Health and universal coverage – Prof. Monika Steffen EUHEALTH

Summary

L'accès universel aux soins de santé, bien qu'idéal, présente des défis importants. Le script aborde la dualité des systèmes de santé, notamment dans les pays avec des services publics gratuits, où les classes sociales influencent la qualité des soins. L'accès en temps opportun, l'égalité de traitement et l'adaptation aux cultures locales sont essentiels. Cependant, des contraintes budgétaires, des listes d'attente et des soins limités complexifient l'accès équitable. Les réformes en Europe visent à concilier l'accès universel avec la maîtrise des coûts, tout en modernisant les systèmes de santé pour répondre aux besoins croissants et technologiques.

Takeaways

• 🌍 L'accès universel aux soins de santé est un concept attractif, mais sa mise en œuvre pose des défis d'équité et de qualité.
• 🏥 Certains pays comme le Brésil et la Russie offrent un accès public à la santé, mais cela peut entraîner un système à deux vitesses.
• ⚖️ L'accès universel ne signifie pas toujours un traitement égalitaire, souvent les systèmes sont séparés entre riches et pauvres.
• ⏱️ Le traitement en temps opportun est crucial pour de nombreuses maladies, soulignant l'importance des soins primaires et des systèmes de transport rapides.
• 👩‍⚕️ L'égalité de traitement devrait inclure une prise en compte du genre et des besoins spécifiques des femmes et des filles.
• 🗣️ Les soins centrés sur le patient doivent être adaptés aux différences culturelles et sociales pour éviter anxiété et souffrance.
• 💰 Les systèmes de santé universels nécessitent d'énormes ressources financières, humaines et technologiques pour garantir des soins de qualité.
• 🌐 Les systèmes de santé doivent être bien organisés, avec une distribution géographique équilibrée pour assurer l'accès même dans les zones rurales.
• 🩺 Les services de santé doivent être bien coordonnés entre les différents niveaux de soins (primaires, secondaires, tertiaires) pour assurer des traitements appropriés.
• 📉 Les systèmes de santé universels, comme ceux du Royaume-Uni, peuvent souffrir de longues listes d'attente, obligeant certains patients à chercher des alternatives privées.

Q & A

Qu'est-ce que l'accès universel aux soins de santé signifie pour la plupart des gens ?

Pour la plupart des gens, l'accès universel signifie pouvoir consulter un médecin à proximité, recevoir des médicaments gratuitement et avoir accès à un hôpital public avec des portes ouvertes.

Quels sont les risques associés à un système de santé avec accès universel ?

Un des risques est la création d'un système de santé à deux vitesses, où les personnes plus aisées bénéficient de soins privés de meilleure qualité, tandis que les plus pauvres utilisent le système public avec un niveau de soins souvent inférieur.

Pourquoi le traitement en temps opportun est-il essentiel dans l'accès universel aux soins ?

Le traitement en temps opportun est crucial car certaines maladies, comme le cancer ou le sida, peuvent être traitées efficacement si elles sont détectées tôt, mais deviennent mortelles si elles ne sont pas soignées rapidement.

Quelle est l'importance des soins centrés sur le patient dans un système de santé universel ?

Les soins centrés sur le patient sont importants car ils s'adaptent aux besoins sociaux et culturels des patients, garantissant que chaque individu reçoit des soins respectueux de ses croyances et craintes.

Comment les systèmes de santé nationaux, comme celui du Royaume-Uni, gèrent-ils les défis de l'accès universel ?

Les systèmes de santé nationaux, comme le NHS au Royaume-Uni, sont fortement contrôlés par le gouvernement, ce qui peut entraîner des budgets limités et des listes d'attente pour certaines interventions.

Quel est l'effet des assurances santé privées supplémentaires dans des systèmes comme le NHS ?

Les assurances privées supplémentaires permettent aux personnes qui en ont les moyens de contourner les listes d'attente, d'accéder à des hôpitaux privés et de bénéficier de meilleurs soins, créant ainsi une version légère d'un système à deux vitesses.

Quels défis économiques ont affecté les systèmes d'assurance maladie sociale en Europe dans les années 1970 et 1980 ?

