UEHP Newsletter - April 12th, 2017  
  April 12th, 2017  
From Rome to all European Citizens
This March, 25th the European Union was celebrated the 60 year anniversary of the Treaty of Rome. From a visionary perspective, the European project proposed by the « Fathers of Europe » in 1957 is still ongoing. Thus, it began an unprecedented period of security and prosperity based on a set of commons rules. UEHP is engaged as a partner of change, trying to improve the everyday life of patients, enhancing major recent changes such as European patient mobility and medical innovation in sustainable healthcare systems.
In a complex and uncertain world, we consider the future of Europe as a chance. We are effective providers of efficient health services dedicated to citizens and we participate to a global challenge, the development of human welfare. Deeply involved in working groups on quality of care, eHealth and cybersecurity, we express our full implication for modern key success solutions.
UEHP was founded in Rome too, more than 25 years ago, and is proud to participate to this anniversary. Great thanks to previous policy makers able to draw the European future. The inheritance is a mix of respect for the past and responsibility for the future.
Born the same year than the Rome Treaty, my own job is to give to the next generation the same opportunity I shared before with the European civil society. The Rome ambition is still alive!
Dr Paul Garassus
President of the UEHP
In Portugal, the regulation of the system is independent.
There are many countries where the Ministry for Health is at the same time, regulator of the medical system as a whole and manager of the public sector, this naturally results in a conflict of interest.
In Portugal, the regulating organisation, the Portuguese Healthcare Regulation Authority (ERS) created in 2003, takes care of monitoring, the regulation of healthcare providers, establishments and suppliers. It is completely independent of the government and is dedicated to protecting the interests of the general public. Its very dynamic director, Sofia Nogueira da Silva, came to the AGM of the UEHP in Lisbon on March 10th.
The Portuguese Healthcare Regulation Authority controls the activities of public, private and non-profit healthcare institutions, private practices of specialists such as dentists and suppliers, etc. The board comprises three members, named for 6 years and they may not have any connections to the healthcare sector. They submit their accounts to the government and to parliament. The organisation includes 60 paid members and external experts.
The ERS aims at delivering independent assurance with regard to:
  • compliance with the legal requirements for healthcare services and establishments,
  • the protection of patients' rights, including access and freedom of choice,
  • legality and transparency in the economic relations between providers, funders and users,
  • fair competition in healthcare markets.
The ERS carries out several regulation and supervision activities.
"There are prejudices among the decision-makers in Portugal with regard to the private sector, which are rooted in history. This cannot be changed from one day to the next. But the regulatory authority believes that the rules must be the same for everyone. We are independent of the government, outside the system and we must be neutral and without prejudice in order to be a balanced and fair authority", affirmed Sofia Nogueira da Silva.
Prof. Sofia Silva, President of the Health Regulatory Authority, Portugal

Financing possibilities for the healthcare sector at EU level exists. If it is acknowledged that the EU-level financing will never cover all needs, it is a welcome complement. UEHP has been invited from the European commission as relevant stakeholder to the seminar “Strategic investments for the future of healthcare”, held in Brussels on 27th February. The seminar was a unique opportunity to learn more about investment possibilities at EU level for innovative forms of healthcare.
The seminar was organised by the European Commission Directorate-General for Health and Food Safety (DG SANTE), in co-operation with DG Economic and Financial Affairs (DG ECFIN), DG for Research and Innovation (DG RTD) and the European Investment Bank (EIB).
The event aimed to promote the Investment Plan for Europe and the European Fund for Strategic Investments (EFSI) in the health sector and to encourage the community of stakeholders in health to design and implement new forms of healthcare, which are necessary part of structural reforms in health systems. Channelling new forms of investments, including using EU financial instruments such as EFSI, which absorbs part of the investment risk and has already benefited major health projects in various Member States, can play a key role in this context.
UEHP is currently collecting information about how to access such funding in the different countries.
