Health policy in Europe – Prof. Monika Steffen EUHEALTH

Summary

Ce script aborde les facteurs clés d'un bon système de soins de santé universelle et de qualité, mettant l'accent sur le pouvoir régulateur de l'autorité publique. Il explique comment le gouvernement peut réguler la formation des médecins, fixer les salaires, négocier les tarifs des médicaments, et définir le panier de soins. Le script compare différents types de systèmes de santé en Europe, en mettant en évidence les dépenses par habitant, la couverture des soins et les paiements à la caisse. Il souligne également le rôle de l'Union européenne dans l'amélioration des systèmes de santé et la lutte contre les inégalités en matière de santé.

Takeaways

• 👨‍⚕️ L'autorité réglementaire du gouvernement est essentielle pour assurer une bonne couverture et une qualité médicale adéquates dans le système de soins de santé.
• 🧑‍🎓 Le gouvernement peut réguler la formation des étudiants en médecine et spécialiser le nombre de médecins selon les besoins régionaux et spécifiques.
• 💼 Il peut fixer les salaires des professionnels de la santé et les tarifs pour les médecins privés, influençant ainsi la tarification des services médicaux.
• 💊 Le gouvernement peut également négocier les prix des produits pharmaceutiques avec l'industrie pharmaceutique, souvent via les assurances maladie.
• 🛡️ Le 'panier de soins', c'est-à-dire les soins auxquels les assurés ont droit, peut être défini par le gouvernement, affectant la couverture des soins innovants et coûteux.
• 🏥 En France, les médecins ont une certaine marge de manœuvre pour les tarifs des consultations, mais ils sont globalement régulés par l'État.
• 🏭 Les soins de santé sont souvent fournis par des fournisseurs publics ou privés non lucratifs, mais une tendance vers la privatisation et la concurrence est observable.
• 🏛️ Les systèmes de santé varient d'un pays à l'autre en Europe, allant de services de santé nationaux à des assurances maladie sociales et privées.
• 💸 Les dépenses de santé par habitant et leur financement public ou privé diffèrent considérablement d'un pays à l'autre, reflétant les choix politiques et économiques.
• 🌍 L'Union européenne joue un rôle important en encourageant les États membres à améliorer leurs systèmes de santé grâce à des comparaisons et des benchmarks.

Q & A

Quels sont les facteurs clés pour avoir un bon système de santé avec une couverture universelle et une certaine qualité des médicaments?

Les facteurs clés incluent le pouvoir réglementaire de l'autorité publique et du gouvernement qui peut réguler tous les aspects de la santé, fixer le nombre d'étudiants en médecine, spécialiser les médecins dans certaines régions ou disciplines, réguler les salaires des professionnels de la santé, fixer les tarifs pour les médecins privés et négocier les prix des produits pharmaceutiques.

Comment le gouvernement peut-il influencer la spécialisation des médecins?

Le gouvernement peut réguler la spécialisation des médecins en décidant par exemple qu'ils doivent exercer dans une région donnée en raison d'un manque de médecins ou en exigeant qu'ils travaillent dans les campagnes pendant les premières années après leurs études.

Quelle est la différence entre un service de santé national et une assurance maladie sociale?

Un service de santé national est géré et financé par l'État, offrant un accès égal aux services de santé à tous. L'assurance maladie sociale est un système où les fonds sont collectés par des caisses autonomes, généralement basées sur des professions ou des branches industrielles, et les membres ont un accès égal aux services de santé au sein de leur caisse.

Comment le gouvernement peut-il réguler les prix des produits pharmaceutiques?

Le gouvernement peut réguler les prix des médicaments en négociant avec l'industrie pharmaceutique ou en fixant des tarifs maximums pour les médicaments réimbusables par les assurances maladie.

Quel est le rôle de l'assurance maladie sociale dans la tarification des services médicaux?

L'assurance maladie sociale peut négocier les tarifs avec les médecins et l'industrie pharmaceutique pour les médicaments, car elle est souvent l'entité qui rémunère ces services et produits.