La crise économique, la mondialisation, et la diminution des cotisations dues à un ralentissement de l'économie ont créé des problèmes de financement pour les systèmes d'assurance maladie sociale, nécessitant des réformes.

Quels types de réformes ont été introduites dans les systèmes d'assurance maladie sociale dans les années 1990 et 2000 ?

Les réformes visaient à contenir les coûts tout en modernisant la gestion des systèmes, avec des privatisations partielles, la réduction des services publics comme l'entretien des hôpitaux, et des listes de médicaments remboursés réduites.

Comment les réformes européennes ont-elles visé à renforcer l'accès universel tout en contrôlant les coûts ?

Les réformes ont renforcé la régulation gouvernementale, modernisé la gestion publique et introduit une concurrence régulée pour maintenir l'accès universel tout en dépensant l'argent de manière plus efficace.

Quelles sont les principales conditions nécessaires pour garantir un accès universel équitable aux soins de santé ?

Il faut un financement suffisant, une distribution géographique équitable des services, des réseaux de soins bien coordonnés, des soins centrés sur le patient et un traitement en temps opportun pour garantir un accès universel équitable.

Outlines

00:00

🌍 Accès universel aux soins de santé : une réalité complexe

Le concept d'accès universel aux soins de santé est souvent idéalisé, perçu comme l'accès gratuit à un médecin, à des médicaments et à des hôpitaux publics. Certains pays comme le Brésil et la Russie disposent de tels systèmes. Cependant, cela peut engendrer un système de santé à deux vitesses, où les classes moyennes et supérieures utilisent des assurances privées pour bénéficier de soins de meilleure qualité. La question essentielle est donc de savoir si l'accès universel garantit aussi une égalité de traitement pour tous, ou si certaines catégories sociales reçoivent des soins de meilleure qualité.

05:01

⏱️ Le traitement en temps opportun : clé de l'accès universel

L'accès universel ne se limite pas à la gratuité des soins, il inclut aussi la rapidité du traitement. Par exemple, un cancer ou le SIDA nécessite une détection et un traitement précoces pour améliorer les chances de survie. Pour cela, un système de soins primaires efficace est essentiel, car ce sont les généralistes qui détectent les maladies à un stade précoce. De plus, des systèmes de transport d'urgence rapides sont cruciaux pour garantir des soins en temps opportun, notamment lors d'urgences comme un infarctus. Le traitement rapide et l'égalité des soins doivent inclure également une dimension de genre.

10:02

💰 Les défis financiers de l'accès universel

L'accès universel nécessite d'importantes ressources en termes de financement, de main-d'œuvre et de technologies. Un défi majeur est de garantir une distribution géographique équitable des services, permettant à tous d'accéder à des soins de qualité, même dans les zones rurales. Cela implique une coordination efficace entre les différents niveaux de soins (primaires, secondaires et tertiaires). L'accès universel ne se limite donc pas à la gratuité des soins, mais implique également une gestion optimale des ressources et des infrastructures.

15:03

🇬🇧 Les systèmes nationaux de santé et leurs limites

Dans certains pays, comme le Royaume-Uni, l'accès universel est assuré via des services de santé nationaux (NHS). Ce modèle permet une inscription automatique des citoyens et un accès gratuit aux soins. Cependant, ces systèmes peuvent souffrir de budgets limités, entraînant des listes d'attente. Parfois, des accords internationaux permettent de contourner ces délais, comme les patients britanniques envoyés en France pour des opérations. De plus, ces systèmes peuvent être complétés par des assurances privées pour des soins plus rapides ou pour des services non couverts par le NHS, créant ainsi une version allégée d'un système de soins à deux vitesses.

20:03

⚖️ Assurance santé sociale : de la solidarité à la modernisation

Les systèmes d'assurance santé sociale sont basés sur la solidarité entre groupes professionnels. Cependant, certaines catégories de personnes, comme les chômeurs, les étudiants ou les femmes divorcées, ont longtemps été exclues de cette couverture. Au fil du temps, des réformes ont été mises en place pour étendre la couverture à l'ensemble de la population, garantissant ainsi l'accès universel. Malgré ces efforts, les crises économiques et les changements sociaux ont créé des défis financiers pour ces systèmes, nécessitant des ajustements et de nouvelles solutions pour maintenir l'accès universel.