Beside that, EFSI published a Fact sheet on mobilising funds for the health sector, providing a series of tips and examples on how the Investment Plan for Europe can be utilised for:
Medical research; innovation in products, services and solutions; new models of health infrastructure especially for primary and integrated forms of care; new technologies and e-health; medical education and training.
Our Secretary General, Ms Ilaria Giannico, has being interviewed by "Global Salud", the magazine released by the Spanish Federation Private Hospitals (ASPE). 
Being appointed new UEHP SG in July 2016, Ms Giannico speaks about her new role at the hearth of Europe and the main battles UEHP is involved in at European level. 
Being appointed new UEHP SG in July 2016, Ms Giannico speaks about her new role at the hearth of Europe and the main battles UEHP is involved in at European level.
The interview also provides some insights on the role of private hospitals in Europe and the main obstacles they are dealing with, with a focus on the Spanish private hospitals represented by Alianza de la Sanidad Privada Espanola (ASPE), member of UEHP.
On the occasion of World Health Day - April 7 – the National Statistics Institute (INE) presents the annual publication of Health Statistics for the period 2005-2015. For the first time in the history of the Portuguese Health System, hospitals with private management (115) represent the majority of inpatient health facilities.
According to the INE, the most relevant facts of the Portuguese health system in recent years are:
  • The upward tendency in the number of private hospitals (from 91 in 2005 to 111 in 2015). Out of the 225 existing hospitals in Portugal 111 are private hospitals and 4 are privately managed ;
  • The increase in emergency care admissions in private hospitals (+ 14.5% compared to 2014);
  • The increase in the number of available inpatient beds in private hospitals (880 more than in 2014, an increase of 8.5%);
  • The upward tendency in the number of outpatient medical consultations, especially in private hospitals (about 500 thousand more consultations than in 2014, an increase of 9.5%).
An increasing number of Portuguese citizens rely on private hospitals for their health care. Private hospitals have made a continuous effort to invest in terms of network expansion, innovative equipment and reinforcement of training and research. The Portuguese Association of Private Hospitals (APHP) salutes private hospitals for their dynamic performance.
The German Association of Private Clinics (BDPK) sued the District of Calw for subsidising local clinics with taxpayers' money with more than 10 million Euros in subsidies, over many years, to the municipal hospitals to refrain from balancing out these deficits.
March 2016: The Federal Supreme Court had stated that the granting of such aid by local authorities to their hospitals is subject to very strict requirements. Particularly lacking, in this case, was a clear allocation, showing which subsidies were made to cover which specific costs at the hospitals (transparency criterion). Therefore, the Federal Supreme Court had referred parts of the proceedings back to the Stuttgart County Court to make the final decision on whether the subsidies made by the District of Calw constitute unlawful aid under EU legislation.
March 2017: The German Association of Private Clinics deplores the decision of the Stuttgart County Court and the outcome of the procedure. According to the Federal Supreme Court, local authorities, which cover operating costs losses of their public hospitals with taxpayers' money are acting in compliance with the EU legislation. The only condition being that the subsidised public hospital is included in the hospital planning program with a supply contract.
"Now consequences of inefficient management of public hospitals can be transferred without restriction to the taxpayer. The provision of medical care to people is not going to be better, only more expensive. Besides, it discriminates against all other hospitals in the vicinity that are operated by private companies, private non-profit organisations or churches", explains Thomas Bublitz, director of the BDPK.
The canton of Zurich intends to tax the revenue that comes from treating patients, who have supplementary insurance policies. Basic insurance is mandatory in Switzerland, but supplementary insurance is voluntary. Last year, Zurich's listed hospitals earned 636 million Swiss Francs from treating patients with supplementary insurance. In the context of the cantonal savings programme, the Health Department wants to claim approximately 43 million CHF of this [link].
The patients of two private hospitals in Zurich would be responsible for 90 per cent of these cantonal tax receipts. This would mean that premium payments intended to fund advanced medical treatment would be removed from the health service. These funds must not be misused for the clean up the national budget. The health insurance law obliges the cantons to enable the regulated, but non-discriminatory co-existence of public and private hospitals. Specific quotas for different groups of insured persons are therefore clearly unlawful. The freedom of choice for patients that is guaranteed by law encourages medical quality.