Quelle est la notion de 'panier de soins' dans le contexte des systèmes de santé?

Le 'panier de soins' fait référence à l'ensemble des soins auxquels les assurés ont droit. Le gouvernement peut déterminer les soins inclus dans ce panier, notamment en fonction de leur efficacité et de leur coût.

Comment les systèmes de santé peuvent-ils influencer la couverture des soins pour les populations défavorisées?

Les systèmes de santé peuvent garantir la couverture des soins pour les populations défavorisées en définissant des exonérations de cotisations pour les personnes ayant faible revenu ou en utilisant des fonds publics pour couvrir les contributions d'assurance maladie de ces individus.

Quels sont les principaux types de systèmes de santé mentionnés dans le script?

Les principaux types de systèmes de santé mentionnés sont le service de santé national, l'assurance maladie sociale et l'assurance maladie privée.

Quelle est la différence entre les systèmes de santé en Allemagne, en France et en Suède?

En Allemagne, la plupart des dépenses de santé sont couvertes par l'assurance maladie sociale. En France, il y a une combinaison d'assurance maladie sociale et d'assurance maladie complémentaire privée. En Suède, le gouvernement couvre la plupart des dépenses de santé via un service de santé national.

Comment les pays à faible revenu comme la Bulgarie et la Roumanie gèrent-ils leurs dépenses de santé?

Les pays à faible revenu comme la Bulgarie et la Roumanie ont une couverture de santé plus limitée, avec une part importante des dépenses à la charge des patients (paiement à la carte), en raison de ressources financières limitées.

Quels sont les défis auxquels les systèmes de santé sont confrontés dans les pays en développement?

Les défis incluent la faible couverture des dépenses de santé par les systèmes d'assurance, une dépense par habitant très faible et la nécessité de mettre en place des systèmes de santé efficaces avec des ressources limitées.

Outlines

00:00

💉 Le rôle de la régulation dans les systèmes de santé

Le paragraphe 1 met en évidence l'importance de la régulation par les autorités publiques et le gouvernement dans la qualité et la couverture des systèmes de santé. Il explique comment le gouvernement peut intervenir pour déterminer le nombre d'étudiants en médecine, les spécialisations médicales nécessaires et les régions où les médecins sont manquants. Le gouvernement peut également fixer les salaires des professionnels de la santé, les tarifs pour les médecins privés et les prix des produits pharmaceutiques. En outre, il peut négocier avec l'industrie pharmaceutique pour réduire les coûts des médicaments et définir le 'panier de soins', c'est-à-dire les traitements auxquels les patients ont droit. Le paragraphe souligne que ces régulations dépendent des valeurs sous-jacentes et de l'opinion publique.

05:01

🏥 Les différents types de systèmes de santé et leur financement

Le paragraphe 2 décrit les trois types principaux de systèmes de santé : le service national de santé, l'assurance maladie sociale et l'assurance maladie privée. Chaque type a ses propres principes et valeurs, comme l'accès égal aux services pour tous. Le financement peut provenir du budget public, des contributions d'assurance sociale ou des primes d'assurance privée. Le paragraphe explique également comment les gouvernements peuvent réguler les tarifs et les contributions, et comment ils peuvent aider à payer les contributions pour les personnes les moins fortunées. L'exemple de la France est utilisé pour illustrer comment le système de solidarité fait en sorte que les personnes les plus à l'aise financièrement contribuent à couvrir les soins des plus démunis.

10:02

📊 Dépenses de santé par pays et système de santé

Le paragraphe 3 présente une analyse statistique des dépenses de santé dans différents pays, notamment l'Allemagne, la France, la Suède, la Bulgarie et la Roumanie. Il compare le financement public et privé et les dépenses de poche. Les pays avec des systèmes de sécurité sociale ont généralement une couverture plus large, tandis que les pays avec des systèmes de santé privés ont des dépenses de poche plus élevées. Le paragraphe souligne également les réformes de contrôle des coûts qui ont conduit à l'introduction de paiements de poche même dans les systèmes de santé traditionnellement sans frais supplémentaires.