🌐 Crise économique, mondialisation et réforme des systèmes de santé

Les années 90 ont marqué un tournant avec la mondialisation et l'avènement de nouvelles technologies, entraînant une pression accrue sur les systèmes d'assurance santé sociale. Avec des marchés du travail fragilisés et des dépenses de santé en constante augmentation, ces systèmes ont dû introduire des réformes pour contenir les coûts. Cela a inclus des mesures telles que la privatisation partielle des services, la réduction des lits d'hôpitaux et l'introduction de paiements partagés pour certains soins. L'objectif de ces réformes était de maintenir l'accès universel tout en modernisant la gestion et en optimisant les dépenses.

🏥 La nouvelle gestion publique et la régulation du secteur de la santé

Pour faire face aux défis financiers, les systèmes de santé européens ont introduit des réformes basées sur la 'nouvelle gestion publique', empruntant des pratiques de gestion du secteur privé. Cela a impliqué des réductions de personnel, l'externalisation de services comme le nettoyage des hôpitaux, et l'optimisation des prescriptions médicales. La concurrence régulée entre les assurances santé a été encouragée, tout en maintenant un contrôle gouvernemental strict pour garantir l'accès universel. Ces réformes visaient à maximiser l'efficacité des dépenses, tout en maintenant une couverture de qualité pour tous.

🤝 Réduire les déséquilibres et moderniser les systèmes d'assurance santé

Les systèmes d'assurance santé doivent lutter contre les déséquilibres entre différentes catégories professionnelles, certaines ayant plus de risques et de dépenses de santé que d'autres. Pour garantir une couverture universelle, des réformes ont été mises en place pour moderniser les règles d'affiliation et harmoniser les contributions. En parallèle, la combinaison entre assurance publique et privée a été repensée. Les réformes en Europe ont cherché à contenir les coûts tout en modernisant les systèmes et en s'assurant qu'ils puissent faire face à l'augmentation des dépenses de santé à long terme.

Keywords

💡Accès universel

L'accès universel fait référence à l'idée que tout le monde, sans exception, puisse bénéficier de soins de santé, quel que soit son statut économique ou social. Dans la vidéo, ce terme est décrit comme une notion populaire, mais souvent mal comprise, car il ne s'agit pas seulement d'avoir des portes ouvertes dans les hôpitaux publics, mais d'assurer également une égalité de traitement pour tous, ce qui soulève des défis d'organisation et de financement.

💡Équité

L'équité est un concept essentiel qui signifie que tout le monde doit recevoir le même niveau de soins de santé, indépendamment de son origine ou de sa classe sociale. Dans le script, il est souligné que l'accès universel aux soins ne garantit pas toujours l'équité, surtout dans les systèmes de santé à deux vitesses, où les plus riches bénéficient de soins de meilleure qualité que les pauvres.

💡Système de santé à deux vitesses

Ce terme désigne une situation où il existe deux systèmes de soins parallèles : l'un pour les plus pauvres, souvent de moindre qualité, et l'autre pour les classes moyennes et supérieures, avec un meilleur accès et des soins plus rapides. L'orateur mentionne cela comme un risque majeur dans les systèmes publics, notamment au Brésil et en Russie, où une partie de la population utilise des assurances privées pour éviter les hôpitaux publics.

💡Traitement en temps opportun

Le traitement en temps opportun signifie que les soins doivent être délivrés rapidement pour maximiser les chances de guérison. La vidéo explique que l'accès universel n'est pas seulement une question de disponibilité des soins, mais également de rapidité de traitement. Par exemple, un cancer ou une crise cardiaque nécessite une intervention rapide pour éviter des conséquences graves.

💡Système de soins primaires

Les soins primaires font référence aux services médicaux de base, souvent fournis par des médecins généralistes, qui jouent un rôle clé dans la détection précoce des maladies. Dans la vidéo, il est dit que ces soins sont essentiels pour garantir un traitement en temps opportun, car ils permettent d'identifier les problèmes de santé avant qu'ils ne deviennent critiques.

