However, they have more in common than what it is thought and they share a variety of common problems, such as the one of sustainability, the pressure from adverse demographics, the low economic growth and high growth in expenditure.

Best practices may differ depending on national tradition, but as the sustainability of the health systems is at stake this should not stand in the way of reform. As inadequate supply – resulting in long waiting times even for serious illnesses – and lack of public finance for sufficient investment in health systems are often a key problem, public and private partnership in health – notably in hospitals – is a way to increase sustainability.

There are many different ways in which such public-private partnerships can develop, and there are different sources of private capital that can be employed. But privately owned hospitals are viewed with suspicion from many sides – not for suspicion of low quality or low productivity – but more as providing poorer employment conditions and creating inequality in access.

However, the UEHP Factbook has found no evidence that there should be a systematically poorer employment record, but there is clear evidence that private hospitals in Europe do not create inequality, as the payer is generally using the same public health system that provides access to the public hospitals. Therefore, inequality is not created by the ownership of hospitals, but by the financing system – who pays.

As private hospitals – living and competing alongside public hospitals – creates more choice for patients and shorter waiting times for illnesses, including for example cancer, and in many cases provide same or better quality of results than public hospitals for less money, there are good reasons to give space for private hospitals in systems where they don’t exist so far and to develop the private hospitals in systems where they already provide their services. But to create a successful partnership with all its benefits, it is also essential that the system treat the private and the public hospitals on an equal basis, which is not always the case today.

The recent debate about health systems around the world, including in Europe, has focused on the value of outcomes of the health systems in relation to cost – the so-called Value Based Health Care (VBHC). To develop VBHC means focusing more on the patient’s satisfaction, accepting higher degrees of specialisation to create higher value, and transforming reimbursement systems from volume to quality.

The whole healthcare system, and indeed the patients, can benefit from this shift and there is no doubt that the private hospitals can play a key role in it and identify themselves as the model of the hospital of the future, (the so-called “Smart Hospital”), more efficient, more specialised, with the patient and his satisfaction at the center of it, always paying attention to cost containment and to the added value all NHS can and should give to their citizens.

The launch event saw the participation of the major stakeholders operating in the healthcare sector coming from all over Europe, as well as representatives from the European Parliament and Commission. It was indeed a unique opportunity to discuss the major topics on top of the European agenda in healthcare, involving all of us, as the healthcare providers of the services of the future.

To order the Factbook : secretarygeneral@uehp.org

Cristina Contel, President of Spanish Federation Private Clinics – ASPE
the Factbook makes clear that the European Healthcare systems, as we understood them so far, are neither viable nor sustainable without the cooperation of the Private Healthcare partners. “Inequality does not come from the hospital’s property (private or public), but rather from who pays and how it is paid.” Private resources provided by private companies play a key role in the service provision, not only because of their complementary means, but because they release public resources and enable the State to save in its investments.

Jens Wernick, German Federation Private Clinics – BDPK
providing transparency on health care services not only is a way to secure sustainable health systems but also a way to actively ensure patient´s security and to promote patient´s rights. As private hospitals, we embrace the challenge of comparing ourselves and we are offering to assist in all necessary activities. German examples coming from our diagnosis-related group (DRG) reimbursement systems do not give proper indications about quality but enable to compare services, which is already a good start. It is a first step towards more transparency. In fact, that is what we need in Europe. We have to be able to compare services in order to find best practices. Further, it would be useful to be able to compare quality on a larger scale rather than compare hospitals according to their ownership. The results would than reflect which ownership group better performs.

Grigorios Sarafianos, President of Hellenic Private Hospitals Organisation
The Factbook is very important as it shows the importance of private hospitals in the delivery of health care for all citizens in each country in Europe. It will help us in Greece to change the common perception and will be a lever to extend our activity to other patient groups, i.e. private patients and medical tourism.

Laura Horvath, Managing Director of Austrian Federation Private Clinics
Presenting the importance of the private clinic landscape for health systems in facts is going to be decisive for the future of this sector. The Factbook is an ideal tool to demonstrate this importance to the public and policy makers. The fact that this Factbook deals with figures that consider private clinics separately is both new and very effective. We will derive beneficial results from it that will help our sector to meet future requirements.

Paolo Silvano, Managing Director of Vivalto Santé Group
I am impressed by the interest in the theme. Hans Martens asked more questions than he gave answers. On the question of evaluating the place of private hospitalisation in the system, there are no absolute truths but rather questions to those who define public policies. I remain convinced that public authorities in Europe should play a bigger role in creating a single health market, which does not exist today. In terms of access to health, it would be great if each patient could get treatment in the European country of his choice, which would enhance international competition where the private sector would do very well because it already has a Service culture and provides adapted care.

