Monday 29th January 2018  
When European Healthcare policy matters!
One of the main European ambition is to reduce inequities among EU citizens, but recent OECD publications demonstrate the gap between East and West EU28 health condition. This major problem remains unsolved: how to improve quality of care in all Member States. Two questions have to be discussed, the first one in favor of strategic investment in healthcare including the private sector. Second, demonstrate continuity in European projects between Semester Presidency assumed by MS and DG SANTE global perspectives. The recent announcement which exposed a very limited ambition regarding healthcare by the actual MS Presidency, is a threat as far as action coordination is concerned. UEHP represents Private Providers under contract with Social Insurances, involved to increase service performance. Must we repeat our permanent determination to offer the best service to all European Citizens, respecting the goal of the 2013 EU Directive on patient mobility and free access to modern healthcare? Therefore, we must ask for a strong coherence between short-term, mid-term and long-term European health policy.
Dr Paul Garassus
President of UEHP
UEHP in Madrid
UEHP speaks at FITUR SALUD 2018 on private hospitals and cross-border healthcare
FITUR SALUD, as the leading tourism trade fair in Spain and well-known at international level, turned its attention to health tourism and launched the fourth edition of FITUR SALUD (Fitur Health), with the aim of offering an outstanding platform for interested agents like hospitals and clinics, thermal resorts, tourism clusters and destinations, facilitators, specialized travel agencies, suppliers and healthcare tourism service companies, to promote health tourism.
On 17th January, llaria Giannico, Secretary General of UEHP, spoke at the fair FITUR SALUD 2018, organised in collaboration with Spaincares and the SPANISH PRIVATE HEALTH ALLIANCE (ASPE) in Madrid at IFEMA (Feria de Madrid).
FITUR SALUD was conceived as a fair, giving the opportunity to professionals and exhibitors to network with a selection of purchasers invited from tourist sending countries and that represent medical opinion leaders, national healthcare organizations, providers, specialized international travel agencies and insurance companies.
FITUR SALUD also featured a series of presentations and roundtables on trends, innovations and the keys to success in health tourism.
In this context, UEHP presented its position on the Directive 2011/24/EU on cross border healthcare, as well as some real experiences coming from UEHP hospitals in different countries dealing with European patients.
After a 45-min presentation on the Directive, the state of play of the implementation in the different Member Countries, some concrete experiences coming from UEHP private hospitals and how to improve information, exchanges and communication on the topic, Ms Giannico had the opportunity to reply to the different questions coming from the audience.
The main questions arising from the public, composed by hospital CEO, members of hospital groups, hospital organisations and other relevant stakeholders, dealt with accessing waiting lists for the various European health services, how patients' medical records are accessed under the Directive, what kind of expenses are reimbursed to the patient, who are the interlocutors with whom to establish a relationship, etc.
All the stakeholders discussed about the necessity and benefits of fostering cooperation among Institutions, patients and care providers organizations, National Contact Points and the European Reference Networks to improve patients’ awareness and access to care abroad. They also explored ways of doing it practically, thanks to the presentation of case histories, experiences, good practices of efficient cross-border cooperation between some Member States.
For more information about the fair and the conferences: follow this link
UEHP in the Spanish press: click here
The case of Poland
Poland is under pressure by the EU, as cited in the Financial Times: “In December, the Commission took the unprecedented step of triggering a censure process against Poland over a judicial reform program”. “We want to be a government that combines the economy with society, and the European dimension with our Polish local dimension, the global dimension with local Poland,” said Mateusz Morawiecki, Polish prime minister.
The conflict between Poland and Europe remains active. We asked the Polish UEHP Member to describe the existing difficulties facing healthcare providers in the country. Investing in Poland is a challenge, policy stability is required for strategic improvement of services. More Europe is necessary, that is our major conviction for quality of services improvement. Our goal is the diffusion of medical progress through technology innovation and management performance. In Hospital services, as well as in other economic sectors.
Polish private hospitals in the turmoil of reforms
The adoption by the European Commission of Article 7 of the EU Treaty against Poland on 20.12.2017, for fear that the country's judiciary become under the political control of the ruling majority, is also an opportunity for UEHP to inquire about the fate of the private hospitals sector in Poland after the implementation of the Hospital Network law in 2017.
