Tuesday, 24th November 2020  
Hope is back!
The recent vote by the European Parliament increasing the #EU4Health budget and aiming to reduce inequalities in accessing health care, is a sign of hope. The latest announcement by a major Big pharma group regarding the possibility to soon have a safe and effective coronavirus vaccine available is also a major new hope.
After such a long and difficult year 2020 which saw health systems and economies across the world under pressure, welfare states close to collapse and the world´s population threatened, good news concerning medical strategy to limit the pandemic risks inspire and strengthen our actions.
European Hospitals, all together, with the total involvement of their workforce, work hard every day towards saving patients´ lives and we certainly cannot forget the health and care workers, our colleagues, who lost their life during this unexpected fight against COVID.
We must remain prudent of course but public and private research will probably be able to offer relevant solutions in a few months’ time and, until then, public and private hospitals will continue their dedicated work towards saving people´s lives.
Hope is back, and we know that a great energy will be required to face the social reconstruction which has been shaken by the virus. UEHP is at work, ready to face all these challenges in the EU27.
Dr Paul Garassus
President of UEHP
UEHP in the media
Observations by Dr Paul Garassus, President of UEHP
Dr Paul Garassus, President of UEHP
Interview published in the newsletter of the French Federation of Private Hospitals (Medicine, Surgery, Obstetrics) FHP-MCO, November 12, 2020
The geography of the crisis is not that of the States
First of all, European private hospitals have earned their credentials in the management of the epidemic. Public institutions played their part perfectly and private institutions earned their place alongside them.
When health systems are saturated, categories are forgotten: all public and private actors answered the call and threw themselves into the battle.
The impact of the epidemic is not ubiquitous
Some areas are more affected by the virus without anyone being able to explain why. In France during the first wave, the Ile-de-France and the Grand Est region were on the front line, and on the contrary, Occitanie or Normandy were spared. Today, all our attention is focused on the South East quarter of our country. Similarly, southern Italy was preserved, as was Austria on the plains, or Portugal, even though Spain was heavily impacted.
What is certain, however, is that the heterogeneity of health systems cannot intrinsically explain these differences. Why is it, for example, that the epidemic per capita ratio varies currently from 1 to 10 in Scandinavian countries with very similar health systems? The severity of the pandemic does not depend exclusively on the organization of care.
Responses to the crisis are exclusively regional
Many federal countries, such as Germany but also Italy or Spain, have autonomous regional health systems. In Germany, each Land has a health minister. Crisis management was done at the regional level with central coordination. However, when the health system was strained, the inter-regional transport of patients was activated. Nowhere has this really been modelled. No one had foreseen the cascade of events that health professionals had to face but they adapted.
A few international patient transfers occurred. From this point of view, Germany has shown great generosity welcoming French and Italian patients.
Similarly, care teams moved between the public and the private sector and between regions but also between countries, for example between Romania and Italy. In general, solidarity emerged between most-affected areas.
A Europe at work but inaudible
A European epidemic crisis cell sits in Brussels. It was very active throughout the first wave and, even today, the cell continues to issue recommendations, publishes synthesis and analysis but it is inaudible. European health ministers have met on numerous occasions without any apparent effect in our respective countries.
The crisis has revealed that health remains ultimately a national prerogative.
For the first time since the European Treaty in 1957, borders between Member States were closed, stopping free movement between countries was symbolically very strong. We closed those borders but not those between regions, but the geography of the crisis is not that of the States. We observe that the crisis has reinforced the notion of nationalism and national security: the other is seen as a foreigner and in fact, we have lost certain values of open-mindedness and exchange. Scientific speech, for example, carried and still carries weight at the national level: everyone listened to their own experts but not to those of their neighbors. The city of Marseille even wanted to have a scientific committee in Marseille! As if the scientific word carried no weight if it came from elsewhere. Despite all goodwill towards cooperation, the identity reflex of self-withdrawal prevails. We are interested in the neighbor's numbers, but not in his methods. Local authorities try to impose themselves when dealing with the concerns of the population which can hardly understand the possible involvement of a supranational regulator.
Competing Member States
The severe global shortage of personal protective equipment showed Europe in a situation of competition within its borders, and even direct competition between Member States. Everyone is trying to have a competitive advantage in terms of materials or molecules. The same situation will happen again regarding access to vaccines. As an economist, I find very intriguing the undisclosed contracts between pharmaceutical companies and the States. Europe hastened to declare that it would pay for all its citizens, and then each State declared the same... However, we could learn from the first wave the necessity to improve coordination between European actors while still preserving the decision-making competence of each country. Autonomy within each country borders but nevertheless a necessary responsibility in terms of health cooperation.
Are our institutions ready?
We need to reintroduce a “Risk Management" strategy to deal with the health crisis or with any other future danger, whatever the cause, and to establish operational bodies with European competences like economic regulation.
