Universal Health Coverage in Europe Not Quite There!! Making the Economic Case for Health Inclusion and Equity
Universal Health Coverage in Europe; not quite there yet! Making the economic case for health inclusion and equity European Public Health Conference 2018 Ljubljana, Slovenia, 1 December 2018 Prof. Rifat Atun MBBS MBA DIC FRCGP FFPH FRCP Professor of Global Health Systems Harvard University Prof. Rifat Atun, Harvard University, 2018 2
1. The Challenge 2. The Opportunity 3. The Transformation Prof. Rifat Atun, Harvard University, 2018 3
Widening inequalities: a global phenomenon challenging the social contract in Europe Prof. Rifat Atun, Harvard University, 2018 4
Prof. Rifat Atun, Harvard University, 2018 5
Gini coefficient of disposable income inequality in 2014 (or latest year) and mid- 1980s when available, total population Prof. Rifat Atun, Harvard University, 2018 6
Access to care vary substantially between countries and income groups Self-reported unmet needs for medical care due to costs, distance to travel or waiting times Source: Eurostat Database, based on EU-SILC (data refer to 2015). Country Health Profiles, EC, OECD, European Observatory 2017 Estonia Greece Romania Latvia Poland Italy Bulgaria Finland EU28 Portugal Lithuania Ireland United Kingdom Hungary Belgium Slovak Republic Croatia Cyprus Denmark France Sweden Luxembourg Czech Republic Malta Spain Germany Netherlands Slovenia Austria
Trends in all-cause mortality by education: Europe,1980-2014 Prof. Rifat Atun, Harvard University, 2018 Mackenbach et al PNAS 2018 8
Life expectancy at birth in UK by decile of deprivation and sex in 2001 and 2016 Bennett et al Lancet Public Healthn2018 Prof. Rifat Atun, Harvard University, 2018 9
1. The Challenge 2. The Opportunity 3. The Transformation Prof. Rifat Atun, Harvard University, 2018 10
Fighting inequalities in Europe 1 Inclusion 2 Investment Tallinn Conference 2018 3 Innovation 11
Inclusion Reducing inequalities by addressing social determinants and effective UHC Prof. Rifat Atun, Harvard University, 2018 12
UHC: leaving no one behind Effectiveness Equity Value for money Value for many Efficiency Responsiveness Prof. Rifat Atun, Harvard University, 2018 13
UHC has a protective function even in economic downturns
Prof. Rifat Atun, Harvard University, 2016 15
Investments are not happening in the right domains Average annual per capita real growth rates for health expenditure components, 2005-2013 (OECD) 6% 2005-09 2009-13 5.8% 5.6% 3.9% 3.8% 3% 2.4% 1.8% 2.8% 1.9% 0.7% 0.9% 0% -3% -1.9% -0.6% Inpatient Outpatient Long-term care Pharmaceuticals Prevention Administration Source: FOCUS on Health Spending @ OECD Health Statistics 2015 Prof. Rifat Atun, Harvard University, 2018 16
Investment: new narrative and a case for investing in health for economic growth and sustainable development Good health Less illness and premature death Sustainable development Healthier and greater human capital Economic growth Higher productivity, and less work absence Prof. Rifat Atun, Harvard University, 2018 Atun, Kaberuka et al 2017 17
Health systems and the Innovation paradox Scientific developments have spurred unprecedented delivery of innovations for new medicines and medical devices, but innovation in delivery has faltered Prof. Rifat Atun, Harvard University, 2018 18
The innovation paradox: consequences 19
1. The Challenge 2. The Opportunity 3. The Transformation Prof. Rifat Atun, Harvard University, 2018 20
Redesigning public health and health systems Organizational design 1 Multisectoral action Integrated networks Financing 2 Integrated financing Service delivery 3 Targeted demand- and supply-side solutions 21
A new public health and a new narrative Investment and innovation for inclusive growth and sustainable development in Europe 1 Inclusion 2 Investment 3 Innovation 22
Universal Health Coverage in Europe Not Quite There!! Making the Economic Case for Health Inclusion and Equity
The situation in Member States Source: Pixabay.com
Any question or comment for the panel? www.healthobservatory.eu 25