15:03

🤑 Les conséquences économiques des systèmes de santé

Le paragraphe 4 discute des implications économiques des systèmes de santé, mettant en évidence les différences de dépenses par pays et les sources de financement. Il explique que pour assurer un accès universel et une qualité élevée aux soins, il est nécessaire que beaucoup de personnes paient plus que ce qu'elles utilisent réellement, pour couvrir les coûts pour les personnes qui paient moins. Le paragraphe compare les dépenses moyennes en Europe et dans d'autres pays, soulignant que les systèmes de santé qui dépensent plus en pourcentage du PIB ont tendance à offrir un meilleur accès aux soins.

20:04

🌍 Les systèmes de santé dans le monde et l'impact de l'UE

Le paragraphe 5 compare les systèmes de santé dans différents pays, y compris les États-Unis et l'Inde, et discute de l'impact du système de santé sur les dépenses et la couverture de la population. Il met en évidence le système de santé américain comme étant extrêmement coûteux et inégalitaire, malgré ses dépenses élevées. Le paragraphe mentionne également l'effort de l'Union européenne pour aider les États membres à améliorer leurs systèmes de santé en utilisant des outils de benchmarking pour identifier et partager les meilleures pratiques.

25:05

📈 L'importance de l'évaluation et de l'amélioration continue

Le paragraphe 6 souligne l'importance de l'évaluation continue et de l'amélioration des systèmes de santé. Il explique comment les comparaisons entre les pays peuvent aider à identifier les domaines où des améliorations sont nécessaires et à partager les bonnes pratiques. L'exemple de la France est utilisé pour illustrer comment les données comparatives ont conduit à des améliorations dans la couverture des soins, en particulier pour les traitements des cancers. Le paragraphe met en évidence la nécessité pour les pays de continuer à apprendre et à s'améliorer pour assurer un accès universel et une qualité élevée aux soins de santé.

Keywords

💡Couverture universelle

La couverture universelle fait référence au principe selon lequel tous les individus d'une société ont accès aux soins de santé de base, indépendamment de leur statut socio-économique. Dans le script, l'accent est mis sur l'importance de cette couverture pour garantir un système de santé de qualité. L'exemple donné est celui des systèmes de santé nationaux qui, bien que ne couvrant pas nécessairement l'ensemble des soins, garantissent un accès universel grâce à des régulations publiques.

💡Autorité réglementaire

L'autorité réglementaire est le pouvoir public qui supervise et contrôle les différents aspects du système de santé pour assurer la qualité et l'accès. Dans le script, il est mentionné que le gouvernement peut réguler le nombre d'étudiants en médecine, les spécialisations médicales et même affecter des médecins dans certaines régions où ils sont nécessaires, illustrant ainsi le rôle clé de l'autorité réglementaire dans la gestion du système de santé.

💡Tarifs des médecins

Les tarifs des médecins se réfèrent au coût des consultations et des services médicaux. Le script explique que le gouvernement peut fixer ces tarifs pour les médecins privés, comme en France où le tarif pour une consultation avec un médecin de famille privé est réglementé à 25 euros. Cela montre comment le gouvernement peut influencer les coûts des soins de santé pour les patients.

💡Négociation des prix

La négociation des prix concerne le processus par lequel les gouvernements ou les assurances maladie discutent avec l'industrie pharmaceutique pour déterminer les coûts des médicaments. Dans le script, il est indiqué que les assurances sociales de santé, qui paient une grande partie des médicaments, négocient les prix avec les fabricants pour obtenir des réductions, ce qui est essentiel pour contenir les coûts du système de santé.