"This tax is a serious foul. Hospital tax is designed in such a way that it does not affect the canton's own hospitals. By competing for patients with supplementary insurance, the canton of Zurich wants to disadvantage successful hospital providers", says Adrian Dennler, President of Private Clinics in Switzerland (Privatkliniken Schweiz, PKS). A tax, which serves the general fiscal purpose and specifically excludes patients from two of Zurich's private listed hospitals, is unconstitutional. The tax goes against fiscal principles and harms the qualitative competition.
IC-Health is a project to develop a series of Massive Open Online Courses (MOOCS) to help improve the digital health literacy of European citizens. MOOCS will be developed in eight languages (English, French, Italian, Danish, German, Swedish, Dutch and Spanish).
IC-HEALTH project is launching a survey meant for children, adolescents, pregnant or lactating women, elderly and people with type 1 and 2 diabetes, to understand how they search for online health information, in relation to which topics, and how they apply it in their health management practices.
This will help the project develop tailored activities on co-creation and design MOOCs that are effective and user-friendly, as well as to maximise the adoption and engagement of future users.

High tech in rehabilitation clinics - how apps and robots aid in rehabilitation
The health industry in particular benefits from the newest technologies that can be used in all kinds of ways. The use of walking robots and therapy apps has become standard in rehabilitation. This makes it possible to tailor far-reaching rehabilitation plans for patients, with long-lasting results.
Interview with Mr. Stefan Günther, Secretary General of the Austrian Federation of Private Hospitals, which, in its capacity as advocate for private hospitals also represents 14 private rehabilitation clinics.
Which technologies are already being used in rehabilitation?
There are, of course, many new technologies, which are offered in rehabilitation clinics, however, these are carefully selected. The use of new equipment or particular apps should make the therapy process more efficient and longer-lasting for the patient. However, we require scientific evidence.
The aftercare app for multiple sclerosis patients, developed by the Rehazentrum Münster in Tirol, is currently being tested in co-operation with many rehabilitation centres in a scientific study. But the pilot study has already shown impressively, which advantages the use of such apps can have for patients following a stay in a rehabilitation clinic- particularly compared with traditional home exercise programmes.
One of the most significant developments in rehabilitation is the various types of computer-controlled movement coaches. One of these innovations is the G-EO gait trainer. This is used for example at the Klinikum Bad Hall in cardiovascular and neurological rehabilitation. It is one of the most modern gait rehabilitation systems, which is able to simulate every single sequence of human movement - including climbing stairs. Using sensors, which measure the actual energy expended by the legs, the robot can produce exactly the amount of energy that the patient is unable to generate in order to complete a certain movement independently.
What do these developments bring?
The greatest advantage brought by the new technologies that we use is the fact that the therapy can be personalised for each patient and this, in the long run means that better and more sustainable progress can be achieved. In this way it we are able to tailor the therapy to fit the needs of the patient exactly and to adapt it accurately to the current state of progress.
At the same time, it has become easier for the therapists to support the patients more individually and to reach the "intermediate objectives" earlier. It also increases the motivation of the patients!
In all, one can say that the possibilities for treatment became much more extensive through the use of these new technologies.
In which other areas of rehabilitation could these new technologies also be used and/or is there still potential for further development?
In the future, the use of those technologies that can be applied to the entire course of therapy, from the acute medical stage through rehabilitation through to aftercare at home, will be most meaningful.
We will also be required to work with the data that is, in principle, already available today, to become much more accurate in diagnosis and to develop more individual therapy plans. This can go from early recognition of risk groups to increasing and to stabilise the success of therapy. The use of the technology for mobile communication will play a significant role in this. How well that actually succeeds will depend on the quality of interdisciplinary co-operation between the doctors and therapists, science, the technical developers and not least also on the creation of the necessary legal conditions. It is, however, important not to forget that the patient must be at the forefront and that practicality and ease of integration into everyday life play a very important role.
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