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Notes for PHA Europe meeting 5th December 2001
Notes for PHA Europe meeting 5th December 2001
from Gilles de Wildt.
Themes: Health for all, including equitable access to preventative and curative services in Europe, participation, privatisation and governance; global solidarity.
Aims:
To build more effective national and international advocacy campaigns, aimed at the general public, media, decisions makers, groups and individuals, lay persons, professionals and researchers interested in health care,
with a view to promoting equity in health, the involvement and participation of the public in the development and implementation of policies, accountability and transparency.
Methods and activities:
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sharing information from different countries on privatisations and responses to it:
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identifying and approaching actors at national, EU and other international level;
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exploring issues of governance and human rights, especially socio-economic human rights in the field of health and health care;
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Exploring the myths and realities of privatisation in health care with a view to informing the public and decision makers and calling for reforms which are based on evidence, and not on implicit ideologies.
Issues may be explored in groups each consisting of persons representing a cross-section of countries and backgrounds (for example advocacy NGO's; clinical/non clinical (including research-based) health professionals; interested others.
Working groups may be formed during the meetings; and continue by email thereafter. They may propose action plans.
Possible issues:
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Health services are under pressure in Europe, from both underresourcing (as in the UK and in the Netherlands) and for-profit-privatisation
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Under-resourcing in the UK and the Netherlands shows by shortages of staff at all levels, and long waiting lists. Shortages are worsened by unfilled vacancies as a result of lack of available professionals (e.g. doctors) and by low wages combined with high cost of living. The latter situation encourages nurses and other health care workers to opt for better-paid jobs.
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In the Netherlands, health insurers state that they want to make a profit and have social responsibilities. Budgets of insurers for marketing and public relations, and remunerations for executives have soared, while performance in terms of obtaining care for patients has worsened dramatically. This includes the most vulnerable such as the elderly. The experiment to let the market provide better quality of care with help of the profit motive has failed and should be ended.
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In the UK, the government approach to long waiting lists in the National Health Service (NHS) is to contract out part of health care to private providers. This is in spite of evidence that the NHS, overall, is a highly cost-effective institution (even beating, in terms of cost-efficiency, the for-profit sector in providing private medical care), and able to speedily deliver additional or new services, if properly resourced.
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In the UK, the government approach to renewing outdated infrastructure is to hand over the construction or renovation of buildings and services to for-profit providers on financial terms which are extremely advantageous for the providers, and, in the long term, extremely disadvantageous for the public. These "Private Finance Initiatives" are a way of quickly raising large sums of money, without these moneys appearing in the columns of the national borrowing deficit. However, they effectively mortgage our children and lock otherwise potentially flexible health services into narrow frameworks, which are oriented towards profit and administration. Governments should 1) be upfront about their motives; 2) base their policy proposals on evidence and 3) allow the public thorough scrutiny of the pros and cons and of such schemes.
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There will be examples from other countries.
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In most countries in Europe, people have shown more interest in health and health care. This includes a willingness to be engaged in deciding about healthy living conditions and about priorities in health care. Health care has gained political importance over the last decade. The Alma Ata principles of health for all remain utterly relevant. Participation, and organised efforts of society to improve health and health care are essential.
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In health services in many countries, health professionals pride themselves on carrying out a social function and not working for the sake of gaining maximum income. They often have a strong sense of "ownership". This ethos is essential to make the Alma Ata principles work, and to deliver good-quality care, which involves patients and communities. Private companies, with their bureaucracies geared towards marketing, public relations and the profit motive, will undermine this ethos and worsen quality of prevention and care. Evidence shows that for profit-privatisation in health care leads to increasing costs, reduced access for the lower socio-economic strata and reduced accountability.
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Actors in the European Health Policy Arena include governments, elected representatives, community and patient groups, established and new financial and business interests. Important actors are management and other consultants, whose firms often act for both governments and for-profit interests. Recently called the "Sixth Force" in the Netherlands, they may allow governments and businesses to promote and implement activities without proper accountability. Their actions should become more transparent and be subjected to codes of conduct and legislation and to public and parliamentary scrutiny.
Possible responses by PHA:
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Demand more openness and public debate about health care reform
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Demand assessments of proposed policies in the field of health and health care in terms of:
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cost effectiveness in the short, medium and long term;
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potential to improve equity, including the potential to deliver preventative and curative care to those who need it most;
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potential to involve communities;
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potential to effectively and quickly respond to changing health conditions
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Most governments and the EU have already stated that they want health impact assessments before implementing policies. This obviously needs strengthening and should, of course, include effects of potential privatisations.
Note on drug pricing policies
PHA Europe may want to become involved in drug pricing policies (or encourage others, e.g. members of parliaments or other NGOs to do so) as a way of stimulating public debate about:
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setting priorities in health care and examining the values and assumptions used in cost-effectiveness analyses;
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reducing prices of drugs to allow more people to receive effective treatment or receive other health care, on a national and on a global scale.
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relationships between governments, international organisations, NGOs, and the private sector including the pharmaceutical industry, taking into account the European Common Market, WTO and TRIPS, as well as socio-economic human rights in the field of health and health care.
Example: Current developments in the EU need to be monitored. In theory, drug prices should go down in a common, free market. In practice, there are a number of obstacles. For example, it is observed that drug companies withdraw patented drugs at short notice some months before the patent runs out, while promoting alternative patented drugs. This destabilises medication patterns and blocks a smooth transition as could be achieved by generic prescribing. PHA could insist that this be monitored and call for regulatory frameworks which allow generic suppliers to jump in instantly when patented drugs are withdrawn in this way.
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