💡Cadre des soins

Le cadre des soins désigne l'ensemble des traitements et des services médicaux auxquels les assurés ont droit. Le script mentionne que le gouvernement peut définir ce cadre, décidant ainsi des nouvelles thérapies qui sont couvertes par les assurances et de leur accessibilité pour la population. Cela peut inclure des traitements innovants, comme les thérapies génétiques, et implique des discussions sur la valeur et les coûts de ces traitements.

💡Assurance maladie privée

L'assurance maladie privée fait référence aux plans de couverture santé fournis par des entreprises privées, souvent en complément des systèmes publics de santé. Le script explique que le gouvernement peut réguler ces assurances, définissant les niveaux de primes et les conditions de couverture, comme c'est le cas dans les pays où l'assurance maladie privée a une part importante dans la couverture de la population.

💡Indépendant médical

Un médecin indépendant est un professionnel de la santé qui exerce en dehors des structures hospitalières ou publiques. Le script mentionne que le gouvernement peut réglementer la pratique médicale indépendante, imposant par exemple des périodes de travail dans les régions défavorisées ou des conditions pour ouvrir un cabinet médical, ce qui influence la répartition des professionnels de santé dans le pays.

💡Solidarité

La solidarité est un principe clé dans de nombreux systèmes de santé européens, où les contribuables ou les assurés paient pour soutenir les soins de santé des autres, y compris ceux qui sont plus malades ou moins fortunés. Le script parle de la solidarité comme un élément essentiel de la couverture santé universelle, où les personnes plus à l'aise financièrement contribuent à couvrir les coûts des soins pour les plus démunis.

💡Assurance maladie sociale

L'assurance maladie sociale est un type de système de santé où les contributions sont basées sur les revenus et où l'ensemble de la population est couverte par des assurances collectives. Le script décrit ce système comme étant courant en Europe, avec des exemples de pays comme l'Allemagne et la France, où les assurances maladie sociales jouent un rôle majeur dans le financement des soins de santé.

💡Système de santé national

Un système de santé national est un modèle où le gouvernement fournit directement les services de santé et assume les coûts. Le script mentionne le Royaume-Uni et la Suède comme exemples de pays ayant des systèmes de santé nationaux, où le gouvernement est le principal financeur et fournisseur de soins de santé.

Highlights

The importance of regulatory power in health care systems for universal coverage and quality medicine.

Government's ability to regulate health care including medical education and specialization.

The role of government in addressing doctor shortages in specific regions.

Regulation of doctors' salaries and tariffs for private doctors by the government.

Government's influence on pharmaceutical product pricing through health insurance negotiations.

The concept of a 'care basket' and how governments decide on the scope of care provided.

The impact of public opinion on government's health care policies and regulations.

How governments set levels of contributions and premiums for private health insurances.

The solidarity principle in French health insurance where the well-off support the less fortunate.

The different types of health care systems: national health service, social health insurance, and private health insurance.

The values and principles behind different health care systems and their funding mechanisms.

The rise of private investment in health care provision and its implications.

Comparison of health care spending and its sources in various European countries.

The average health care expenditure in Europe and the role of social health insurance.

The unique challenges and health care spending in poorer European countries like Bulgaria and Romania.

The contrast between European and American health care systems in terms of cost and coverage.

India's low health care spending as compared to other countries and the need for improvement.

The role of the European Union in benchmarking and improving health care systems across member states.