Polish Association of Private Hospitals: The situation of private hospitals in Poland has worsened since the introduction of the Hospital Network reform at the end of last year, preventing the majority of private hospitals from contracting with the National Health Service and receiving funding from the National Health Fund (93 %). Hospitals not included in the list have to compete for the remaining 7%.
Only about 40 out of several hundred Polish private hospitals entered this network, mainly due to their medical specialties enabling the State to fill the gaps in public hospitals infrastructure. The current system replaces the former, which consisted in annual contracting between the State and private hospitals, with funding from the National Health Fund, for half as much money.
In addition, the crisis in health protection was deepened by the action of the medical community, with doctors limiting their overtime to a maximum as a protest. In the last couple of years low payment per hour encouraged doctors to work more. Currently, wages have risen significantly, but staff shortage is still huge.
Also read our post in the June 2017 edition of UEHP newsletter
The private hospital sector in Poland is facing hard times
Poland is facing a difficult time due to an undergoing legislative process to reform its healthcare system, as well as social consultations and protests of the private and business community.
The current government has undertaken a remodelling of the Polish healthcare delivery system around the national public hospital network, discarding the previous government’s efforts to privatize hospitals. Public hospitals will then become 93 % of the health care budget, leaving the private sector with the remaining 7%. These changes will affect hospitals and clinics that have so far been able to operate based on their contracts with the National Health Fund (NFZ).
The National Private Hospital Association foresees that 80% of private hospitals in Poland will find themselves in a difficult economic situation without their current income coming from the NFZ.
At the same time, a new form of universal health insurance system, -moving from a national insurance model to a model funded by government revenues and covering hospital services- is under discussion. The Ministry of Health also recently announced the ban on subcontracting (prohibition to sell, lease or rent out durable assets) and the authorisation for public healthcare establishments to provide commercial services once the limit of publicly funded services runs out, creating then a state of competition with private hospitals.
In these conditions, the future of the private hospital sector in Poland is uncertain.
A continuity in European Health Policy reforms?
According to the Lisbon treaty, every semester a European Member State presides the EU Council. In January 2018, Bulgaria took the lead, and holds now the rotating presidency for the first time since it joined the EU in 2007. Three key words were chosen to describe priorities: Consensus, Competitiveness and Cohesion.
May we express our disappointment as we discovered the first publication? Not a word on health, or merely repeating the necessity of “effective medicine at affordable prices”. No connection to previous decisions and projects, such as e-health or quality indicator programs. We clearly understand practical priorities as a first step to improve health status. But a poor coordination between successive EU MS policy which deserves long term strategy, limits incentives concerning innovation in healthcare. Continuity as well as stability, are major tools for improvement, Europe needs more consensus and coherence. We are still waiting for more information concerning a new impulse in the healthcare sector, but budget restriction could cancel the European Health meeting during the Bulgarian presidency. We know the complex Bulgarian situation, international press has published specialized articles on this topic (The Economist, January 13th Issue). The role of the EU Commission is certainly to support a global project for quality of care and effective investment as required in previous recommendations by the “Investing in Health” Expert Panel. The UEHP opinion is not controversial but remains proactive for sustainable development in the healthcare sector, respecting long term strategy. European coherence is required for long term healthcare policy. Private Hospital Managers expect to see continuity in 2018, but the current developments do not keep pace with their expectations, harming professional development and limiting the global vision of a common future.
The future of healthcare in Italy
What will the future of healthcare look like in Italy and, particularly, what are the auspices of the private hospital sector?
In a scenario made uncertain by the difficult economic situation and by the upcoming national political elections on 4th March 2018, the President of AIOP, Gabriele Pelissero, illustrated AIOP position last 17th January in Rome, on the occasion of the presentation of the 15th edition of the annual report “Health & Hospitals in Italy”, a study focusing on the National public and private hospital system.
The Italian NHS, a Beveridge-based model, constitutes itself on the two pillars of universality and solidarity, two characteristics facing many problems nowadays. The universality principle, in fact, falls if accessibility and high quality of care are not guaranteed. The solidarity principle is linked to the budgetary restrictions on public expenditure. These preconditions underline that the functionality of the Italian NHS is skating on thin ice because of lack of available resources and the consequent reduced capability of providing services to the population. Moreover, the Italian NHS is characterized by a strong regional role and by the pluralism of healthcare providers, causing regional differentiation and competitiveness.