💡Infrastructures de transport médical

Les infrastructures de transport médical, comme les ambulances, sont cruciales pour garantir que les patients atteints de maladies graves reçoivent des soins d'urgence à temps. L'orateur utilise l'exemple d'une personne ayant une crise cardiaque pour illustrer l'importance de transporter rapidement les malades vers les hôpitaux, afin de maximiser les chances de survie.

💡Soins centrés sur le patient

Les soins centrés sur le patient désignent une approche des soins de santé qui prend en compte les besoins individuels et culturels des patients. Le script indique que pour atteindre l'accès universel, il est important que les professionnels de santé adaptent leur approche aux différentes cultures et situations sociales, afin de mieux communiquer avec les patients et de réduire leur anxiété.

💡Ressources suffisantes

Les ressources suffisantes englobent les fonds, le personnel et les technologies nécessaires pour offrir des soins de santé équitables et rapides à toute la population. L'orateur souligne que sans des ressources financières et humaines adéquates, il est impossible de garantir un accès universel aux soins de qualité pour tous.

💡File d'attente

Les files d'attente dans les systèmes de santé se réfèrent aux délais que les patients doivent attendre avant de recevoir un traitement. Le script mentionne que même dans les systèmes de santé universels, comme au Royaume-Uni, les patients peuvent être confrontés à de longues files d'attente pour certaines procédures médicales, ce qui pousse certains à souscrire à une assurance privée pour recevoir des soins plus rapidement.

💡Assurance santé privée complémentaire

Les assurances santé privées complémentaires sont des polices d'assurance que certaines personnes souscrivent en plus du système public de santé. Dans la vidéo, il est expliqué que dans des pays comme la Suède et l'Angleterre, les employés peuvent bénéficier d'une couverture complémentaire pour éviter les files d'attente et obtenir un traitement plus rapide, soulignant ainsi l'existence d'un système de santé à deux vitesses.

Highlights

Universal access to healthcare is a widely desired concept.

Universal access often means free healthcare services without the need for health insurance.

There is a risk of creating a two-class medical system with separate healthcare for the poor and the wealthy.

Universal access should also mean equity and equal treatment for all.

Timely treatment is crucial and should be part of universal access.

Primary care systems are essential for timely treatment and early detection of illnesses.

Rapid transportation systems are necessary for emergency situations.

Gender equality in healthcare is a component of universal access.

Patient-centered care is important for culturally sensitive healthcare delivery.

Sufficient resources in terms of funding, manpower, and technology are required for universal healthcare.

A good geographical distribution of services ensures accessibility across the country.

Coordinated networks between care levels are necessary for effective treatment.

National health services provide universal access but may have issues with waiting lists and limited care options.

Supplementary private health insurances are common in countries with national health services.

Social health insurance systems face challenges with economic crises and changing labor markets.

Reforms in social health insurance systems focus on cost containment and modernization.

Regulated competition and privatization are strategies to improve efficiency in healthcare systems.

Reinforcing patient rights and involving users in decision-making processes is part of the reform strategy.

The goal of healthcare reforms is to maintain universal access while improving quality and efficiency.

