Health policy in Europe – Prof. Monika Steffen EUHEALTH
Summary
TLDRCe 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
💉 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.
🏥 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.
📊 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.
🤑 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.
🌍 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.
📈 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.
Mindmap
Keywords
💡Couverture universelle
💡Autorité réglementaire
💡Tarifs des médecins
💡Négociation des prix
💡Cadre des soins
💡Assurance maladie privée
💡Indépendant médical
💡Solidarité
💡Assurance maladie sociale
💡Système de santé national
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
[Music]
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
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