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Organization and Financing of Public Health Services in Europe

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Organization and Financing of Public Health Services in Europe 50 How are public health services in Europe organized and financed? With European health ORGANIZATION AND FINANCING OF PUBLIC HEALTH SERVICES IN EUROPE SERVICES PUBLIC HEALTH AND FINANCING OF ORGANIZATION systems facing a plethora of challenges that can be addressed through public health interven- Nolte Ellen McKee, Martin Jakubowski, Elke Rechel, Bernd by: Edited Organization and 50 tions, there is renewed interest in strengthening public health services. Yet, there are enormous gaps in our knowledge. How many people work in public health? How much money is spent on public health? What does it actually achieve? None of these questions can be answered easily. financing of public Series This volume brings together current knowledge on the organization and financing of public health services in Europe. It is based on country reports on the organization and financing of public health services in nine European countries and an in-depth analysis of the involvement of public health services in addressing three contemporary public health challenges (alcohol, health services Health Policy obesity and antimicrobial resistance). The focus is on four core dimensions of public health services: organization, financing, the public health workforce, and quality assurance. The questions the volume seeks to answer are: in Europe • How are public health services in Europe organized? Are there good practices that can be emulated? What policy options are available? • How much is spent on public health services? Where do resources come from? And what Edited by: was the impact of the economic crisis? Bernd Rechel • What do we know about the public health workforce? How can it be strengthened? Elke Jakubowski • How is the quality of public health services being assured? What should quality assurance Martin McKee systems for public health services look like? Ellen Nolte This study is the result of close collaboration between the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe, Division of Health Systems and Public Health. It accompanies two other Observatory publications: Organization and financing of public health services in Europe: country reports and The role of public health organizations in addressing public health problems in Europe: the case of obesity, alcohol and antimicrobial resistance. The editors Bernd Rechel is Research Officer at the European Observatory on Health Systems and Policies, based at the London School of Hygiene & Tropical Medicine. Elke Jakubowski is Senior Advisor for Policy and Strategy at the Division of Health Systems and Public Health for the WHO Regional Office for Europe, based in Copenhagen. Martin McKee is Professor of European Public Health at the London School of Hygiene & Tropical Medicine and Research Director at the European Observatory on Health Systems and Policies. Ellen Nolte is Professor of Health Services and Systems Research and was previously hub coordinator for the London hubs of the European Observatory on Health Systems and Policies. Health Policy Series No. 50 www.healthobservatory.eu Organization and financing of public health services in Europe The European Observatory on Health Systems and Policies supports and promotes evidence- based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy issues. The European Observatory on Health Systems and Policies is a partnership between the WHO Regional Office for Europe; the Governments of Austria, Belgium, Finland, Ireland, Norway, Slovenia, Sweden, Switzerland, the United Kingdom and the Veneto Region of Italy; the European Commission; the World Bank; UNCAM (French National Union of Health Insurance Funds); the London School of Economics and Political Science; and the London School of Hygiene & Tropical Medicine. The Observatory has a secretariat in Brussels and it has hubs in London (at LSE and LSHTM) and at the Berlin University of Technology. Organization and financing of public health services in Europe Edited by Bernd Rechel Elke Jakubowski Martin McKee Ellen Nolte European on Health Systems and Policies a partnership hosted by WHO iv Organization and financing of public health services in Europe Keywords: PUBLIC HEALTH PUBLIC HEALTH ADMINISTRATION, HEALTHCARE FINANCING INSURANCE, HEALTH HEALTH SERVICES ADMINISTRATION HEALTH SERVICES ACCESSIBILITY EUROPE © World Health Organization 2018 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies) All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Address requests about publications to: Publications, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark. Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the European Observatory on Health Systems and Policies to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the European Observatory on Health Systems and Policies be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the European Observatory on Health Systems and Policies or any of its partners. ISBN 978 92 890 5172 9 Printed in the United Kingdom Cover design by M2M Contents List of figures, tables and boxes vii List of contributors xi Acknowledgements xiii Chapter 1 Introduction 1 Bernd Rechel, Elke Jakubowski, Martin McKee, Ellen Nolte Chapter 2 Conceptual framework 9 Bernd Rechel, Elke Jakubowski, Martin McKee, Ellen Nolte Chapter 3 Organization of public health services 17 Elke Jakubowski, Hans Kluge, Bernd Rechel Chapter 4 Financing of public health services 59 Bernd Rechel Chapter 5 The public health workforce 95 Robert Otok, Erica Richardson, Katarzyna Czabanowska, John Middleton Chapter 6 Assuring the quality of public health services 113 Gemma Williams, Ellen Nolte Chapter 7 Key policy lessons 147 Bernd Rechel, Elke Jakubowski, Martin McKee, Ellen Nolte List of figures, tables and boxes Figures Fig. 2.1 The 10 essential public health operations 11 Fig. 2.2 A public health system 12 Fig. 3.1 Principle vertical forms of institutions providing public health services 29 Fig. 4.1 Typology of financing for public health services 60 Fig. 4.2 Spending on public health as percentage of regional expenditure on health in Italy, 2014 66 Fig. 4.3 Share of financing for public health as percentage of current health expenditure, 2009 and 2014 67 Fig. 4.4 Expenditure for prevention in the Netherlands, 2005–2013 70 Fig. 4.5 Public sources as percentage of expenditure on preventive care, 2015 77 Tables Table 3.1 Main types of institutions coordinating and providing public health services 21 Table 3.2 Features of national public health institutions in selected European countries 30 Table 3.3 Organizational features of local public health institutions in selected European countries 34 Table 3.4 Selected public health laws and their implications for organizational reforms 48 Table 4.1 Information in the WHO Global Health Expenditure, Eurostat and OECD databases as of January 2018 62 Table 4.2 Lowest and highest expenditure on public health in the European countries covered in the WHO Global Health Expenditure, Eurostat and OECD databases 62 Table 4.3 Data sources for OECD Health Statistics, 2017 65 viii Organization and financing of public health services in Europe Table 4.4 Spending on “institutional prevention” in France, by type of prevention, 2014 72 Table 4.5 Estimated budget for public health in the Netherlands, 2015 73 Table 4.6 Public health services budget in the Republic of Moldova by operational expenditure, 2013 and 2014 73 Table 4.7 Providers of preventive care as percentage of total spending on preventive care 74 Table 4.8 Expenditure on preventive care by financing scheme, in percentage, European OECD member states, 2015 78 Table 6.1 Key actors involved in quality assurance of public health services in nine European countries 119 Boxes Box 1.1 Key questions this volume seeks to address 3 Box 1.2
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