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Ministerial Roundtable

by Lloyd Davis

Key to Participants

NM: Dr Nata Menabde, Denmark Moderating
MG: Marina Geli i Fàbrega - Catalonia, Spain
BK: Bernard Kouchner - France
TJ: Dr. Tomás Julínek - Czech Republic
AK: Andrea Kdolsky - Austria
FT: Flavio Tosi - Veneto Region, Italy
GLC: Guillem López-Casasnovas, Universitat Pompeu Fabra, Spain

Ministerial Round TableNM: Reflecting first on challenges with financial sustainability, health system performance, payment and quality which are all very important. I also hear that there are predictions of increasing expenditure around the world. Should we be talking about expenditure or rather investment to show how health contributes to social development. It’s a substantial amount of resources, playing a substantial role in our economies

AK - I’m new in this function, I’m a doctor who’s become a politician. All of these points we’ve been looking at have been around for a long time. I think we have to look at our structures - the separation between health and social care for example. Now we’re trying to bring them together while decentralising power to the regions. We also need better IT structures - we’ve been told that politicians should care more - I care a lot - my problem is with the medical doctors, not politicians, not communities or patients but clinicians. We have a big discussion going on about data security - i liked Harry’s picture of collapsing paper systems - I’m hopeful that e-health can thrive in the next 20 years making the system more effective, improving networking and communication between people and better sensibility to the patients because we know them better. We also have to modernise our finance - we’ve tried public private partnership, we must be open to new ways of doing things.

NM: Yes we see better progress in some societies and less elsewhere.

MG: (translated & summarised by GLC): I challenge the earlier comment that the forecasts are harsh. We need to count differently because we know that spending money on health is important for our economic development and for the developing world.

NM: It’s important too to develop outcome-based indicators to see how that’s working - we’re all struggling with it but we’re making progress - we need good management information systems to help with this. The models aren’t importatn, what’s important is that they deliver - you can deliver equity in different ways, so we can’t promote specific models and generalise across contexts

BK: Don’t separate so much medicine with politics - we need a common ground for health in europe, it should be one of the next benchmarks in the setting up of europe - in the previous treaties, we can’t work together because of the different access to social funding. the people believe that we have commong ground, but it’s not true at all. I’m not bothered by which system we choose, but I want us to have something more common to us all - after all we’ve got a common currency, let’s make this an adventure for the next generation.

GLC :the discussion is not how we do that, but how we understand the financing of these systems. So far we’ve closed down the debate around innovation in finance - if it can only be funded by taxes it’s difficult to get equity.

NM: we’re seeing lots of good co-operation not only for emergency but also routine procedures. but it does have financial and economic repercussions and an ethical dimension.

FT: we have some cooperation with other countries - we have collaboration with Catalonia and other neighbouring states but the problem is that there are different models of government with different levels of autonomy and independence. We want to have cooperation but we have to modify our health system standardising our model and making it more generous, but we have a lot of different rules. If I have to sign a protocol with someone else, I need authorisation from cetnral government, I can change my own system, but it is limited by the national system and changes have to be decided together. In the future it will be more simple to debate between the 250 regions rather than the 27 nation states.

TJ: I want to talk about future of healthcare finance - the current problems of growing demand and a shrinking tax base cannot be solved with the existing financing arrangements. So how do we preserve access, renew responsibility for costs and ensure that citizens have consumer rights. Our next steps are to increase efficiency via comptetition, increase the flow of private money without threatening the poor and looking at different approaches to financing and cross border provision. The systems across Europe are very different and act against free movement.

NM: interesting to hear the perspective of a new member of the EU. Aging population is true also about health service professional and there is an issue of having an adequate workforce - which is expensive and time-consuming. Migration is an issue here too, people are moving to get more money and better conditions. What do ministers think of this?

MG: there is an important shortage in doctors and nursing and doctors feel badly paid and demotivated, we need to move forward on integrating health and social care exploring micropayments and the consequences of “brain-draining” from developing countries

AK: We have no problem with not enough doctors in Austria, but we do have a problem iwht the quality of education - older people need different kinds of treatment, new kinds of illnesses are appearing and we have to look at educating our professionals. Our other problem is too many acute beds and not enough in rehabilitation - we have to focus on change and not throw up our hands and say it’s too difficult.

Questions from the floor

Q: What is the future of competition of healthcare in europe?
A: BK - I believe that in 20 years all patients will be allowed to cross borders and get help in all countries, this is difficult but do-able. France is different from UK - we can’t harmonise but we can compete, in a good way, by encouraging specialism, not by quickly trying to harmonise our social welfare systems but step by step finding a way through.

Q: as demand outstrips resources, will there be an integrated healthcare system across europe:
A: AK - Hopefully but it’s a long way off - the next step is to work on pilots at the borders. I think it’s a good idea so that we can lose the “white spots” - this is one thing the EU can do.
MG - We should go for common training programmes and find a common european space

Q: Ministers come and go, but patients and people stay around, so what influence do you truly have?
A: AK - Some patients die, some ministers stay longer :) we need a new kind of politician - ones who know what they’re talking about (she’s a doctor) we need to talk to the people and see what they need.

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