Transcripts

so the key factors

in all this to have a good health care

system with

universal coverage and a certain quality

of medicine

is the regulatory power of the public

authority

and government can regulate all aspects

of health care even if it's not a

national health service it can fix the

number of medical students

including how many doctors should be

specialized for heart disease or cancer

disease or whatever

uh it could decide this is difficult

because the medicine doctors don't like

it but the government theoretically can

do it by law and say well you have to

exercise in that or that region because

there are doctors lacking in that region

or if you want to be a doctor an

independent doctor after your studies

you have to work the first six or seven

years somewhere in the countryside so

government can do all this depends on

what are the values at the basis and if

public opinion will follow

it can fix the salaries or honorary of

doctors and all the other health

professionals already because many of

these professionals are in public

employment but it can also fix tariffs

for private doctors if i see my private

family doctor here in france it costs 25

euros that's the tariff of the

government the doctor can't take

more well he he can take more but then

he needs to have a special authorization

and a special regime and

all sorts of special things it's

regulated

the government can fix the prices for

pharmaceutical products

uh

very often it's

health insurance when the social health

insurance who will negotiate with

doctors on tariffs and with the

pharmaceutical industry for medicine

prices because they reimburse it these

this money

it's not the people who pay it

so it's insurance but in cases sometimes

when you have

a regulation a little bit softer the

government will try to negotiate every

year with the pharmaceutical industry

to see

if there are products which we may have

for less money

or if we accept to reimburse very new

products with a high price you know very

innovative counter treatment for

instance

um

then will you lower prices for this and

this and that because you do it for many

years and the production should be

cheaper so the government comes in to

negotiate very often because

finally it's public money who pays this

so the government can do lots of things

it can also fix the care basket it can

decide

um

his have to respect

ah with the head's insurances have to

respect okay the care basket is the

the the care you are normally entitled

to

if there is innovative care for instance

we have not yet so much security about

a new

genetic

treatment or something like this then

there's a security question and there's

a price question is it worth to pay so

much money for this treatment for just a

few patients

or just to give a few patients some more

months to live is it worth it

then doctors say yeah it's also for

research we will know more

and afterwards we benefit more from it

because we are collecting you know

clinical experiences and so on so

in all these discussions the government

will be somewhere present

it can decide the level of contributions

and even the premiums

to private health insurances if

the private health insurance

have the monopoly for covering the total

population as it is the case now in the

netherlands and in switzerland then the

government will come and regulate how

much money they can take from these

people

and it can define the government who are

the free beneficiaries who will be

health insured without paying any

contribution because people are too poor

don't have much money

so

who can go just walk into a hospital or

a doctor's office

in health insurance systems generally

these people need to be affiliated with

health insurance and the problem is who

is going to pay the contribution

sometimes the government will pay it

we'll send the money to the health

insurance corresponding to these people

sometimes it will be

francis find a very good answer they

take the money

for these poor people about 10 percent

of the population is freely insured they

don't pay any contribution and they have

the same care basket than i have

or even

more in it they get dental care free

which i have to pay out of pocket

because otherwise i couldn't afford it

so

um

the government

started paying the contribution for this

for these people and then it started

taking the a special tax from the

voluntary from the private complementary

voluntary health insurance to say well

uh you should contribute also to cover

these poor people and they accept it say

okay we are nice we are also for

solidarity

um we will pay you when they read about

one percent on their business

[Music]