The urgency today is to ensure continuity of care in conjunction with the management of the Coronavirus. A recent paper in the scientific journal BMJ shows that a one-month delay in cancer management increases the risk of death by 10%.
No one had foreseen a crisis of this magnitude and leaders have shown a major commitment to find the best solutions and adapt. However, we need to improve the necessary resilience of our health systems, and what we have just experienced must be a lasting lesson. We have to find the critical "nodes" in the network structure and find a way to prevent their blocking.
Read the interview in French : here
UEHP in the media
The role of private hospitals in Europe during the pandemic
Ilaria Giannico, Secretary General of UEHP
Interview in the November newsletter of the Austrian Federation Private Hospitals.
From the crisis of confidence to confidence through the crisis: On the leading role of private healthcare facilities in Europe during the Corona crisis.

Read the interview with Ilaria Giannico, Secretary General of UEHP.
Article in the November release of Global Salud from the Spanish Alliance of Private Hospitals.
Ilaria Giannico, Secretary General of UEHP, gives a first-hand account of how the pandemic has been experienced in other European countries and how they can serve as an example to Spain.
European Beating Cancer Plan – Recommendations of the BECA commission
Interview with Pr. Véronique Trillet-Lenoir, MEP and Rapporteur of the BECA Commission
Pr. Véronique Trillet-Lenoir, MEP and Rapporteur of the BECA Commission
On October 27, 2020, MEPs exchanged views with Stella Kyriakides, European Commissioner for Health and Food Safety, on the Europe's Beating Cancer Plan, which the European Commission will soon be presenting. Pr Véronique Trillet-Lenoir, oncologist, MEP and rapporteur of the BECA commission (Special Committee on Beating Cancer), presented the working document of the BECA commission, which aims to positively influence the future Europe’s Beating Cancer Plan.
The Europe's Beating Cancer Plan aims to establish common standards in Europe to fight cancer. Which priorities have been identified by the BECA commission that you chair?
Our working document is a first step for the European Parliament and its objective is to have an impact on the proposal which will be presented by the European Commission. This proposal will then be discussed between the European Parliament, the European Commission and above all the Member States, which have a very important voice at the discussion table. Europe's Beating Cancer Plan must above all make it possible to reduce health inequalities in Europe, despite the fact that the organization of health systems remains the prerogative of each Member State. A common policy at European level should however make it possible to achieve progress. For my part, I am pleased that cancer has been placed at the top of the EU agenda.
One of the most important domains of action we have identified is prevention, simply because more than 40% of all cancers are preventable through coordinated actions on individual, social, environmental and commercial health determinants. Fight against tobacco, harmful alcohol consumption, sedentary lifestyle, unhealthy nutritional habits, exposure especially to chemicals, vaccination campaigns, etc., the areas of action are multiple. Prevention is therefore a major component, offering a broad field of action in which health care institutions and healthcare prescribers have a key role to play, in order to change behaviours, promote good health practices, and reach populations that are most at risk or socially excluded.
Another central aspect is screening and early detection, an area with significant disparities between European countries, to the extent that some of them do not have standardized cancer screening procedures. Beyond setting up programs, we want to encourage the use of new technologies and innovations: biology (genomic signatures), scanner imaging for lung cancer detection, etc.
Then we have the more complex aspect of access to patient-oriented treatments. This issue at the European level is currently dominated by that of medicines, partly due to certain shortages, but mainly because the European Union has a strong competence in the matter, guided by axes included in the European Commission's Pharmaceutical Strategy: equitable access to cutting-edge medicines and treatments, at an affordable price, fight against shortages, access to innovation, etc.
In the field, many cancer patients in Europe simply encounter difficulties in accessing protocolized treatments, and we see strong disparities between European regions, in terms of the quality of treatments and access to surgery and radiotherapy for example. We therefore believe it is essential to formalize and standardize quality assurance, on the basis of authorization criteria, as it is done in France and in other countries, for performing cancer surgery, radiotherapy and chemotherapy. I have also proposed that the Organisation of European Cancer Institutes, chaired by Prof. Thierry Philip and which certifies cancer reference centres, could be activated to ensure that there is at least one accredited reference centre in each European country, which is responsible for innovation, primary treatments and a certain form of organisation of clinical research. These centres could operate as a network. This could be a line of approach that would allow us to move forward on common bases.
Then there is the post-cancer period, a component which is well developed in the French cancer plan, which includes psychosocial, socio-aesthetic and financial aspects among others. I am campaigning for the generalization of the right to oblivion, which is currently deployed in only 4 European countries and which I would like to see generalized in all the countries of the Union.
What actions can be taken?
