Wojciech Dziworski
Senior Economist and Political Analyst, Innovation and Healthy
Ageing, DG Health and Consumers, European Commission
Transforming Long Term Care in Europe : Improving Quality and Ensuring Access
Transforming care in Europe
Wojciech Dziworski
Innovation for Health and Consumers UnitDG SANCO
European Commission
Ageing and care challenges
Chronic conditions
Workforce shortage
Financial unsustainability
Health inequalities
HLY vs LE
Ageing society
Age dependency ratio Age-related total spending in % of GDP
Ageing – global challenge
Source: Ageing Report 2009, OECD*data for 2000 and 2050
EU27
Japan
US
2010 205023,2
13,711,1
27,8
16,7 16,6
Number of working age population for one older person (+65)
New paradigm of ageingfrom to
societal challenge major opportunity
burden asset
passive care pro-active care
curing diseases improved functioning
Social protection - contributions from Europe
• Europe 2020 / European Semester (Country Specific Recommendations – CSRs)
• Social Investment Package
• Employment Package – Towards a job rich recovery
• European Year 2012 on Active Ageing and Solidarity between Generations: pillar on independent living
• Open Method of Coordination – Social Protection Committee
• European Innovation Partnership on Active & Healthy Ageing
• Funding (ESF)
• RTD research projects
• Ageing Report
• Pilot project on elder abuse 6
Europe 2020 – priority areas for action at EU level
Single Market ActTrade and
external policiesStructural Funds
Modernised EU levers for growth and jobs
Europe 2020 flagships for smart, sustainable and inclusive growth
Strengthened EU economic governance
Macro-economic & fiscal surveillance
Regulation of financial services
Targets and guidance for structural reforms
Innovation Union
New Skills and new Jobs
Digital Agenda
Youth on the Move
New Industrial Policy
Platform against Poverty
ResourceEfficiency
7
5 EU objectives and 7 flagship initiatives
8
2013 CSRs on long-term care
• European Council issued CSRs on LTC to seven Member States (AT, BE, DE, FI, LU, NL, SI)
• CSRs based on fiscal sustainability considerations calling for improved cost-effectiveness
• 5 CSRs recommend stronger focus on prevention, rehabilitation and independent living
AT: The issue of the fiscal sustainability of the health care and long-term care system has to be addressed, also in view of the increasing need and demand for long-term care provision. (…) There is scope to enhance prevention, rehabilitation and independent living to contain future costs of long-term care.
BE: In long-term care, improved cost-efficiency of public spending on long-term care services and cost-saving measures of health prevention and rehabilitation, and for the creation of better conditions for independent living should be explored in the light of the relatively high cost of institutional care in Belgium.
Social Investment Package - functions
10
Three functions of social policies:
•Investing in human capital, strengthening people's current and future capacities
•Protecting against life's risks, ensuring adequate livelihoods and preserving previous investments in human capital
•Stabilising the economy by consumption smoothing, cushioning the impact of economic shocks
Social Investment Package - framework
11
1. Social investment throughout the individual's life
• Investing as early as needed to allow people to prevent disadvantage from compounding
• Investing throughout life to allow people to adapt to changing circumstances (Work/life reconciliation measures, Lifelong learning, Active ageing, Long term care (LTC))
2. Activating and enabling policies through targeted and more effective support
3. Increase the sustainability and adequacy of social systems through simplification of administration and delivery of services and benefits
Investing in Health
Commission Staff Working Document adopted on 20 February 2013 as part of the "Social Investment Package"
Key Messages:
extends the Health Strategy establishes the role of health as part of Europe 2020
health is a value in itself and also a growth-friendly type of expenditure
a healthy population and sustainable health systems are decisive for economic growth and social cohesion
12
Open Method of Coordination
Guarantee access for all to adequate long-term care and ensure that the need for care does not lead to poverty and financial dependency
Promote quality in LTC, notably by establishing quality standards
Ensure that adequate and high-quality LTC remains affordable and sustainable
Large diversity in supply of LTC in EU
• Informal care provided by family carers versus formal care in institutions or provided by home care services
• Formal care is organised by public, for-profit or NGO providers
• Financing from general taxation, obligatory insurance, private insurance or private spending
• Services in kind, allowances paid to the family carer or cash benefits for the recipient of the care
• Legal obligations on family members
Similar public budgets for social protection lead to very different outcomes
• Demography: tripling of people in age groups at particular risk of developing LTC needs
• LTC needs likely to rise dramatically over the next decades even if incidence of disablility reduces
• In its present organisation both informal & formal care provision will be overwhelmed
• Ressources will not increase = How to do better with less
Increasing gap in LTC
16
17
Immense differences: Expenditure in the base scenario, EU27, % of GDP
Source: Commission Services , EPC
How to close the gap?
