POLICIES THAT MIGHT IMPROVE THE SUSTAINABILITY OF HEALTH SYSTEM

Policies that can help to sustain and improve health system performance, maintaining access and quality and improving cost-effectiveness :

1. Effectively, efficiently and equitably invest in Public Health, based on the concept of Health in all Policies, at national and EU level (TFEU). There is extensive evidence on the cost-effectiveness of many (although not all) types of prevention, often leading to savings in cost of treatment or long-term care. Knowing that there are effective public health interventions that can avoid unnecessary illness and pain, these interventions should feature prominently in health policies. Investments in national health strategies that achieve public health goals are an important means of promoting sustainability of health systems.
2. Link levels of public spending to population health needs. Each country should ensure that there are adequate resources to guarantee the right to health, taking account of the principle of progressive realisation according to the national economic context. Health Systems should offer access to high quality, safety and cost-effective interventions to address health needs.
3. Control growth in care expenditure. As resources are limited, cost-effectiveness in the use of available resources is essential.
4. Adopt quality improvement as a driving force for change. Doing things right first time is cost-effective
5. Better health system governance. Develop appropriate governance structures, with an appropriate balance between centralization and decentralization of functions (consistent with the national political context). Ensure that operational information systems and arrangements for accountability align with organisational structures. Develop mechanisms to disseminate good practices within the health system. Stimulate communication and other interchanges between policy makers at regional and national level.
6. Encourage the provision of and access to effective primary health care services. Primary care, adequately funded, can address the majority of health problems affecting patients and populations. Investing effectively, efficiently and equitably in Primary Care is highly cost-effective, especially when based on well-equipped multidisciplinary Primary Care centres
7. Invest in integration of services: primary care, hospital care, home care and social services (funding, insurance, provision, processes, information channels). Development of e-health/m-health where this can be shown to be cost-effective.
8. Policies to increase the cost-effective use of medicines. Identify more efficient ways to fund R&D, linked to lower prices of new medicines. Increase the use of generics and biosimilars. Improve public / joint procurement. Encourage rational prescribing and dispensing of medicines, medical products and diagnostic tests. Avoid over-medicalization.
9. Actively manage investment in facilities, infrastructure and equipment. Reduce fragmentation, with hospitals and other facilities organised in networks.
10. Continually assess the benefit package, linked to health technology assessment (including medicines) as a basis for reimbursement decisions. Ensure that the publicly financed benefits package covers the full spectrum of essential services, reflecting population health needs in an equitable fashion. Put in place systematic priority-setting processed to support decisions about coverage of both new and existing technologies in ways that are HTA-informed and cost-effective
11. Reduce unnecessary use of health care services. The wide variations in use of medicines, hospital admissions, diagnostic procedures, etc., between and within EU countries suggest possibilities for improvement.
12.  Improve mechanisms to raise revenue: including action on tax havens; combating tax fraud; and minimising tax evasion and avoidance. Ensure that taxation systems are progressive.
13.  Reduce / eliminate informal payments. Guarantee an adequate system of remuneration, so as to ensure appropriate motivation of health personnel.
14.  Shift care from inpatient to day-case or ambulatory care. Encourage home care and care at the workplace (when appropriate), using e-health, m-health, and task shifting where this can be shown cost-effective
15. Adequate training and support to deliver services in line with evidence. Active and engaged patients / citizens should stimulate a new vision of partnership and shared decision-making with health workers
16. Improve motivation and working conditions of health personnel. The key element to improve efficiency and quality is high quality performance of health personnel. In this complex, personalized service, where more than 50% of total expenditure corresponds to remuneration of personnel (personnel intensive), adequate personnel policies are essential. This requires a shared vision, with attractive working conditions, effective participation, continuing professional development, and adequate support.
17. Develop and support self-management of health conditions. The role of engaged patients / citizens can be facilitated and reinforced with appropriately structured information and training programmes. There is a need for adequate support by the health team (at home, in schools and the workplace, etc.), coordinating their efforts with other networks (social, education, etc.), making effective use of m-health and e-health tools.
18. Improve health system performance assessment. A basic step to improve efficiency and sustainability of health systems is to know what is happening. Evaluate the impact of measures being adopted. Implement systems that generate the knowledge needed to reorient policies in the appropriate direction. Support countries to identify actionable indicators for performance assessment and support to interpret the results of monitoring.