A central lever for action is the sharing of knowledge and data. Data collection is extremely uneven and heterogeneous from one European country to another and information is only partially centralized. The idea would be to deploy cancer registers, to make them communicate and link them to one or more big data platforms, which would collect both clinical and biological hospital data, data from the National Health Insurance, but also "real life" data that provide social, environmental information, etc. in order to improve the understanding of the disease and to contribute to personalized medicine. In addition, there are already networks that help pool knowledge, such as the European Reference Networks, which bring together healthcare professionals from all over Europe to share their expertise on complex diseases, such as paediatric cancers. Two of these networks are dedicated to rare cancers.
The pooling of knowledge also underlies research: fundamental, translational, interventional, clinical, but also research in social sciences and humanities, and in particular research on health inequalities and environmental and social determinants. The Horizon Europe funding program will include a significant cancer component.
There is also, very strongly supported by the commission, the will to set up common training programs in close connection with European learned institutions. Training health professionals better and more regularly, in a multidisciplinary manner, training them in new professions (genomic medicine, artificial intelligence) is a priority, as is therapeutic education and the training of patients and their families, and in particular young people.
What do you believe will be the main obstacles to a uniform implementation of a cancer plan in Europe?
Some points of the plan will be put into legislative terms, binding for the Member States, such as the tobacco directive or the regulations on medicines, but many points will be recommendations and each State will decide how to transpose them in its country. There are many levers that can be operated but the systems are not equal... so not everything is going to be fixed only with legislative measures. In any case, such a plan will bring major advances for all the countries.
A large part of the proposal, in order to be effective, relies upon the good will of governments, their ability to act collectively, but also on the agility of actors in the countries, such as health institutions, including private health establishments, members of UEHP. The hardest part of the battle will be to demonstrate to the Member States, by referring to examples from other Member States, the benefits and opportunities brought by cooperation, interpenetration, strong and lasting commitment to quality assurance, registers, screening, etc. This could be considered within the framework of a European Cancer Institute.
Release of the Factsheet: A European Health Union: tackling health crises together - Coronavirus impact and response
The European Commission began to lay out precisely what it would do with more power over health policy, by publishing yesterday the Factsheet "A European Health Union: tackling health crises together - Coronavirus impact and response".
The Commission is proposing to:
  • declare emergency situations at EU-level to ensure EU measures
  • take risk management decisions at EU level
  • harmonise EU, national and regional preparedness plans
  • regularly audit and stress-test preparedness plans
  • monitor supply of medicines and medical devices and mitigate shortages.
The Factsheet is available at the following link in 23 languages: here
European Health Data Space
The European Commission and the German Presidency of the Council of the EU underlined the importance of the European Health Data Space: yesterday, at the virtual High-Level Conference "Digital Health 2020 - EU on the Move", the Commission and Germany's Presidency of the Council of the EU announced their intention to work closely together on a secure and patient-oriented use of health data for Europe, and EU-wide collaboration in this area, through a European Health Data Space for better healthcare, better research and better health policy making. 
As first steps, the following activities starting in 2021 will pave the way for better data-driven health care in Europe:
  • The Commission proposes a European Health Data Space in 2021;
  • A Joint Action with 22 Member States to propose options on governance, infrastructure, data quality and data solidarity and empowering citizens with regards to secondary health data use in the EU;
  • Investments to support the European Health Data Space under the EU4Health programme, as well as common data spaces and digital health related innovation under Horizon Europe and the Digital Europe programmes;
  • Engagement with relevant actors to develop targeted Codes of Conduct for secondary health data use;
  • A pilot project, to demonstrate the feasibility of cross border analysis for healthcare improvement, regulation and innovation;
  • Other EU funding opportunities for digital transformation of health and care will be available for Member States as of 2021 under Recovery and Resilience Facility, European Regional Development Fund, European Social Fund+, InvestEU.
More here
Health system responses to COVID-19
The European Observatory on Health Systems and Policies has just published a special issue of its journal, Eurohealth, in collaboration with WHO/Europe and the European Commission. This issue draws on data from the COVID-19 Health System Response Monitor to examine health system responses to COVID-19.
This special issue includes perspectives on the pandemic by WHO/Europe and the European Commission as well as lessons from the first wave, health system resilience, responding to the economic crisis, and translating evidence into policy. Additionally, this Eurohealth provides analyses of the challenges, progress and lessons with responding to the COVID-19 pandemic.
  • Preventing transmission
  • Ensuring sufficient workforce capacity
  • Providing health services effectively
  • Paying for services
  • Governance
Find here the registration links to the upcoming webinars of the European Observatory on Health Systems and Policies available. 
European Alliance for Value in Health
After more than a year of work, the European Alliance for Value in Health has been launched on 16 November 2020.
UEHP is member of this alliance together with other 10 associations representing patients, scientific and professional societies, healthcare managers, hospitals, regional health authorities and life-science industries.
