have a fine example of cooperation and complementarity between the two sectors.
|
|
Why did you apply to become a UEHP Board member? What would you like to achieve?
I have chaired the Union of private health care institutions in Monaco for many years and it was logical for us to join a European structure. UEHP invites us to take part in the reflections and actions carried out at European level, in particular those concerning the quality of care, the directives relating to cross-border patients, the flat-rate pricing systems by pathology... I joined the Cardio-Thoracic Centre in 1989. I was immediately won over by the innovative concept of this establishment, which is now one of Monaco's leading companies. Since then, I have been fascinated by the evolution of European private health care, its challenges and its impact, and my permanent involvement in the development of the Cardio-Thoracic Centre feeds my commitment to UEHP.
How can UEHP best help you to defend the private healthcare sector in your country?
Even if private hospitalization in Monaco is known and recognized, we are a small State with very few private health care structures. Our contribution cannot be put on the same level as that of countries with a strong private sector such as Germany, France, Italy, Spain or Portugal. On the other hand, our particular financing model, coupled with the French social security system, is interesting for all countries. Our model of care based on excellence and quality is shared by most private institutions in Europe and we are happy to present our know-how in this field. Thanks to UEHP, all the representatives of the private hospital federations in Europe, gathered around the table, exchange on their respective problems and get inspired by each other. It is together and united that we will be able to move the lines.
GERMANY
Jens Wernick, Vice-President of UEHP and advisor of the German Federation of Private Hospitals (BDPK)
How would you summarize the place of the private healthcare sector in your country?
The German health care system is a very complex regulatory system. In recent years, the legislator has transferred more and more tasks to the so-called self-administration and withdrawn from direct regulatory responsibility. The self-administration makes its decisions, among others, through the umbrella organisations of payers and service providers, such as BDPK, and through the Federal Joint Committee (Gemeinsamer Bundesausschuss). The private hospitals are fundamentally involved - albeit indirectly - in the discussion on the further development of the system.
|
|
The impact of this system on the hospitals can certainly be criticised. However, it can be stated that the German health system - at least so far - does not fundamentally place private hospitals in a worse position than public or non-profit hospitals. For example, private hospitals do not receive lower remuneration for their services than other hospitals. They are subject to the same quality requirements. Patients with statutory health insurance have, in principle, free access to authorised private hospitals, as to other hospitals. If one compares the situation with other European countries, this is obviously not a matter of course.
In principle, the German system is open to quality and performance-based competition between service providers in a system of financing based on a planned economy. As the increasing market shares of the private providers in recent years show, the private hospital providers work very successfully in this system.
The argument of cherry-picking, which is often used by critics, could be refuted during the pandemic. Private hospitals - like the public and non-profit hospitals - were fully integrated into the pandemic response concepts and made their capacities available as part of the disaster response.
Why did you apply to become a UEHP Board member? What would you like to achieve?
UEHP has achieved amazing things in the past years and has built up an organisation that - considering limited resources - does an immense amount of work. This is only possible because of the full commitment of all those involved - first and foremost UEHP President and its Secretary General. This is also due to the many technical and organisational contributions of the delegations and the careful and precise work of our treasurer.
In this way it has also been possible so far to limit the economic burden on the member unions. In the last few years, there has been no increase in membership fees.
In my opinion, UEHP will have to face considerable challenges in its work in the coming years. As UEHP Vice-President, I see it as my task to support UEHP not only in these substantial issues. It is also necessary to work towards ensuring that UEHP is organisationally and economically capable of facing these challenges. This task will hardly be achievable in one term of office of the Board. A medium to long-term period should be considered. Through my work as Vice-President, I would like to work in the next term to ensure that UEHP can grow as an organisation.
How can UEHP best help you to defend the private healthcare sector in your country?
In a system - such as the German one - which is fundamentally open to competition between service providers, the protection of fair competitive conditions against distortions of competition is of enormous importance. Unfortunately, it has been necessary for the BDPK to be involved in litigation on state aid for public hospitals in recent years. Even though some results have already been achieved, the discussion cannot yet be considered closed. On this point, UEHP has supported the private hospital sector in Germany enormously with its activities at the European level. Even though - due to the pandemic - this topic may have taken a back seat at present, it will continue to retain its importance in the future. The BDPK is therefore pleased to see that this topic will continue to be worked on by UEHP.