Transcripts

so i start with this magic word

universal access everybody loves it

the international organization and every

every

every person would like to live in a

country with universal access to health

care but what do we mean by this well

generally people mean simply

well i will have a doctor next door and

i will get free medicine and there will

be a hospital public hospital with large

open doors and i can just walk in and

that's it

we do have such systems in

quite a lot of countries with huge

populations i don't quite know about

india but i know quite a lot of things

about brazil and russia

these countries do have public health

care systems where everybody can go like

this and they function partly without

any health insurance without any money

so it's just open doors um

but there's a risk

because when i see when i saw these

countries and they have all these

wonderful public hospitals in rio de

janeiro on the bottom of every favela

there's a brand new hospital my

colleagues from university they don't go

to that hospital they all have a private

health insurance from your their

employer from the university or from if

they work for the government and they go

to different hospitals as they see

different doctors and they seem to be

all in very good health

so

the risk the risk with this idea of

universal access just open doors

is very often you will have two separate

health care systems what we call in

in german or in french a two-class

medical system

one for the poorer people and one for

the people who have sort of middle class

upper middle class and the upper class

and they they don't use the same

institutions and from there you can

guess that probably they don't get the

same quality of care these people

so

this is the basic for me the basic issue

in

in the world in the concept of universal

access does it also mean equity does it

also mean equal treatment the same good

treatment with the same good technology

for everybody

because then you have a quite different

problem of organization

it's not enough just to set up a few

public

providers of health care now we had a

little reading on axis where it was

already a little bit extended the term

and it was explained you also need

timely treatment it means

it's not enough to have just access

let's say you have a cancer if you if

you're not treated in time you will

probably die if you treat it very early

or the same is true for

aids now if you get medicine very early

a diagnosis very early you can live with

it

so timely treatment is very is part for

me

of universal exit access it needs two

conditions

it needs to be

there needs to be an accessible primary

care system because it's a general

practitioner who does the surveillance

of people and he will see early enough

that you have some illness which if it's

not treated becomes severe severe and

maybe even a vital issue so timely

treatment is very very important and for

this you need primary care not big

hospitals

at that at that first step and you need

rapid transportation systems for

emergency imagine a man drops down in

the street with a heart attack if he's

in the hospital with a very rapid

warning system and transport he will

survive and he will survive well but if

it's three or four or five or six hours

or a day

if we get to a hospital just for dying

so

timely treatment is part of universal

access

equal treatment i said it already and i

would add it includes gender

equal treatment does not only mean that

all the boys get good treatment and all

the men it also means that all the women

and all the girls get treatment and this

is not so in every country

uh what else does it need well i would

say what we call in europe now

patient-centered care that means the

care that is delivered in a region or in

a country should be socially and

individually adapted

to the people

so the different cultures are different

ways of talking to people you know

different conceptions of health and all

this should be integrated in universal

access that you have a doctor who knows

how to talk to you without

making you

suffer or fear

so then you have very material

conditions you need sufficient resources

in terms of funding money manpower and

technology because if you want to care

for everybody in the country in a timely

way and an equal way with the same good

treatment you will need a lot of money a

lot of manpower and a lot of technology

so where does it come from who will pay

for this

you need a good geographical

distribution of the services

so that in every parts of the country

the services will be available of course

you cannot put a hospital into every

village but you can organize the

networks that every ill person from

every village will get in time

to a hospital

where he can be treated in good

conditions

so it also needs coordinated networks

between all the care levels in my first

lesson i talked about primary care level

secondary care level and tertiary care

level that's in terms of technology so

there need to be networks

between these levels in order to get

timely treatment equal treatment and the

right treatment so it starts here with

the zp with the general practitioner

so far for the term for this magic word

universal access so there's much more

behind than just open doors and free

medicine

now we talked about different health

care systems uh types of health care

systems and how do they react towards

the issue of universal access just to

record

it is universal by origin so you don't

need to add any

universal access when you people who

have lived in britain they know it you

will get an inscription in the national

health service and then you can go to

any doctor to any hospital and you don't

need to pay this is the basis of a

national health service

um but they're problems

national health services are very well

managed uh and controlled by the

government

regulation is very strong they can limit

the budget they do limit the budget they

decide how many people will be recruited

and how many hospitals will be built and

the equipment will be renewed or not

it's according to these um

discussions at the high government level

so if you then have everybody who has

access to universal care

you may have problems with not enough

means and you have waiting lists and