turnover per year they will give into

this common fund to pay

to the public health insurance the

equivalent of the contributions these

poor people don't pay

and now ten years later

it's about six or seven percent this tax

and the total

charge

for

free affiliation of all this about 10 11

of the population

is paid by the private complementary

health insurances

so

this is a very complicated uh

architecture where the french they are

very good in making people who have a

little bit more

pay for all those who have a little bit

less they call this solidarity

so the health insurance in france for

those who don't have who don't have

enough money to pay their own

contribution

it's paid it's under threshold of income

and it's paid by the supplementary

private health insurance

which covers you know the rest of the

population every french person has such

a insurance

okay

now the theoretical summary of the major

health care system types

all the things i said already are

summarized here the type of system

national health service social health

insurance private health insurance the

values and principle principles

here it is equal access to services by

everyone

the funding comes from the public budget

from the general taxes

the provision is mainly by public

providers

oh sorry

public hospitals or public

doctors and the governance is state

planning and state control very tight so

they have control over their budget

that's why their health care system

costs less but they have waiting lists

social health insurance that will be

equal the value will be equal access to

services among the members of that

special fund because they are organized

generally by

by a profession so as a fund for

engineers as a fund for

i don't know for trained

drivers and pilots and so on

and for industry branches and they have

to fix up their budget and they can play

a little bit on the on the care basket

and on the contributions within the

limit fixed by the government

also the funding is as i said social

contracts insurance contribution

according to income

or to salary

the service provision is either by

public providers or private providers

but mainly in non-for-profit

setups

that is changing now a little bit

uh the municipalities for instance in

several countries among them germany

sold their little hospitals which their

owns and 100 years and they didn't have

enough money to modernize them and so on

and it was found out that small

hospitals are not really so safe so we

should have bigger ones so they sold

them to private investors

who transformed them into something

which is for which is a big business for

instance they do only one type of

operations and then they're very

specialized doctors

and they contract them with the

social health insurance

for the price but they get a lot of

activity because public hospitals are

not built anymore because the money is

not there

so a lot of private investment is

entering now and it's not always not for

profit or they transform it into all

people's residency which is a big market

so there are a little bit things

changing

uh governance and regulation well as i

said collective bargaining of corporist

actors the doctors on the one side the

health insurance bodies on the other

side

and growing state regulation

private health insurance access

according to your ability to pay

premiums

higher premiums you get a better care

basket

better better clinics better doctors

private insurance premiums are according

to the risk

the best client would be somebody who's

just 20 years old old has never been ill

and it doesn't move very much doesn't

have risk for accidents that's the best

client

um

private private

for-profit providers so everything will

be somehow for profit making even if

there's government regulation clinics

will be private all people's house will

be private there will always be sort of

you know calculation for profit

and there will be a lot of competition

between all these private actors

competition which the state can limit

we

talked a lot in our

in our science about regulated

competition

and regulated private privatization that

means we privatize certain things but

there will be regulation around it

or we allow a lot of competition but it

will not be just for money-making

there will be something like quality

and user satisfaction and things like

this will come in into the basket

now here's uh summing it up you will see

the different health types again

i put together in a statistic the

funding of the current heads expenditure

for 2000

it must be 2019.