Those 11 associations today form the European Alliance for Value in Health in order to CONNECT different stakeholders to CREATE conditions and INSPIRE others. The vision of the Alliance for a value-based, sustainable and patient-centred health system is one where:
  1. Outcomes that matter to people and patients, as well as benefits valued by health systems and societies, are at the centre of decision-making;
  2. Interventions and services addressing prevention, social care and healthcare are organized in an integrated way around people and patients;
  3. Resources are allocated towards high value care and prevention, with outcomes and costs of care measured holistically;
  4. Continuous learning, education and healthcare improvement is based on evidence, and supported by data and insights;
  5. Innovative ways of care delivery are fostered;
  6. Financing models and payments reward value and outcomes.
The Alliance will work together towards this goal through building a common understanding of the enablers and barriers to transforming health systems in this direction, through sharing and spreading knowledge and best practices and through engaging with policy makers and stakeholders at European, regional and local levels. Among other things, the Alliance will:
  • Issue joint opinions on current health policy topics or the specific elements and enablers of a value-based system;
  • Bring together the members of our organisations to network and exchange views;
  • Connect with other actors at European, national or local level that work towards the same goals;
  • Provide a hub for news and knowledge.
Read the full press release here
Health First Europe - Report on Surgical Site Infections
HFE Report on "Identifying the gaps between evidence and practice in the prevention of surgical site infections"
Last 17th November, UEHP was invited to speak to the launch event of the Health first Europe Report "Identifying the gaps between evidence and practice in the prevention of surgical site infections". The report shows a striking gaps between evidence-based measures suggested by official guidelines and medical practices in European hospitals which represent a serious concern for the safety of European patients. Surgical Site Infections (SSIs) are infections that occur within 30 days following a surgical procedure and affect either the incision or deep tissue at the site of the operation. Their costs in Europe is up to 19 billion euros per year. We all need to play our role to protect and promote patient safety while decreasing the rate and burden of infections, especially in relation to AMR bacteria. SSIs are largely avoidable and up to 50% can generally be prevented through the successful implementation of clinical practice guidelines. 
The report includes a paragraph written by our President, Dr Garassus, on the current challenges to implement an infection prevention approach on European healthcare systems and how to overcome them on short and long term. 
Health First Europe Webinar Tuesday 17 November 2020 was dedicated to Surgical Site Infection. UEHP presentation: be simple, make it clear and transparent “Collect and Correct”! (to collect information and to correct malpractices)
Extract from Dr Paul Garassus’ presentation
Surgical site infections are caused by bacteria that get in through incisions made during surgery. WHO recommends 29 ways to stop surgical infections and avoid superbugs. Hygiene in hospital starts with simple process as “Hand drying in hospitals” (cf. European Tissue Symposium, Professor Marc Van Ranst). The key success is not to have big ideas, but to implement them. A collaborative process is required among hospital staff. Why international working groups are useful? For a positive strategy to improve quality and to limit severe adverse events SAE. The goal is not to determine standards on a mean value, but to propose incentives to reach best practices.
Fig 1. OECD 2019 - Percentage of hospitalised patients with at least one healthcare-associated infection and the proportion of bacteria isolated from these infections resistant to antibiotics, 2015-17 (Health At A Glance, 2019)
Challenges and Solutions “Primum non nocere” et “Si vis pacem, para bellum” (against infection)
With general data coming from a wide European hospital range, all professionals could easily know their individual performance. A positive attitude can emerge from European data. Europe for Health is a chance. That is the only one way considered as an international benchmark to impose a quality culture in hospitals and to compete all together to the same goal, a high-quality level, limiting patient harm and extra-cost related to adverse events. All information is collected and analysed by medical staff and quality managers. The full implication is required for the key success process. Then based on results, comparison by year and hospital categories, all professionals are informed on their position. Based on these data, then have to develop their own strategy to reach the top level on quality results. Where to invest? In prevention including initial formation for MD, standards and process, SAE reporting using specific codes, and peer review developing a collaborative process.
During the launch event of the report, our President was invited to present the UEHP position on SSI, how private hospitals are trying to prevent hospital infections in the surgical care, with some case studies from our member hospitals.
The full report is available here
OECD and the European Commission – release of “Health at a Glance: Europe 2020”
Press release 14.10.2020
This biennial publication presents a set of key indicators of health status, determinants of health, health care resources and activities, quality of care, health expenditure and financing in 35 European countries. The selection of indicators is based largely on the European Community Health Indicators (ECHI) shortlist, a set of indicators that has been developed to guide the reporting of health statistics in the European Union. It is complemented by additional indicators on health expenditure and quality of care, building on the OECD expertise in these areas.