britain has always had waiting lists

they exported many patients to france

for hip operations for instance because

they had to wait two years in britain

and in france i could have it

immediately so we made agreements

between french hospitals and the

national health service in britain and

the people could come and then the bill

would be sent to britain to the national

health service so it was

sometimes within the european union you

can make

these type of arrangements

another problem of national health care

systems and universal access is the care

basket may be a bit limited so there may

be many things like

glasses or hearing aids or things like

this or complicated operations which

will not be done

inside the national health service

because it would cost too much money

or

which will not be done for

only for young people not for old people

and things like this

so because these problems exist very

often in national health systems we have

read it in the reading about sweden we

have read it about england

and the whole literature tells you the

same they are very often private

supplementary private health insurances

in these countries so supplementary

means that they bring a supplement there

where something is lacking

many of these private health insurances

are sponsored by your employer your

office is oh sorry he can offer it to

his employees or to his um

to his uh

most important employees for instance

and it allows you to jump the queue to

have less waiting time you go to some

other hospital a private one where

there's no waiting time it's reserved

for this private supplementary health

insurances

or you can

see privately

people from the national health service

also

you may have a right to private hospital

room or better and quicker medical

procedures more benefits like little

things like glasses hearing aids or

dental replacement they may pay for

alternative medicines like chinese

medicine or thermal course so we have

these private health insurances which

live as a supplementary thing

uh

besides the national health services to

go around the problems for

the people who can afford such a private

health insurance

because there is no option to leave the

national health service you will always

pay your contribution either to the

national health service you pay

it's paid by the general taxes you will

continue to pay your taxes to the

national health service even if you are

always cared for by private health

insurance so we will have somehow to pay

twice

you cannot there is no exit option from

the national health service in britain

or in sweden

the result of all this is

universal access understood in the way

of national health services has the risk

of

waiting lists on limited care basket

and the possibility for some people to

have a supplementary issue to get out of

this problem and it is a sort of light

version of a two-class system

a light version not a heavy version i am

precise about this

so so far for the national health system

it comes

becomes more complicated with the

social health insurance systems like i

have to explain more things three slides

because the origin if you remember of

social health insurances was some sort

of solidarity between professional

groups or between

economic branches and they had their

health insurance for their members

so people were grouped

let's say inside germany by different

groups

who had different health insurances and

they were looking after these people and

the solidarity was within this group

so there were people then of course who

were in no group because they didn't

work they were too old or they were too

ill or they were peasants didn't have

such things it came later

um domestics or you know all sorts of

groups who didn't have these uh

institutions they were then not covered

at all

so this was managed in the way that in

the inter-war time

to world wars and in the 50s and 60s in

these countries who have these

social health insurances they extended

it to other groups to complete the

universal access to make it universal

and

that was achieved more or less in most

major european health care systems in

the early 70s

but then we had an economic crisis first

oil crisis and

economic economy shrunk taxes shrunk

contributions shrunk and

more people were ill because of stress

and economic problems

so the health insurances these social

health insurances they all had a problem

with money

so they had to do something

because the world had changed social

changes people got divorced so there

were women without health insurance they

used to be insured with their men with

their spouses unemployment people who

were unemployed over a certain longer

time they were not health insured

anymore

uh young people who couldn't find a job

students who were a little bit older

already studying too long they didn't

have a health insurance so there were

all sorts of problems because we had an

economic slowdown so the old model was

some sort of breaking

so we found partial solutions which were

we did something for the unemployed we

did something for the divorced people we

did something for the young people for

the students and so on and some some

countries did a very big change in those

70s 80s italy and spain for instance

changed their health care system from a

social health insurance system to a

national health service a decentralized

one

so this somehow worked from the 70s 80s

early 90s the thing works but then came

a new big change that was new technology

globalization

with competition with countries where

wages were much lower

so the labor market was changing in

europe

and that made the same problem then the

first economic slowed down even

worser

for the health insurances because they

had less money coming in because the

economy was slower

and they had more money running out

because health expenditure was growing

it's always growing because of

technological progress because of

chronic illness where people don't die

anymore because they have this or this

illness they become chronically ill and

they need care for years and years

30 years earlier they died so you have a

natural growth of health expenditure and

then you have changing labor markets and

you have a problem you cannot manage

anymore and came a new ideology

neoliberalism