In my opinion, the pandemic has also highlighted another point that will have to be dealt with at the European level from a German perspective. In Germany in particular, we are currently seeing a discussion on the future structure of inpatient care that could lead to a considerable reduction in care capacities, although it became clear during the pandemic that this is to be regarded as critical from the point of view of care.
However, the question that currently seems to be crystallising in this context in Germany is again not "public" or "private", but rather "centralised care in large units with a few decentralised basic care units" or "decentralised, citizen-oriented care with the necessary focal units". In my opinion, it is clear that this raises the question of existence, especially for smaller and highly specialised units. Even though private hospital operators in Germany are active at all levels of care, the proportion of private units threatened by such a market shakeout is likely to be relatively large.
In view of this threatening dismantling of care structures on the one hand and the importance of these capacities especially for supra-regional disaster management, as in the case of a pandemic, on the other, I think the question must be asked whether the contractually stipulated responsibility of the nation states for the health care system is still in keeping with the times. It would have to be clarified, for example, what right Europe has to have a say in the further development of national health care systems and whether there are principles of health care whose realisation Europe can demand from the member states.
In my opinion, one of the most important tasks of UEHP in the future will be to participate in a comparison and evaluation of the existing health care systems in Europe and to demand the resulting consequences from the point of view of private hospital owners. Here, too, the question will not be "Public or private?" but "How can a modern, efficient and financially viable health system be designed in Europe?
PORTUGAL
Oscar Gaspar, Vice-President of UEHP and President of APHP (Portuguese Association of Private Hospitals)
How would you summarize the place of the private healthcare sector in your country?
The Private hospital sector represents about a third of all hospital capacity in Portugal and we have been increasingly gaining the trust of citizens who choose to be treated in our facilities. Today, private hospitals form networks of modern, differentiated, well-equipped establishments with the capacity to attract and retain highly qualified professionals.
The Portuguese health system is based on the Beveridge model, it has a strong public component and very often there is bias against private participation, but we have worked hard to show that the high investment that private hospitals have made is a very significant contribution to greater access and efficiency, and thus to the sustainability of the health system.
|
|
Another aspect that I must also highlight is the participation of private hospitals in all relevant debates on national health policy.
You are Vice-President of UEHP. What would you like to achieve?
The COVID19 pandemic crisis made it even more evident, even among people otherwise distracted, that Health has a fundamental European dimension. The signing of the Porto Declaration is an excellent example of how private players understand and embrace their role to achieve more resilient, sustainable, and inclusive health systems.
Each country is a different reality but there are many common issues, and, in the case of the European Union, Brussels policies are becoming more and more important for all countries (in terms of access and public health but also standardisation, competition, etc.).
UEHP is the voice of private hospitals in Europe and my ambition is that it gains visibility and is recognized by all stakeholders as an active and representative interlocutor, with the capacity to intervene (this requires policy effort, internal cohesion, and communication). Strengthening the UEHP, to be of better service, could be achieved through the reinforcement of the participation of national associations and the ambition to have members from all European countries, and in particular from the EU.
How can UEHP best help you to defend the private healthcare sector in your country?
In Portugal, we consider that our participation in the UEHP is essential to pursue our goals. UEHP enables us to have a voice and ears in Brussels, that is to say, to capture what is being discussed in EU policies and to convey our positions and concerns.
UEHP is also a way to show in our country that the private hospital sector has a significant presence and a strong dynamic in many European countries.
To have, for instance, the President, Dr Paul Garassus, take a public position on the framework of the private hospitals' activity in Portugal was very important for our sector.
UEHP has also been a platform for sharing information (namely on public policies and positioning of private hospitals) between all national associations.
In 2019 we proposed the launch of an initiative: the European Private Hospital Awards, we were pleased to have been entrusted with its organisation in Lisbon and we hope that the project can be resumed shortly after COVID19. We believe that it will help showcase the best achievements of the private hospital sector across Europe and that this event will enhance the work of all national associations.