About the 2020 edition: The 2020 edition of Health at a Glance: Europe focuses on the impact of the COVID‑19 crisis. Chapter 1 provides an initial assessment of the resilience of European health systems to the COVID-19 pandemic and their ability to contain and respond to the worst pandemic in the past century. Chapter 2 reviews the huge health and welfare burden of air pollution as another major public health issue in European countries, and highlights the need for sustained efforts to reduce air pollution to mitigate its impact on health and mortality. The five other chapters provide an overview of key indicators of health and health systems across the 27 EU member states, 5 EU candidate countries, 3 European Free Trade Association countries and the United Kingdom. Health at a Glance: Europe is the first step in the State of Health in the EU cycle.
You can find the publication here
1 000 extra COVID-19 beds from the private healthcare sector
As hospitals deal with the second wave of the COVID-19 pandemic, one of the key issues facing hospitals is the availability and management of medical staff. How are private hospitals in Poland dealing with this problem?
There is a huge shortage of doctors and nurses in Poland. In the frame of the pandemic, public hospitals have absorbed some of the staff from private hospitals. Currently, the Territorial Defense Forces have started to help.
Do private clinics cooperate with the public sector?
Yes - 18 private hospitals across the country offer a total of 1,046 beds for treatment of COVID-19 patients. The private hospitals that will provide the beds are mostly located in large cities and will be financed from the country's National Health Fund (NFZ). The other private hospitals treat patients in their own specialties, however, they work under very limited conditions. Health Minister Adam Niedzielski told during a press conference on 22 Octobre that the extra beds constitute a "very real support" in the government's fight against the virus.
Which financial conditions benefit the employees ?
Employees receive preca benefits in the Covid zone, and those administratively assigned to work in covid hospitals receive double wages.
Second pandemic wave, private clinics cooperate with public hospitals
The corona pandemic is leading to high levels of stress in hospitals due to the rising number of infections. In order to relieve the capacities of the public hospitals, private clinics in Vienna and Salzburg cooperate once again with the public healthcare sector.
In Salzburg, the private clinic Wehrle-Diakonissen of the PremiQaMed Group and in Vienna the private clinic Rudolfinerhaus and the private clinics Confraternität, Döbling and Goldenes Kreuz of the PremiQaMed Group are taking over plannable and urgent operations of patients not infected with COVID-19. Within the scope of the cooperation, patients are treated in the general fee class, so they do not need supplementary health insurance.
"Our most important common concern is to keep our healthcare system efficient even during the pandemic. The private clinics are part of the health care system. Together with the City of Vienna, it is an absolute priority for us to provide the highest possible capacity for medically necessary treatments", emphasizes Julian Hadschieff, CEO of the PremiQaMed Group.
Hospital staff shortage, the search for solutions
Even before the Covid crisis, healthcare establishments were facing a significant shortage of trained professionals. 100,000 jobs are vacant in health establishments (public and private), including 34,000 nurses and 24,000 nursing assistants.
The French government has made a major effort on this issue, within the framework of the plan « Ségur de la Santé », by upgrading the salaries of non-medical hospital staff and by announcing the creation of 16,000 new training places for nurses and nursing assistants. However, this will not be enough to fully resolve the current shortage and will only take effect several years from now.
This is why the Federation of Private Hospitalization requests that continuing education be further developed and adapted to the specificities of the health sector. It is essential to promote skills development and internal promotion through continuous training systems that meet the needs of healthcare establishments. This calls for a major funding effort on the part of the State and the regions. Clinics should also be allowed to redirect their legal contribution (tax) towards trainings that meet the needs of their current employees.
The Covid crisis has accentuated these shortages, in particular for certain professions such as nurse anaesthetists. During the first wave, many professionals from clinics located in regions less affected by the epidemic were able to support the very mobilized public and private health establishments. An impressive inter-professional solidarity was set up to fight the virus. The deployment of staff reinforcements between regions is currently less obvious. Indeed, the French territory is affected in a more global way by this second wave and the health professionals were very hard hit by their mobilization in the spring.
Solutions to the alarming shortage of qualified health professionals
The Spanish General Nursing Council (CGE) and the Spanish Private Healthcare Alliance (ASPE) have requested that, given the shortage of health professionals, nurses be allowed to work in more than one position, to face COVID-19.
"This measure, with the conditions that can be agreed upon, would expand the possibilities of fighting COVID-19 in the current situation of outbreaks that we are experiencing in all areas of the country," said Carlos Rus, president of ASPE.
“If this measure were adopted, it would be possible to alleviate, at least in part, this shortage of nurses, also avoiding competition in recruiting professionals”, emphasized Florentino Pérez Raya, president of the CGE.
The example of the Region of Murcia should be noted, where the Governing Council of this Autonomous Community has validated the simultaneous provision of services in public and under contract private health establishments.
Madrid, September 21, 2020 - Faced with the second wave of infections from the COVID-19 pandemic, the health community once again shows its concern due to the alarming shortage of qualified health professionals which hinders the due assistance to the population.