where we were told everything has to be

private then it's better

so

we introduced a lot of reforms in our

european social health insurance systems

in the 90s and 20s

and it introduced cost sharing with more

out-of-pocket payment

de-listening medicines so medicines that

were paid by the health insurance before

if they were not really very important

they would not pay for them anymore you

would have to pay out of your pocket for

these little things

um

all sorts of things were changing as

what was

because of cost cost control yeah we had

to save money but the main thing

changing was a changing labor market

many people had not secured jobs anymore

and for that reason also were not health

insured all these fragile little jobs

um

so the result was

after the 70s when we could do with

partial solutions in the 80s and 90s

with the globalized world there was a

need for changes bigger reforms because

we had a growing number of people who

dropped out of the coverage of the

social health insurance system and the

social health insurance had to do

reforms for cost control which made

cost sharing bigger so for poorer people

this was to a problem so there was a big

problem with universal access so we had

to maintain universal access but how so

the policy report responses reforms in

europe in these social health insurance

countries were very intelligent it was

not cutting the benefits like the leo

liberals wanted and make private

insurances it was saying well we have to

spend the money better

more efficient spending we have to do

more with the same money or even with

less

so we have to reinforce regulation with

the government reinforced its control

over all the social health insurances

they were much more independent before

than they are now from the government

we had to do internal management reforms

to manage the system better and this is

what we call the new public management

here you have some details

uh formerly the healthcare system was

more or less managed in bureaucratic

ways whether it was public or private

because the heads insurance is a big big

organizations

now we try to manage them

uh according to private enterprise

management so compress the labor force

uh take away everything that can be

replaced by cheaper solutions for

instance

they checked in most countries all the

medicines we prescribed and took out of

the reimbursement list all those who

were not proven really very

efficient or the medicines a little bit

that were thrown out of the basket

uh

we restricted public works for instance

cleaning in hospitals is not done

anymore by hospital stuff it's done by

private enterprises who work with

cheaper labor we had to reduce the

hospital beds

because we wanted to save money

saving hospital beds means home care so

they're less less nurses needed less

less doctors needed

you can do all this by internet too you

don't need to travel to the home anymore

we did privatize a few things also in

order to introduce competition between

health insurances for instance

formerly you could not enter any health

insurance like this social health

insurance because they work for certain

groups

and now in

particular countries i think they opened

it you can choose freely and they can't

refuse you i think i said it already

so

they have to be managed very well they

have to have at the top a real manager

not a bureaucrat

so

this we call regulated competition and

regulated privatization because there

was always the government behind with

its control because he wanted to keep

general access and a certain quality the

thing was not only saving money it was

spending the money better

get more out of the money more quality

and more people covered

so we reform the hospitals and the care

structures

and reinforce patients rights and

patient power

in europe practically every hospital

and every community like the state the

the towns government who has to do with

medical structures they will have some

committee with the users of the health

care system and they will give their

opinion and they will be consulted for

all sorts of decisions

so choice for the users i can choose my

hospital my health insurance has also

become a policy tool which reinforces

the government control over the system

so there are policy partners now the

patients so securing the social health

insurance coverage

for universal access

it meant in reality you know i i told

you a few details now go over the

details

uh you have to counteract the

traditional imbalance of risks between

different health insurance bodies if you

have health insurances for certain

groups you have always

uh groups with a certain income in a

certain health insurance engineers for

instance or house cleaners so

the house cleaners have more health

risks

and less life expectancy and less salary

so their health insurance is much poorer

than those the health insurance of

engineers i think this is easy to

understand so if you want to have

universal coverage you have to break

this imbalance between the different

heads organize insurance organizations

whether they're public or private is not

really important but it's important that

you break this imbalance

so you have to modernize the rules for

affiliation i said already you know you

can affiliate rather freely in those

countries where you have the choice

between different health insurances in

france we don't have choice because we

have only one it's unified

um

and you have to reconsider the public

private health insurance mixed with

this exists in some countries

oh sorry it's always running away

so all these reforms

are based on combining cost containment

so that we will be in the future also

capable of paying the growing health

expenditure because there's not only now

in the past there's also the future and

it will grow the health expenditure so

course compare containment combined with

modernization of the system and its

organization and universal access this

was the idea of the reforms in europe it

took a while to work on this because

this is really a bit difficult

and the strategy is not yet finished

it's still going on we have health

reforms all the time now but it is

within this vision cost containment

modernization also in terms of research

and technology how to have a modern

healthcare system and universal access