HEALTH POLICIES IN THE EUROPEAN UNION

Prof. Dr. Zafer Öztek

MEMBER STATES of EU ( 25 states )

• Germany • France• Italy• Belgium • Holland • Luxembourg• United Kingdom• Ireland• Denmark• Greece• Spain• Portugal• Sweden

• Austria• Finland• Hungary• Litvania• Cyprus• Check Rep.• Poland• Malta • Slovakia• Slovenia• Estonia• Leetonia

ORGANS of the EU

1. Main Organsa. The European Councilb. Council of Ministersc. Commissiond. European Parliament e. Court of Justice f. European Court of Auditors

2. Advisory Organs a. Economic and Social Committee b. Committee of the Regions

3. Other Organsa. European Investment Bank b. Institutions for monitory unity

Decision Procedures in the EU(The Institutional Triangle)

• Political decisions are taken in between three organ :CommissionThe ParliamentCouncil of Ministers

• Commission : Recommends the policies and laws; The Parliament and/or the Counsel of Ministers decide. The Commissions are independent and inform the Parliament and explain the justification of their recommendations.

• Parliament : Consists of 625 members selected by the citizens of EU states. The states are represented by their size of populations. It prepares the budget; supervises the commissions and the Counsel of Ministers; Appoints and remove the members of commissions; approves the conventions and new members states.

• Council of Ministers : It is the executive organ. Consists of the Foreign Ministers of the member states.

Advisory Organs of the EU

1- ECONOMIC AND SOCIAL COMMITTEE

- Consists of representatives of economic and social groups such as labors, employers, farmers, independent business workers.

- The Community consults the Committees before deciding on regulations.

2- COMMITTEE OF THE REGIONS

- The Community consults this committee for subjects which impacts the regional benefits such as education, youth, culture, public health, energy, telecommunication.

Other Organs of the EU

1- EUROPEAN INVESTMENT BANK

- It is a non-profit bank financed by the member states.

- Finances the policies and projects of the EU.

2- CENTRAL BANK OF EUROPE - It realizes the financial policies of the EU.

GENERAL DIRECTORATES OF THE EUROPEAN UNION

AGRICULTURE DG

COMPETITION DG

ECONOMIC AND FINANCIAL AFFAIRS DG

EDUCATION AND CULTURE DG

EMPLOYMENT AND SOCIAL AFFAIRS DG

ENERGY AND TRANSPORT DG

ENTERPRISE DG

ENVIRONMENT DG

FISHERIES DG

HEALTH AND CONSUMER PROTECTION DG

INFORMATION SOCIETY

INTERNATIONAL MARKET

JOINT RESEACH CENTRE

JUSTICE AND HOME AFFAIRS

REGIONAL POLICY

RESEACH

TAXATION AND CUSTOMS UNION

Tasks of the General Directorates of Health and Consumer Protection

• Consumer relations

• Public health and risk assessment

• Animal husbandry

• Food chain and safety

• Food and veterinary affairs

HEALTH INSTITUTIONS of the EU

• European Environment Agency (EEA)• European Monitoring Center for Drugs and Drugs

Addiction (EMCDDA)• European Agency for the Evaluation of Medicinal

Products (EMEA)• European Agency for Safety and Health at Work

(EU-OSHA) European Food Safety Authority (EFSA)

• European Centre for Disease Prevention and Control (ECDC)

Health Policies are Decided in Three Ways in EU

1. Direct way (Deciding regulations with the cooperation of member states – e.g. Tobacco control )

2. Indirect way (Deciding on common standards – e.g. Pharmaceutical policies)

3. Unwillingly (Impact of other policies on health – e.g. Agriculturetural policies)

HEALTH POLICIES in EU

• There is no standard health policy in all member states.

• Health policies and implementations are peculiar to individual countries.

• EU complements the efforts of member states and add value to their actions in reaching higher levels of health status.

HEALTH PRINCIPLES of the EU

• Equity• Availability• Solidarity• Social security• Sustainability• Priority for prevention• Use of general practitioners• Referral system• Continuous improvement of quality• Right to chose physician and patient• Prevention of premature deaths• Prevention of communicable diseases• Solving health problems of the elderly• Prevention and promotion of environmental quality• Improvement in the safety and health of workers at work• Enabling the consumers to reach health information

Problems of Health Care Systems

• Cost – National health expenditures are increasing. E.g.. Italia (1977, 5.7 % – 1997, 7.4 %)

• Demographic Changes – By the year 2020, the percentage of the population over 75 years will increase by 40 % according to 1990 figures. Increase of dependency ratio will lead an increase in health budgets.

• Medical Technologies – Sustainability and rational use of technology is a problem.

• Satisfaction of the communities – Satisfaction of the consumer is becoming more difficult gradually.

Status of Physicians in EU

• EU, released the barriers and enabled the traveling of people within member countries in 7 Mart 2002.