• Reducing the incidence of frailty and disability through prevention and rehabilitation strategies
• Enabling elderly people to continue to live independently (adapted housing, use of ICT)
• Improving efficiency of care delivery through better care coordination, organisation and quality control
European Innovation Partnership on Active & Healthy Ageing
+2 HLY by 2020Triple win for Europe
Specific Actions
crosscutting, connecting & engaging stakeholdersstakeholders across sectors, from private & public sector
Implementation of the EIP on AHA actions
• national, regional and local level
• bottom-up approach
• creating critical mass and scale
• mobilisation of efforts, resources
• leveraging funding opportunities
• tangible outcomes – benefits for citizens, care systems and economy and society
•All 28 EU MSs
•Health providers in 271 commitments
•Public authorities from all levels in 170 commitments
•SMEs in 130 commitments
•Large industry in 79 commitments
2nd Invitation for commitments(310 Commitments)
1st Invitation for commitments(261 Commitments)
Examples of commitment/action
Prevention of functional decline & frailty
Commitment
•Developing, assessing and implementing technologies (built and ICT) infrastructure and related services that promote clients' abilities to live independently and self-manage
•Supporting healthcare professionals in the development and application of efficient and suitable care in or close to the home and the daily life context
CCTR-Centre for Care Technology ResearchInternationally accredited Innovative Medical Devices
Initiative in the Netherlands
A1. Prescriptions and adherence
to treatment
A2. Preventing falls
A3. Preventing functional decline
& frailty
B3. Integrated care incl. remote
monitoring
C2. Independent Living
D4. Age-friendly cities and
environments
Mapping of innovative practices
PracticalToolkits
More integrated, more efficient services
Implementation on large scale
provide input and expertise through an open collaboration
Commitments of the partners
Better professional cooperation: standards, guidelines
Preliminary achievements• mapping the good practices in the EU and beyond (over 300
examples)
• identification of benchmarks on physical and cognitive decline;
• testing of protocols on frailty in larger cohorts;
• improvement of screening methods for detecting early dementia;
• building of international networks for innovation and evidence
development;
• mapping the risk stratification tools for targeted care
• matrix of necessary ICT services for integrated care
• replication of best practices in new regions and scaling-up existing
innovative solutions for healthy ageing.
Region Skane
University Hospital Olomouc
City of Oulu
Coimbra
Southern Denmark
Collage (3)
Saxony
Ile-de-France Pays de la Loire
Lower-Rhine Council Languedoc-Roussillon
Liguria Campania
Friuli Venezia Giulia Emilia-Romagna
Piemonte
Northern NetherlandsTwente
Province of Gelderland and Overjssel
South Holland Province Noord-Brabant:
Slimmer Leven
GaliciaBasque Country
MadridCataloniaValencia
Andalusia
LiverpoolScotland
Northern Ireland Wales
Yorkshire
32 RSs =>12 MSs
selected for self-assessment and peer-review
(innovation, scalability, outcomes)
71 good practices of innovation-based integrated care models with sound impact on the ground
1 July 2013 – Star Ceremony
announcement of best RSs with stars, ready for replication and coaching
13 Reference Sites
12 Reference Sites
7 Reference Sites
Reference Sites - coverage
Concrete examples of innovative services
With proven added value to citizensand care systems in EU regions.
With evidence of contribution to growth and job creation in their settings
With evidence of transferability from local to regional or national level.
The first signs that such innovations meet the ambitions of the triple win of the EIP-AHA:-quality of life -sustainable care -economic growth
-HOW Guide to support scale up -published
Reference Sites –showcasing impact on the ground
develop policy on active & healthy ageing
Political added value of the EIP
EC: facilitator & supporter
align policy priorities with funding
support from the ground
mobilise efforts & resources
inspire for policy action
identify good practices working in real life
High level conferences (e-health, Gastein
Forum, Conference of Partners, Frailty
and Adherence Conferences, EUPHA-
polipharmacy)
Alignment of priorities in Horizon 2020,
CIP 2013, PHP 2013 etc.
Joint Action on Chronic Diseases and
Healthy Ageing (28 countries + 5
networks)
Reflection process of the MS: Towards
modern, responsive and sustainable
health systems
Funding
7th Framework Programme (FP7) Competitiveness and Innovation Framework Programme (CIP)
Public Health ProgrammeStructural
Funds(2007-2013)
(2014-2020)
•Good practices exchange•Clusters internationalisation
(2014-2020)
• INTERREG V• Possibility of co-investments• Possibility of 15% spent outside your
area• ESF – Targeted mobility schemes
TODAY
FUTURE
€ 446 million (2014-2020)
Health Programme
€ 9 billion (original proposal) for
Health, Demographic Change and Well Being
KIC - Innovation for healthy living and active ageing,
Societal Challenge 1-Health, Demographic Change & Wellbeing
Personalising Health and Care (PHC)•understanding of the causes and mechanisms of ageing/diseases;
•Improve monitoring health and to prevent, detect, treat and manage disease;
•support older persons to remain active and healthy;
•test and demonstrate new models and tools for health and care delivery.
Health Co-ordination (HCO)•1 dedicated support to the EIP on AHA (communication, identifying new priorities, improved framework)
Other Activities (not in the Work programme)Innovative Medicines Initiative, the European and Developing Countries Clinical Trials Partnership (EDCTP), and the Active and Assisted Living Programme.
http://ec.europa.eu/programmes/horizon2020/en/h2020-section/health-demographic-change-and-wellbeing
Horizon 2020 – 1st Work Programme 2014-15
WP '1
4/'1
5: €
1,2
000 m
Health Programme 2014-2020
• 3rd Union action programme in the field of health 2014-2020
EUR 449,4 million
Links:
Reference Site guidehttps://webgate.ec.europa.eu/eipaha/library/index/show/id/688
Action group flyerhttp://ec.europa.eu/research/innovation-union/pdf/active-healthy-ageing/achievements_2013.pdf
Planned SPC report on LTC
� How to define adequate social protection against the risk of dependency in old age?
� How to fill the data gap (MISSOC, OECD, ESTAT)
� Discuss the potential costs of meeting/not meeting needs for a better social protection
� Discuss various ways for closing the gap between care needs and supply
� Identify priorities for the exchange of experiences and mutual learning
� Identify priorities for EU policies
� Present country fiches
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Joint Reports EC/OECD
Thank you for your attention!