The biggest restrictions on public expenditure are recorded within the health sector, the so-called dangerous "culture of disinvestment", as shown by the Document of Economy and Finance approved by the Italian Parliament in October 2017: the level of financing in healthcare drops to 6,3% GDP, under the 6,5% GDP threshold established by the World Health Organization.
It is clear that Italy needs an adequately financed NHS, always trying to improve quality and efficiency, accepting the coexistence of public and private providers, with the same rights and duties, being able to guarantee the patient’s freedom of choice at all stages. The new legislature opens with the need of rethinking healthcare in order to protect the right to health for all citizens.
In such a situation, AIOP reflects on the possible paths for improvement and proposes itself as one of the leaders of the healthcare of the future. However, the actual pre-electoral phase makes it impossible to know the political choices concerning the healthcare sector that will be made by the future Government. A clear trend reversal, bringing the healthcare expenditure to 7% GDP, would draw an optimistic scenario with considerable qualitative and quantitative improvements of performances. This is what AIOP really wishes for the future. But what if this is not happening?
The consolidation of the actual levels of expenditure could determine a substantial buoyancy of the Italian system. This situation would bring to an increase of the private expenditure, leading to a clear stratification of the population and of the regions with greater economic resources.
Instead, a drastic drop of the public expenditure in healthcare would open two new scenarios: the first one characterized by the use of additional financial resources and the second one characterized by a permanent erosion of the NHS.
The first scenario would need the adoption of targeted structural reforms to explore and attract additional resources. In such case, the possible pathways are two. The first one would be characterized by initiatives aiming at widening the levels of profit-sharing of the expenditure preserving the model of actual financing (an example could be a strong action on the “tickets”, limiting the exemption for pathology to the lowest tax brackets). The second one introduces elements of the Bismarck systems, like the reduction of the universality of care guaranteed by the NHS only to those groups of citizens who do not have the means to replace the national care coverage with other tools (other funding and insurances). This approach needs a precise normative intervention, but above all a vast level of social consent.
All the solutions proposed above ask for a strong reforming vision to create a coherent and effective organizational systems. What if this is not happening?
A progressive decrease of the public expenditure, without compensatory solutions, would surely lead to the collapse of the Italian NHS, with increasing disparities in universality and equity, an uncontrolled increase of the out-of-pocket expenditure and a strong social suffering.
In this complex transition phase, which position does AIOP intend to adopt?
"In the uncertainty of the future, the presence in Italy of a great network of private hospitals represents a remarkable advantage for the NHS, a precious opportunity to provide healthcare services with high levels of efficiency, even in the eventuality of a productive crisis in the public sector – says Gabriele Pelissero, AIOP President. - This is a lot, but clearly not enough! Without the adoption of targeted measures in healthcare, the AIOP network will not be able to guarantee the universal coverage of health services. Another important advantage for the Italian NHS is the ability of the AIOP network to react and adapt effectively to changing environments, tackling significant challenges with limited resources.
This resilience represents a added value for the whole country. The auspice is that national and regional governments would recognise this added value the more and more, to help guarantee the health of their citizens."
New year, new wishes, new challenges
For 2018, the first wish we have is an improvement in our country economic situation, in particular with the doubling of health expenditure, a better cooperation with private insurance companies and the development of medical tourism.
We will be busy this year with the new legislation for private Clinics in Greece, which will be voted by the Greek Parliament in May. As early as November, a special seven-member committee in the Ministry of Health in which I participate as a member, meets day after day, for the changes of legislation and the submission of the proposal to Parliament in the next May.
Financing I do not think is possible in the new year...
However, reforms can exist in both public and the private sectors. Already the next week, real-time online connectivity begins with the only insurance fund EOPYY.
We are still aware of a new way of controlling the medical expenses we submit to the State Fund (in February) and negotiating after 6 years a new contract with EOPYY.
The wishes of the Portuguese Association of Private Hospitals (APHP) for 2018 are the sustained growth of the private hospital activity. We are working to reinforce and deserve patients' trust (with differentiation, focus, innovation) and institutionally affirm private hospitals as an essential pillar of the Portuguese health system.
We also expect to establish a dialogue with the Insurance Companies Association in order to study and develop the Health insurance market.