• This will effect the medical market which is already saturated negatively.

• Medical unemployment is a growing problem in the member EU countries.

Unemployment Among Physicians

• Concentration in urban (Especially gynecologists, orthopedists, general surgeons)

• Lack of primary care physicians in the urban• Physicians do not prefer to work in the islands, mountainous

and poor regions• According to WHO the physician/population ratio in the

European Region is 1/500. [2002 – Italia (1/176); Norway (1/212); Greece (1/242); UK (1/610); 2004 – Turkey (1/735)]

• Medical unemployment – (Switzerland %5, Spain %5-10, Sweden %4)

Common Programs Before 2003 in EU

• Public Health Framework (2001-2006)

• Cancer Control Programme (1996-2000)

• Prevention and Control of AIDS and Communicable Diseases (1996-2000)

• Programme for Controling Narcotics (1996-2000)

• Control of Diseases Due to Pollution (1999-2001)

• Prevention of Injuries (1999-2003)

• Surveillance of Health Status (1997-2001)

PROGRAMME OF COMMUNITY ACTION IN

THE FIELD OF PUBLIC HEALTH

• In 2002, EU merged all health related programmes as “Programme of Community Action in the Field of Public Health”

• First Programme of Community Action in the Field of Public Health covers the term of 2003-2008

• Turkey was included in this programme in 27 November 2002.

2003 -2008 Programme of Community Action in

the Field of Public Health Programme focuses on three priority areas :

• Health Information System

• Rapid reactions to health treats (especially infectious diseases)

• Health promotion

The total budget of the

“European Programme of Community Action in the Field of Public Health”

was 61.460.411 Euro for the year 2005.

“European Programme of Community Action in the Field of Public Health” (2003-2008)

• Project proposals are evaluated and rated according to the following criteria :

– 1. Technical content– 2. Methodology– 3. Relevance of proposed budget– 4. Accretion value to EU– 5. Visibility in the EU

– Proposals which get less then 50 % of the scores from one or more of the above criteria are rejected.

NATIONAL PROGRAMME FOR REVISING REGULATIONS ACCORDING TO EU NORMSin TURKEY

The health related topics stated in the National Programme refers to a road map for adapting the Turkish regulations to the EU norms.

NATIONAL PROGRAMME FOR REVISING REGULATIONS ACCORDING TO EU NORMSin TURKEY

• Health related topics stated in the National Programme* Free movement of goods

* Free movement of person

* Statistics

* Social policies and accommodation

* Environment

* Consumer protection and Health

* Customs Union

Topics

• Free movement of goods

The activities are gathered under 7 headings

a. Food

b. Detergents

c. Psychotropic drugs

d. Medical goods

e. Cosmetics

f. Toys

g.Medical equipments

Topics

• Free movement of person – Physicians and other health personnel– According toe the general norms of EU physicians in a

member state can also have the right to practice in other member countries. Therefore, the medical training in member states should be standard. However, there are serious differences between member states regarding medical education.

– Due to these differences, some member countries give special tests to foreign physicians before licensing ( PLAB test in the UK, DIKATSA in Greece)

Topics

• Statistics

1-Formulation of health indicators

2-Formation of a network between member states for sharing health information

3-Use of common health indicators

Life expectancy at several life periods

Deaths related with smoking

Standardized death rates in 0-65 years…

Topics

• Social policies and accommodation

a. Health and safety of workers

b. Public health (programme)

Topics

• Environment

The activities regarding environment are carried out according to the following headings in the National Program :

1- Water quality2- Air quality3- Community prevention 4- Noise caused by machines and other equipments5- Chemicals and genetically modified organisms6- Waste management7- Control of industrial pollution and risk assessment8- Nuclear safety 9- Good laboratory practice

Topics

• Consumer protection and health Scientific committees will be established. Main committees will be on :

FoodCosmetics Goods other than foodMedical supplies and equipmentsToxicologyEnvironment

Topics

• International Customs Unity (Medical goods)

Tissue typing agents

Humoral threupatic agents

Blood typing agents

Medical, surgical and laboratory equipments

Selected Health Indicators -1

Indicators EU TRHealth expenditure- Percent in National budget 10-14 3.18

Health expenditure per person (US $) 693-3036 202

Percent of health investments in total investments

10+ 3,5

Person per physician 244-667 797

Person per health professional 160-990 1010

Hospital beds per 10.000 people 42-83 25,7

Access to safe water (% of population) 90+ 69

SELECTED HEALTH INDICATORS - 2

Indicator EU TR

Infant mortality rate (Per thousand live births) 5-9 28.8

Maternal mortality rate (Per 100.00 live births) 7-15 80

Life expectancy at birth (years) 75-79 70.3

Crude birth rate (Per thousand) 9-13 19.9

Increase rate (Per thousand) 1-6 13.3

Thank You