In this context, and considering it to be in the public interest, the General Nursing Council and the Spanish Private Healthcare Alliance (ASPE) have requested the Health Ministry and the regional autonomous Minister to adopt a regime of absolute compatibility for the free practice of care between the private, private under contract and public spheres of these professionals while the pandemic lasts. At the moment, with few exceptions, a nurse who already works full time cannot practice as such anywhere else.
“This measure, with the conditions that can be agreed upon, would expand the possibilities of fighting COVID-19 in the current situation of outbreaks that we are experiencing in all areas of the country. Furthermore, we also have the support of the medical community, which has urged the Legislative Authority on more tan one occasion to urgently reform the Law of Incompatibilities”, says Carlos Rus, president of ASPE.
“There are many hospitals that are desperate because they need to hire nurses to be able to respond to the COVID-19 pandemic, but they are not succeeding because there are no unemployed nurses and the job pools are drained. If this measure were adopted, it would be possible to alleviate, at least in part, this shortage of nurses, also avoiding competition in the recruitment of professionals”, underlines Florentino Pérez Raya, president of the CGE.
The Region of Murcia is an example to follow. There, the Governing Council of this Autonomous Community has validated the simultaneous provision of services in public and under contract private health establishments.
For this reason, both entities urge that this resolution be adapted at the national and regional level so that health professionals, especially nurses and doctors, can make their main activity compatible at a key moment like the one we are experiencing.
The General Nursing Council (CGE) is the regulatory body and competent authority of the nursing profession in Spain. It represents more than 316,000 nurses and brings together the 52 provincial nursing colleges and the 17 Autonomous Councils that exist throughout the territory. CGE represents the nursing profession before national and international authorities, institutions and entities and its main objective is to ensure the well-being of the patient by promoting an ethical, responsible and competent professional nursing practice.
The Spanish Private Healthcare Alliance (ASPE) is the employer organisation of the Spanish private healthcare. It represents more than 1,300 health entities and represents 80% of all hospitals in the country. ASPE works to enhance the value of private healthcare, which employs more than 260,000 professionals in Spain and represents 3.5% of the GDP.
Cooperation to deal with the second wave
As hospitals deal with the second wave of the COVID-19 pandemic, one of the key issues facing hospitals is the availability and management of medical staff. How are private hospitals in Germany dealing with this problem?
The current problems affect all hospitals in the same way, regardless of their ownership, be it public, private or private non profit. Moreover, since the first peak of the pandemic registered in March in Germany, hospitals alongside other service providers as well as politicians have acted very responsibly and cautiously and have learned a lot. What has been achieved and the experience gained is now being incorporated into the measures put in place to deal with the second wave. We are confident that we will also be able to master the coming challenges. The task is made more difficult by the shortage of nursing staff, which affects all hospitals equally and which already existed before the pandemic. In some regions particularly affected by COVID-19, hospitals will therefore be forced to gradually reduce scheduled procedures in some departments in order to be able to deploy staff flexibly depending on the situation. At the beginning of the first wave, elective procedures had also been cancelled and people were only admitted to the hospital in case of an emergency. According to the previous findings, there was no excess mortality for other diseases other than COVID-19. The mortality rate of patients who did not receive inpatient treatment or were treated late has apparently not increased. 
Do private clinics cooperate with public and non-profit hospitals in this regard?
Of course, a state of emergency can only be managed jointly, and the legal nature of hospitals should play no role. This is certainly the view of all actors involved because, throughout Germany, hospitals have joined forces with prevention centers, rehabilitation facilities, and the outpatient sector, forming networks and cooperating with each other. Among the different types of hospitals, Germany traditionally has a very objective and trusting working atmosphere characterised by mutual respect. This good cooperation has always proved its worth, and it still does today.  
Which financing agreements are planned?
The German government has repeatedly reviewed and adjusted the measures adopted at the beginning of the pandemic to stabilise hospital care. Even today, in anticipation of a second wave, hospital financing rules are being reassessed. A commission of experts appointed by the Federal Ministry of Health and composed of representatives of health insurances, sciences, and hospitals - including private hospitals, by the way - has provided analyses and recommendations for their implementation. According to the new regulations, hospitals will receive a similar protective shield as in the spring (from EUR 360 to 760 per bed and per day, depending on the size of the clinic), although in the future this remuneration will be based on local infection rates. In addition, the federal states define which clinics are eligible, according to a list of defined criteria. The aim is to achieve a more targeted scheme of the compensation payments. Special regulations apply to preventive and rehabilitation clinics. They can be designated as substitute hospitals by the federal states and receive compensation for loss of income due to coronavirus at 50% of the average reimbursement rates agreed with the health insurance funds.
ITALY - Bologna
9th Aggregated Social Report of AIOP Bologna
The 9th Aggregate Social Report, represented by AIOP Bologna, builds an overview on the current developments of the health sector.