In Portugal we are facing a trend against private initiative in health. In political terms there is a lot of "noise" against Public Private Partnerships in Health and there is the idea that it is necessary to reduce the margins of the private sector despite the proven benefits of private management of public resources.
On the other hand, a great discussion is now underway regarding the NHS and its financing, which may be an opportunity to note the importance of private hospitals in terms of efficiency and even access.
Internally, we continue the challenge of increasing cohesion among all private health providers.
Private hospitals in Austria would welcome an important and necessary change of approach in our health policy: "Equal pay for equal performance". We also wish to have more transparency in our health system financing policy, which would lead to more efficiency and best secure in the long run our health system based on solidarity.
Those wishes are not new, we would then welcome prompt solutions. Since years, private hospitals invest a lot in quality – in their workforce and infrastructure – and make thus a growing contribution to healthcare delivery in our country.
In 2018, we will be busy with the implementation of the regulation on data protection in relation with our processes and transparency. An other important topic will be the regulation on practitioners working time, from which we hope some facilitations for our daily management.
For 2018, AIOP wishes that the new legislature (upcoming elections on 4th March 2018) opens with the need of rethinking healthcare in order to protect the right to health for all Italian citizens (the level of financing in healthcare drops to 6,3% GDP, under the 6,5% GDP threshold established by the World Health Organisation.).
Italy needs an adequately financed NHS, always trying to improve quality and efficiency, accepting the coexistence of public and private providers, with the same rights and duties, being able to guarantee the patient’s freedom of choice at all stages.
We wish from our new Government in 2018, more confidence in a competitive organisation of our healthcare system. Then only competition can create the positive steering impulses needed by a healthcare system that have to provide care to a population with limited resources.
Our main ongoing issues. For acute care hospitals: a fair competition for a better quality of care, no public subsidies from tax revenues for public hospitals, more transparency for patients as regard to quality, less bureaucracy and more time allocated to care, more investment to modernise infrastructures, equipments and e-health. For rehabilitation hospitals: more reha and less unnecessary care, free rehabilitation hospital choice for patients, better agreements between rehabilitation hospitals and paying authorities.
We wish for 2018 a stronger entrepreneurial approach in healthcare policies, less planning privileges in the form of cross-subsidizing or deficit guarantees for public hospitals, organizational unbundling of regional governments and public hospitals.
Our main issues for this year are: shift to ambulatory care, overall budgets in health care, people's initiative against rising health insurance premiums (in preparation), people’s initiative for premiums relief (in preparation).
In 2018 we will continue working to obtain from the administrations a real recognition of the private health sector as an essential part of the National Health System and to defend the different models of public-private collaboration for its efficiency and usefulness.
In addition, we will continue asking that the decisions on the Spanish health system be taken by objective, measurable and transparent criteria and not by ideological or political interests, and that public and private health have the same criteria of control and measurement of results, legal requirements, etc.
The main challenge for the Spanish health system in 2018 and in the coming years will be to guarantee the sustainability of the system itself. The Spanish population is increasingly ageing and there are more and more chronically ill and complex patients, which is generating an increasing expense that we will hardly be able to assume without the appropriate reforms in the system.
One of the most discussed topics this year will undoubtedly be the need to increase the importance of socio-health care and long-term healthcare centers, which can take care of patients who do not have an urgent illness with lower costs than traditional hospitals.
On the other hand, the technological evolution of health centers and issues such as the electronic prescription for the Spanish private system or the compatibility between the different information systems that are used within the sector will occupy a large part of our time.
Our two main challenges are:
  • Improve the quantity and quality of information available on health outcomes, both public health and private health.
  • Update or clarify the regulations regarding health system professionals, especially regarding the incompatibility to work in the public and private system and in the homologation of training and work experience in private health.
For 2018, the French Federation Private Hospitals (FHP) wishes a responsible health policy that supports healthcare establishments in their development and mission to provide care to all citizens, despite economical constraints.
2018 will be a crucial year as regard to healthcare reforms. FHP will actively contribute to the work on strengthening quality and appropriateness of care, key levers in health system transformation. FHP will also be involved in the reform of health authorizations. The coming reforms should support the further development of outpatient care by allowing private hospitals to extend their actions ‟outside their walls”(new legislation on health centres). It is an issue at the crossroads of innovations.
2 February
UEHP General Assembly
14-15 June
European Hospital Efficiency Forum
20-22 June
EHMA 2018 Annual Conference