MEMBER'S CORNER
Shortage of health care professionals in European hospitals
FRANCE
French hospitals of all types are currently experiencing difficulties in recruiting health care staff on contract or on a temporary basis, a historic situation, even though the shortage of doctors and nurses was already present before the crisis. Some institutions are now having to deprogram and close services, sometimes even emergency services, a dramatic situation in terms of public health. Maternity wards are also experiencing the same difficulties with midwives.
How can this situation be explained? The nursing staff is tired after the 3rd wave of COVID and many are currently missing due to sick leave, annual leave, etc. The intensive care units have been under pressure and some young nurses and those in training have been catapulted into difficult units without much preparation. As a result, a number of nurses, including senior nurses, are leaving the nursing profession and choosing to retrain. The nursing training programme offers bridges to Masters level, so that nurses now have other possibilities for retraining and career development. This is a problem that surprised us and was not anticipated at all. Quotas for nursing schools are defined by the government, so this problem is becoming systemic and will not be solved quickly since in France it takes three years to train a nurse”.
Another problem created by the crisis is that laboratories and vaccination centres have been recruiting nurses en masse in recent months, offering working conditions and salaries that hospitals cannot offer. “We would like to see vaccinations provided by other professionals, such as the army or the fire brigade, as there is a lack of nurses in our institutions. The Ministry has its own priorities and this situation is destabilising health establishments, public and private, regardless of their status or type of specialty. The national "Ségur de la Santé" plan granted a salary increase for nurses and a second one is to come, but despite this, we can see that working conditions are important to retain nurses. This is another project...
By Frédérique Gama, President of the French Federation of Acute Care Private Hospitals (FHP-MCO).
GERMANY
Currently, three quarters of German hospitals are having difficulty filling nursing vacancies. More than 40,000 nursing positions are unfilled in old people's homes and hospitals alone according to a BDPK (German Federation of private hospitals) publication. A Federal Employment Agency's current analysis of the skills shortage shows that it takes 149 days to fill a vacancy in the health care and nursing sector. Germany is currently experiencing a major shortage of doctors, nurses and therapists. This gap is widening from year to year. The reasons for this are the increasing number of patients, the retirement of health care professionals due to their age and the reduction of working hours due to changing requirements in working conditions. With a law to strengthen the nursing workforce, the federal government now wants to reduce the number vacant nursing positions.
The Federal Minister of Health, Jens Spahn, sees the working conditions as the trigger for the above-average reduction in working hours for nurses and the shortage of qualified nurses. For the BDPK, the attractiveness of the nursing profession must be increased in order to attract newcomers and returnees to the profession. The BDPK is committed to raising the profile of the nursing profession and developing new and innovative models of task allocation. It advocates also that staff responsibility should go back to the hospitals and that inflexible specifications such as nursing staff floors and staffing targets should be abolished.
ITALY
Entire nursing homes, but also entire wards of accredited private hospitals, are at risk of closure, or at least they are in serious difficulty: the emergency arises from the shortage of health personnel, nurses and doctors. Throughout history, they have preferred to move to the public sector, even on a similar wage.
It is estimated that there is a shortage of around 60,000 units. This alarming situation preceded the COVID emergency, but the pandemic has contributed to increase the problem, exactly when the need to find staff has opened the doors to recruitment in public structures, previously held back by a much slower turnover. This happens precisely when private healthcare is called to play a more complementary role within the National Health Service - more than ever - regarding all those health services sacrificed by the pandemic emergency.
Several Regions have already received pleas from private hospitals, asking for a solution - at least temporary - in anticipation of a long-awaited structural reform. The goal is to ensure the survival and good functioning of private health facilities, especially in a phase in which, within the Health package, the Recovery and Resilience Fund also provides for the implementation of case di comunità. At stake is the grip of a health system where bodies governed by private law and those governed by public law are increasingly complementary and integrated, and therefore the right to care of Italian citizens.