With 13 Private Hospitals, the Health Department, represented by AIOP Bologna, was able to provide significant performances: 1,400 hospital beds, 2,900 employees and over 40,000 in-patients every year. The aggregated production value amounts to 227 million euros, with a part of investments aiming to improve the infrastructures, amounting at 12.5 million euros invested in 2019.
These performances confirm the strength of the Private Health Sector that were illustrated in the webinar conducted on Tuesday, November 10 from 10 am to 12 pm.
In light of the current developments of the pandemic, the webinar was held by different experts of the sector, such as: Carlo Luison, Partner Sustainable Innovation, BDO Italy; Averardo Orta, President of AIOP Bologna; Paolo Bordon, General Director of USL, a public health Company of Bologna; Giuliano Barigazzi, Health and Welfare Councilor of the Bologna Municipality. The moderator Valerio Baroncini, editor-in-chief of “Cronaca Il Resto del Carlino Bologna”, was in charge of managing and supervising the aforementioned session.
During the webinar, the speakers explained the results and the perspective framework with which AIOP Bologna, along with its members, intends to move in the near future.
‘This year more than ever, in the context of the ongoing sanitary emergency, the Social Report is evidence of the commitment to social responsibility by Private Health Sector’ states Averardo Orta, President of AIOP Bologna. Specifically, he adds: ‘We conducted an analysis regarding the experience of the different health care establishments, which were engaged upfront during the first wave of the Covid-19 pandemic, as it gives an overview of AIOP’s skills and its impact on the N.H.S (National Health Service).
The outstanding influence of Aiop Bologna on the total of hospital services provided by the N.H.S is extensive; as a matter of fact, it represents almost one third (32%) of the total beds accredited by public and private health system in Bologna in ordinary admission, in day surgery and day hospital, while it covers almost a quarter (24%) of the total number of discharges by N.H.S. in different local health units.
Social performances are evidence of the creation of value for the territory and its community. As a matter of fact, healthcare is a sector with high job retention: 93% of employees are permanent staff and their employment is generated locally: 79% of employees live in Bologna area. Moreover, it is important to highlight the presence of women, which is equal to 53% of the total workforce and rises to 75% of employees. In addition, the investment in training is high: 30,000 hours of training have been provided to healthcare professionals.
Healthcare is considered first and foremost a motor of local economic development but also an essential economic force for the whole country: therefore, it emerges, that Private Hospitals have an added value generated by the wealth of the 13 healthcare establishments, which is equal to 145 million with a profitability set, especially, for human resources, banks, lenders and the public administration. Moreover, the supply relationships remain mainly concentrated within the regional territory: 36.6 million euros are intended for supplier companies in Emilia-Romagna.
BDO Italy was responsible for the scientific and methodological support regarding the Aggregated Social Report of the Bologna Private Hospital Department, confirming its role as strategic partner in the project.
‘We are proud to offer our support to the 13 Private Hospitals associated with AIOP Bologna. In this delicate and critical moment, these structures are active supporters and respondents to the healthcare needs of the community and its stakeholder, able to guarantee quality services and added value for the whole territory‘ states Carlo Luison, Partner Sustainable Innovation at BDO Italia.
The authors
Martina Lucrezia Pellegatti (BDO Italia - Sustainable Innovation)
Caterina Molinelli (BDO Italia - Sustainable Innovation)
Signature of a protocol to improve access to care
Second from left : Oscar Gaspar, President of APHP (Portuguese Association of Private Hospitals)
The National Health Council of CIP - The Business Confederation of Portugal -of which APHP is a member - promoted a wide debate among its members and 70 patient associations aimed at promoting better conditions in the relationship between health establishments and patients and ensuring that citizens have access to quality and patient-focused care.
The members of the National Strategic Health Council of CIP and 70 Patient Associations signed on November 11th, a Document of Understanding that establishes measures to guarantee and improve the access of patients to care.
The protocol provides for the adoption of measures based on common objectives, namely: promoting the humanization of care and bringing care closer to citizens; creating digital interoperability in order to improve access and optimize resources; promote the connection and deepen the relationship between health institutions and patients; guarantee the quality and safety of health services and contribute to the execution of the Maximum Guaranteed Response Times.
The document is composed of 13 measures of immediate implementation, agreed between Patients' Associations and private health establishments, for the urgent continuation of care for these patients.
Among the 13 measures, it is worth stressing the creation of a specific recovery plan for effective and urgent access to Primary Care, the creation of a Patient Support Service in health establishments of greater complexity and dimension , and the guarantee of accompanying the patient via special assistance to those in need, namely elderly people and those who have limited physical or mental capacities.
The signed protocol also defines other common points such as the need to encourage the provision of a telephone contact which would ensure clinical screening for the patient in the event of the aggravation of the disease, and determines that hospitals must create means for safe digital access for the patient to avoid unnecessary travel.