i generally took to the year 19 in order

to avoid the kovit incidence

so we have seen the percentage of gdp of

has expanded so we have seen per capita

here it's ppp dollars because the

statistic comes from the oacd

which works with dollars the other one

came from europe european commission

they work with euros um

so this is just a recall on we have seen

these things

but i put together here three countries

because you have it also in your

readings germany france and sweden

and then the two poorest countries in

our statistics bulgaria and romania so

you see here the difference

between per capita uh

spending

it's varies between 6500

ppp dollars and

1900 let's say in bulgaria that's three

times more

now the interesting thing which we

haven't seen yet is where does this

money come from

um how much is public spending

in this current health expenditure

current health expenditure uh means all

the expenditure of the health care

system which is sort of day after day it

it does not include investment if you

buy and you

build a new hospital that's not in it's

just the care and and the salaries for

the people who work there and the

pharmaceutical products and all this

so the public spending would be either

the social health insurance or

government

now

and here you have the private health

insurance

a percentage of this current health

expenditure which will be paid by

private health insurance if there is one

and out of pocket what people will pay

out of their pocket

okay

now let's look at these figures in

germany

78 of the current health expenditure is

paid by the social health insurance so

this is a proof that this is a social

health insurance

type because most of the money is

covered by these social health

insurances the government gives 6.5

so the total public coverage in spending

terms it's

84.6 percent of the current health

expenditure so that's quite a lot

so private health insurance is is little

uh if i have time i will say a few words

about it but

maybe tomorrow

and out of pocket will be an average

something like uh 12 to 13

of this

current expanded show

now the 6.5 will be some government

subsidies maybe for special programs

like looking after children or for

special rare illness or

for the poor people's coverage

contributions they don't pay the

government will pay maybe pay it through

the health insurance

now in france you have more or less the

same

the same

the same

profile

except

you have seven percent which is covered

by private health insurance

because the french system has never

uh been free when it was when the hedge

insurance was uh founded she actually

won after the second world war it there

was a money problem that didn't have

enough money and they said well the

people should pay 30 percent and 70

should be the health insurance of the

expenditure

and then

different levels were established

according to all sorts of criteria

so reimbursement was never a hundred

percent

and that's why

private complementary health insurance

exists they existed before but it's only

health insurance there was no other one

and they were kept alive with this

complimentary part so all the french

people have two health insurances

including me

um

a public one

major health insurance which pays these

78

percent of the expenditure

and a private health insurance which

will pay

uh the rest which i don't reimburse

and that is about

in average seven percent of the current

total expenditure but out of pocket will

still be nine point three percent so you

see france here is very proud that they

have the smallest out of pocket in the

whole of europe

but they never tell you that you have to

pay twice the contribution because into

this health insurance the private

complimentary one you have to pay

contribution

and mine takes the solidarity principle

they take it in percentage of income

so that's rather expensive for what they

give back so um

they don't count family members for

instance if i had five children and an

ill husband they would all be insured

for the same money then i pay for myself

so

it's according to need

um

so this is a little bit

true we don't have much out of pocket

payment but we should consider that we

pay much more contribution than other

europeans because we pay twice

okay sweden you see they don't have any

social health insurance the government

pays everything because they have a

national

national health service

so the government pays about 85 percent

of the

current health expenditure

and they have very few

private health insurances

very little it's just one percent of the

expenditure and they have about 14 of

out of pocket payments today

so it grow there were days when there

was zero here

zero here and in germany there was zero

here

and the cost control reforms it has care

became more expensive

led to the introduction of small sums of

out-of-pocket payments but if you sum it

all up it's about 10

in most countries now

okay now let's look at the poor

countries bulgaria they have a social

health insurance system which pays about

half of the expenditure government pays

something like 10 percent

so you see they have about nearly 40

percent out of pocket payments which is

a lot

considering notably that salaries are

low

in bulgaria

romania

they have the the lowest percentage of

gdp for health care

and the lowest per capita

uh

spending

and you see

the government makes a bigger effort

than in bulgaria

they have little private health

insurance and people pay about 20 out of

their pocket

now if you come to the average for the

27 countries in europe who are

completely differently organized in

their health care systems and they have

different levels of

being rich or poor as a country and as a

health care system you have average uh

gdp spending will be nearly 10

with 3 700 ppp dollars per person

every year so that means a family of

four will have

a health expenditure on average about 12

000 ppp dollars but salaries are

something like 2 500. so practically

half of the year

what these people would earn it will be

spent for the health expenditure in

average

and it's other people who will pay this

this means universal access

so if you want a country with universal

access you have to be prepared to pay

for it you pay for a lot of other people

or you have a bad care system for all

the people this was more or less the

common

situation in communist countries it was

not very expensive and it was all free

but it was not very good and only

special people could go to very good

clinics

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so we don't want such a system