There are several proposals formulated by trade associations to the Regions, such as increasing the number of places in training schools, postponing the entry into service of successful candidates in an open competition, and providing facilities for the return of new graduates from abroad. But, above all, there is the issue of hiring nurses (but also doctors) from abroad, in particular from Cuba. Thanks to a relationship already established with the professionals of the Island, in March 2021 the AIOP has submitted to the Minister of Health a project for the recruitment of specialist doctors and nurses, with costs borne solely by the associated structures. In particular, the AIOP proposes to overcome the bureaucratic obstacles of a timely recruitment. The main one being the temporary recognition of the automatic equivalence of degrees obtained by Cuban professionals, whose level of preparation is universally recognized and who are trained in a system which is similar to the Italian one.
Internally, the AIOP has taken steps to make the connection between the demand for personnel and their availability more agile: this is how AiopJob was born. It is the program that allows AIOP member structures to take advantage of an online database of professionals - owning the qualifications required for a specific profile - available to work in health structures of several Italian regions.
FOCUS
FRANCE
Doctolib
Arthur Thirion, Director of Doctolib France
The COVID crisis has been an accelerator of digital tools within the medical profession, how would you sum up Doctolib's contribution?
During the first lockdown, the Doctolib teams deployed teleconsultation free of charge in 30,000 practices within a few days. Now Doctolib's teleconsultation service is popular with patients: 4.6 million had used it since the service was launched in January 2019, and now 10 million have used it.
We have also launched plans to support private practices to continue to see their patients in their practice during the first wave, thanks to a new management of their diaries with dedicated slots for patients suspected of or suffering from COVID19. We also helped them to resume their activity so that they could restart with their consultations without overloading their workload and in the best possible safety conditions.
|
|
We have equipped ephemeral COVID19 consultation centres, as well as emergency services (SAMU) in France, so that their staff can refer patients to medical practices, screening centres or COVID19 private centres.
In November 2020, we developed a vaccination management module integrated into our software for medical practices. Health professionals in the city should then be responsible for vaccination. We are in partnership with 20,000 general practitioners and wanted to help them.
In December, the state of Berlin asked us to open the first vaccination centre in Europe. Then, in January, the French government approached us. The Ministry of Health wanted every vaccination centre to be equipped with online appointment booking.
- Overnight, we mobilised 300 of our 1,700 employees in the various centres.
- More than 90% of vaccination centres have chosen to use Doctolib.
- Today, we equip 1,700 vaccination centres throughout France.
- Nearly 54 million vaccination appointments have been made on Doctolib (1st and 2nd dose).
What does the post-COVID medical world look like according to Doctolib?
The crisis has highlighted the fragility and vulnerability of our health care personnel at the heart of our health care system and has revealed, in the eyes of the French, their major role.
The need to invest in our health system, in people and in services, particularly in the organisation and "logistics" of the health care system, is now obvious to everyone. These services already existed, Doctolib is accelerating the deployment of these "logistic tools" to help healthcare workers and patients overcome the crisis (teleconsultation, access to the vaccination campaign, etc.).
In the post-COVID medical world, Doctolib thus has a double challenge to meet:
- to create the hospital and practice of the future where digital technology leaves more room for the human being, reducing administrative time and therefore freeing up available medical time,
- to improve the care pathway and the patient experience.
To achieve this, we are constantly developing our solutions, in co-construction with healthcare professionals, to reduce administrative time and free up time for patients. Our software is perfectly in line with this, helping patients to have better control over their overall health care, and making them actors in their care.
What impact has the COVID crisis had on the national and international development of Doctolib? What are your European projects?
Doctolib was strongly mobilised from the start of the crisis in France and Germany. This led the governments of these two countries to call on Doctolib from the start of the vaccination campaign to support the logistical effort.
We are continuing to develop, serving healthcare professionals and their patients in order to provide access to healthcare for as many people as possible:
- With Doctolib Médecin, we have launched a new-generation medical software in France, which is a high-end service to enable doctors to save time and comfort and improve patient care.
- With Doctolib Patient, we are working to increase the number of users because making an appointment is the first access to health.
And to do this, we are recruiting 100 people per month.
|