Another highlight is the commitment of the Pharmacy network to maintain the therapy of patients by dispensing hospital drugs in proximity. Pharmacies, in collaboration with the distribution sector, are also committed to study support mechanisms for medication home delivery, so that the patient can order and receive his medication without leaving his home.
In turn, the Pharmaceutical Industry and the Medical Device Industry agreed to develop Patient Support Programs which would enable the strengthening of a differentiated service, namely the possibility of administering drugs at home and the creation of online support platforms and applications for patients.
Shortage of medicines, the root of the problem
An interview with Emmanuel JAMMES, Delegate for the Society and Health Policies Mission at the French Ligue contre le Cancer
France is facing a shortage of medicines. What is the magnitude and the nature of this shortage?
For a few years, we have been receiving sporadic testimonials from patients concerned about the unavailability of their medication. First, we responded individually and looked for solutions, then we decided to take into account the sum of individual situations to attest to a collective problem.
The National Medicines Agency declares shortages of all types of medicines every year, not just in oncology, the number of which has been increasing over the past ten years. In 2019, 1,499 drugs were in shortage in France. Have these drugs been unavailable for 3 days or 1 month? One or more times? Who are the people who did not have access to their medication on time?
As often, oncology is a model. There are a lot of shortages of cancer medicines because they are quite old and not very profitable, and none are among top drugs. Running out of a signature drug like BCG Medac used for bladder cancer is not the same as running out of Doliprane. However, the only alternative to BCG Medac is to remove the bladder: it is a loss of opportunity!
This situation of shortage is very anxiety-provoking for patients because we do not know how long the drug will be unavailable for. Likewise, managing a pharmacopoeia when the essential elements are unavailable is very difficult for healthcare professionals whose vocation is to provide care. Powerless, they sometimes hide this information when in fact patients have a right to know. It is necessary to identify the shortages but also the patient victims of these shortages in order to measure any harmful consequences in the long term. We are not completely sure that there is no loss of opportunity.
The Covid crisis was revealing and put a spotlight on products which were out of stock because demand was very high. This is a different issue from the structural supply problems of drugs used in the treatment of cancer and other chronic conditions where we have a lean supply flow in order to avoid costs.
What are the causes of these shortages?
Causes are multiple: supply problems because substances are manufactured far away, especially for drugs which are the least profitable; industrial choices to reduce production costs and circumvent regulations relating to more drastic environmental standards in Europe than in South East Asia; Lower production costs but at the cost of greater logistics subject to organizational difficulties in the supply chain for hospitals in France and Europe.
Shortages is a global problem but even more in countries which more strongly negotiate drug prices. We are in the early stages of a European negotiation and are working on this issue with the European Cancer League.
Reindustrialization projects have long been shelved by manufacturers, but they have now reappeared opportunely because of Covid, but we are not fooled. They have a good role to play at the moment: being the only ones to have substances, nobody can do without them.
Storing drugs has a cost for manufacturers, this industrial logic must match that of public health: we are in the middle of both at the moment. We are still awaiting the release of the decree on stock management and hope that the most important drugs will be integrated into the longest stocks. It is up to manufacturers to find solutions and it is not for the Health Insurance Fund to pay more for drugs at inflationary costs.
As far as we are concerned, no matter where the drug is produced, we just want it to be available. It is obvious that it is easier if it comes from Clermont Ferrand rather than Shenzhen, China. It is up to the Ministry of Industry and Economy, with the support of the Ministry of Health and other relevant agencies, to find solutions for the public good.
What actions are you asking for?
We want an information system to be put in place regarding drug shortages in order to know the origin, the duration and the history of the shortages. Since drugs are not a consumer product like any other, it is not acceptable that its shortage be merely an accounting fact, without any transparency nor a deep analysis of the causes.
We are also asking for the enforcement of the coercive actions planned for drug manufacturers. It is the role of associations such as the Ligue contre le Cancer or France Assos Santé to enter into this balance of power and to remind people that we must not resign in the face of the relocation blackmail. We represent sick people, and they have something to say.
All transparency and full traceability of these shortages must be carried out. Of course, the causes are complex, financial, political, economic, etc., but we must focus on the consequences because the patients suffer. For now, we are moving forward with the growing number of patient testimonials. For the past month, we have been collecting data via https://penuries.ligue-cancer.net/ in order to gather ever more information and strengthen our proposals to the public authorities. We must not forget either that even if the phenomenon of drug shortage is globally known, some patient victims are not necessarily aware that they are directly concerned because they are not informed by their doctor. We are thus fuelling the debate on this subject. I think the Minister of Health is listening to the problem, but he is not the only decision-maker in this complex issue which has colossal stakes in play.
At the Ligue contre le cancer, we are well aware that we have a long fight ahead of us on this issue.
5 February 2021
UEHP General Assembly