so if you want universal access

for everybody

quality access and equal treatment

you will have to have a lot of people

who pay a lot more than they do actually

because i will pay for all those who pay

less and spend more

because they have the children or

because they're very ill and so on

that's in the logic of a socialized

health care system

so the average is about half is social

health insurance

and the third is government spending so

the

we can conclude here that the

bismarcking system with the social

health insurance is still the majority

in the european union today

uh at least in terms of

the coverage of the current expenditure

they pay more than half

and

they have about 20

in average of out-of-pocket payments

because in these eastern countries they

are very high because these countries

don't have yet a very mature health care

system because of the economic basis and

maybe also because they just fail to

organize it this is what is said partly

in the reading you have and i agree with

it

now if you look at ocde average because

that's more countries

all sorts of other countries in it

it's the percentage of spending is a

little bit less than in europe also see

already europe spends more

of gdp i know sorry i take back what i

said first of all i have to say

the oscd

includes the u.s health care system

and that's a very particular system

it costs a lot of money and the results

are not very good but in the average

this will show

so the u.s has

spent on health care 17 of its total

riches

of the gdp

it's equivalent to 11 000 ppp dollars

for each resident in the us every baby

and every grandmother counted that's an

enormous a lot of money and with all

this money they are not able to cover

the total population

they don't have

a

complete coverage as we have in europe

so this is in my opinion the worst

healthcare system you can have extremely

expensive

and absolutely unequal

and you know this is when you make

health care is half

a business market

now the health insurances are private in

america

and not even president obama got his

plan through for universal health care

you have still about 12 of the people in

america who have no insurance at all

or

are very underinsured because they have

options they can choose i want to be

sure just for this and thus for that

which you can't do in europe normally

so you're insured once for all and you

pay once for this and in america you can

choose all sorts of things so people

they underensure themselves and then

they have a big heads drama

and they can't pay

um

i have read several times that

personal bankruptcy in america was

mainly due to medical

bills people have to declare sell their

house have to declare bankruptcy totally

because they can't pay their medical

bill

because it's so ex so expensive

and they don't have a proper health

insurance so nobody goes bankrupt in

europe because of medical bills because

we have health insurance compulsory we

can't choose we have to have it and if

we are too poor then we don't pay the

contribution until we earn more money

and then we start paying contribution

but we will be insured we will not pay

the hospital at least not completely we

will pay maybe this part but poor people

don't pay it

at least not in germany france and so on

for the eastern countries probably they

will have to

okay now i put india because i found a

few statistics of the o

ucd

which included india and look at the

figures

3.6

of

gdp in india is spent on health care

that's the lowest figure of all the

countries which were in the statistic

and that was

the 36 ocde countries plus six or seven

others so 40 40 or 44 countries india

was the least spender

and in p in pps dollars it means 257

in 2019 before kovit per capita spending

on each indian which is really nothing

the government puts about 33 percent of

this expenditure probably because

of all these public health programs you

have in india for rural areas and so on

and um

11

is employer

private health insurances people who

have a good employment they will have a

health insurance a proper one like in

europe with their employer

and

the most of the money will be paid out

of pocket so you see there's a lot of

things to revise in india probably if

you see these statistics oscd

includes countries like chile

all sorts of brazil and all sorts of

countries who are not really

particularly rich

so

and india turned out to be with this

booming

economy to be the least health spender

of all i think it's a good idea to run

this master bring some new ideas

okay

the european union has a powerful role

to uh tools to bring

the member states into

upgrading the healthcare system

those who are not very good that they

learn to be better

so um

they make bench benchmarking on all

sorts of situations

let me give some examples

we have benchmarkings in europe on

survival

rates

five years after a heart attack or after

cancer all the different types of it

counts survival rates for all sorts of

illnesses

and then you can compare countries and

say and we had a case from britain

britain had survival data about maybe 15

years ago

for cancer which were similar to

below turkey

there was none in europe we had so poor

results

so britain was very much ashamed when

these statistics came up

we didn't know before it was a european

union who organized this benchmarking

and in very very quick time it was i

think tony blair in those days britain

set up proper cancer services and the

survival rights went up very quickly

because it was so shameful so you have

um

you don't have a

power at the european union to intervene

with the national health care systems

but they have all sorts of soft power

and benchmarking is one of the very

important ones

so

just a little example about the french

report i was reading out of per capita

spending in france

we know we spent much more than european

countries on hospital care

much more in pharmaceuticals because we

have in france some

something against generics

doctors don't prescribe much generics so

we are still at the end of the european

list for use of generic medicine

and doctors have total prescription

freedom they prescribe what they think

is good for the patient and they don't

care much about the money which is a

good thing

but there's also uh economically it's a

little bit

uh a little bit difficult because uh

many people have lots of medicine in

their bathroom and it's all to be thrown

away afterwards because there's too much

prescription and we always have complete

packages when you need three pills only

they give you the package with 40 pills

even if it's very expensive because i

don't have packages for three bills

so they're all these things

um

and this comes out when you do compare

comparing with european countries before

if you look only in your country you

think this is normal and you can't

change it but you see all the other

countries do it differently then you can

have new ideas