Hans Martens, Health Economics Expert
The European Health system model can only survive if we have sufficient resources. The public sector does not have the resources because of demographic developments with too many old people and not enough young people to pay the taxes, so we need private capital to go in otherwise the system will collapse. Then, the issue is not about who owns the hospitals as long as they function perfectly. The question is rather about who pays. If it is the same payer, the insurance companies or the public sector, there is no inequality because of the status of the hospital. Inequalities can be observed in countries where the patient has to pay a lot out of pocket. We have national data but no comparable European data. We do know that the number of hospital beds in Europe is being reduced but the number of private hospitals is increasing. That is interesting. The reason are the lack of new investment from the public sector and higher patient satisfaction from private hospitals. They are more efficient. This analysis is designed to stimulate a policy debate at European level with a positive message by linking it to the hot topic of sustainability of the European way of health systems. A debate to be continued…

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The UEHP President, Dr Paul Garassus, replied expressing his satisfaction to be in Belgrade. Serbia joined UEHP in 2015 and, despite being a young association, Serbian private hospitals have shown their dynamism and share with its European colleague common goals: the pursuit of quality, ethics and economic performance. The «Code of Ethics» elaborated by the Serbian Association reflects its full commitment in quality of care.

Regarding the accession of Serbia to the European Union, the UEHP is pleased to witness Serbia´s engagement and to be a vector in this accession process.

The President then presents few slides portraying the UEHP past, present and future activity.

UEHP members had the chance to listen to the first presentation of the day from Dr. Milan Dinic, Director of the Serbian Medical Chamber. He spoke the Republic of Serbia, its NHS, its Health Insurance Fund and the plan of activities for 2017/2018.

The second interesting presentation of the morning session was held by Dr. Maja Vuckovic-Krcmar, Msc, MPH, programme Manager – EU policies / Horizontal coordination and Health /DMO. Delegation of the European Union to the Republic of Serbia. She spoke about the “state of the art” of the negotiations between the EU and Serbia about the accession of Serbia to the European Union, with a specific focus on Chapter 28, which deals with health protection.

After the activity report from Ms Giannico, UEHP Secretary General, and the future actions by the President, the floor was given to the Serbian Association of Private Providers. Dr. Dragana Milutinovic, Executive Board Member presented the Serbian Association of Private Healthcare Providers and Dr. Dusan Ratikic, Ethical Board Member presented the Serbian Association´s Code of Ethics.

Dr Ratikic explained that the role of private providers in Serbia is still being defined. There is still a certain mistrust and it is one of the reasons the Association decided to create the Code of Ethics: to establish trust and educate society about the importance of nexus between business and ethics.

The document was written to overlap with the current legislation and it should be a tool to be used by the members and it should be binding for the membership.

The afternoon session was opened by two interesting presentations by two of the major French groups:

• Silver Economy: Care and Cure – European Experience by Emmanuel Masson, International Deputy COO Clinics Department ORPEA – CLINEA
• SHAM Hospital Insurer in Europe: Management of medical liability risks: global approach / local variation. Erwan Trividic Head of Sham International Development – executive Management, and Christophe Julliard CEO SHAM Italia

After that, UEHP officially launched its Factbook with a presentation form the author, Mr Hans Martens. In view of the presentation of the UEHP Factbook at the European Parliament on November 7th, Mr. Martens stressed that it is important to send a positive message and gave an overview of the points he will be focusing upon, such as Inequality, Trends in the hospital world (toward specialization), Waiting times/access, Key to sustainability: the place and role of private hospitals in an integrated healthcare system, Value-based healthcare, Difference cost/investment.

Then, UEHP benefitted from the interesting session organised by the Serbian Association of Private Healthcare Providers, leading a working group aiming to support neighbor countries in the development of private healthcare provision and the creation of private healthcare associations.

In this context, the Serbian association kindly invited the countries listed below to attend the UEHP Council meeting and give an overview of their situation.

Dr. Jasmina Knežević, Member of the Executive Board of the Serbian Association and owner of Bel Medic Hospital, served as moderator:

• Croatia: Mrs. Jadranka Primorac, as Chief Operating Officer of Sv. Katarina Hospital, explains that Katarian Hospital is the largest private hospital in Croatia and is accredited by Global Healthcare. There are about 8 to 10 big private hospitals in Croatia. Cooperation with the public sector for MRI scanning mainly.
• Macedonia: Mr. Jana Marin is Member of the Board of Directors of Acibadem Sistina. This Macedonian hospital has 285 beds and is JCI accredited. 20% of the revenue comes from the Health Insurance Fund, otherwise mainly out of pocket.

There are 2 more big hospitals in Macedonia, the rest are small policlinics.

• Montenegro: Mr. Igor Ivanovic is the Director of Codra Hospital, the biggest private hospital in Montenegro. Revenue from 50% private patients paying out of pocket and 50% from public fund. There are 10 other small hospitals in Montenegro.
• Romania: Mr. Eduard Dobre is the Executive Director of the Romanian Private Medical Services Association (PALMED). The association was created in 2007. Mr, Dobre expresses his wish to become a member of the UEHP.
• Republic of Sprska: Mr. Miodrag Marjanović represents the Association of private medical doctor of the Republic of Srpska. The republic has 5 private hospitals. Regarding the price paid by the government to private hospitals, there is a capitation agreement in place but the amount is very low.

After the public afternoon session, UEHP members discussed privately about the logistics and content of the launch event of UEHP Factbook at the European Parliament next November 7 and about the Financial situation of UEHP with a report by the Treasurer – Mr. Guy Nervo.

The next General Assembly will take place on Friday 2 February in Brussels.

The President thanked the Serbian association for their warm welcome and closed the session.

UEHP meeting was filmed by the National Serbian Television. See the interviews here.