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Health System Snapshots: Perspectives from Six Countries Eurohealth RESEARCH • DEBATE • POLICY • NEWS Volume 14 Number 1, 2008 Health system snapshots: perspectives from six countries Prospects for a new golden era in vaccines? Access to research data Supporting and using publicly orientated health research Irish private health insurance market • Pharmaceutical policy in Central and Eastern Europe Diabetes risk • Lives saved vs life years saved • Pharmaceutical sector governance Knowledge: our most precious Eurohealth commodity LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom C We hear a lot about the soaring price of commodities fax: +44 (0)20 7955 6090 www.lse.ac.uk/LSEHealth such as oil and gas. The global energy crisis will not be resolved through further exploration for fossil fuels. Editorial Team Instead, that most precious of commodities, EDITOR: knowledge, can help find innovative ways of David McDaid: +44 (0)20 7955 6381 email: [email protected] harnessing new sources of energy. O FOUNDING EDITOR: Elias Mossialos: +44 (0)20 7955 7564 Knowledge is also priceless for health policy. email: [email protected] Intelligence on the state of health systems is vital, yet DEPUTY EDITORS: it can be difficult to keep up with the rapid pace of Sherry Merkur: +44 (0)20 7955 6194 email: [email protected] change. In this issue of Eurohealth we include Philipa Mladovsky: +44 (0)20 7955 7298 M email: [email protected] snapshots on six countries. Originally commissioned and funded by the New York based Commonwealth EDITORIAL BOARD: Reinhard Busse, Josep Figueras, Walter Holland, Fund, and prepared in a common format, they provide Julian Le Grand, Martin McKee, Elias Mossialos an opportunity to reflect on approaches to efficiency SENIOR EDITORIAL ADVISER: and quality improvement. Paul Belcher: +44 (0)7970 098 940 M email: [email protected] We are also delighted to include a contribution from DESIGN EDITOR: Sarah Moncrieff: +44 (0)20 7834 3444 historian Louis Galambos, who highlights challenges email: [email protected] for the global vaccine industry and how these parallel SUBSCRIPTIONS MANAGER past events. In an economic downturn, cost pressures Champa Heidbrink: +44 (0)20 7955 6840 may first be felt in areas viewed as low priorities. All email: [email protected] E too often public health research can suffer. As well as Advisory Board the potential lost health benefits, the economic Anders Anell; Rita Baeten; Nick Boyd; Johan Calltorp; consequences of reduced investment into vaccine Antonio Correia de Campos; Mia Defever; Nick Fahy; Giovanni Fattore; Armin Fidler; Unto Häkkinen; Maria research and development may be substantial: Europe Höfmarcher; David Hunter; Egon Jonsson; Meri Koivusalo; currently produces around 90% of the world’s Allan Krasnik; John Lavis; Kevin McCarthy; Nata Menabde; Bernard Merkel; Stipe Oreskovic; Josef Probst; N vaccines. Professor Galambos argues that we should Tessa Richards; Richard Saltman; Igor Sheiman; Aris focus on the long-term benefits of vaccines to society, Sissouras; Hans Stein; Jeffrey L Sturchio; Ken Thorpe; Miriam Wiley rather than just being mindful of short-term budgetary requirements. Article Submission Guidelines see: www.lse.ac.uk/collections/LSEHealth/documents/ We also feature two articles looking at how knowledge eurohealth.htm can better inform policy making. Hans Stein looks at Published by LSE Health and the European Observatory T on Health Systems and Policies, with the financial support the role of international organisations in public health of Merck & Co and the European Observatory on Health research across the EU. He calls for more emphasis on Systems and Policies. ensuring that research is feasible, policy relevant and Eurohealth is a quarterly publication that provides a forum for researchers, experts and policymakers to express their linked to the policy making process. Philipa views on health policy issues and so contribute to a Mladovsky and colleagues, meantime, argue that we constructive debate on health policy in Europe. are losing an opportunity to make use of much The views expressed in Eurohealth are those of the authors alone and not necessarily those of LSE Health, Merck & Co existing knowledge. The European Commission, they or the European Observatory on Health Systems and contend, should adopt measures to promote much Policies. more open access to data collected within Research The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Framework projects. Again, secondary analyses of Regional Office for Europe, the Governments of Belgium, such data could prove invaluable in generating new Finland, Greece, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the knowledge that might be used in countering the global Open Society Institute, the World Bank, the London School health crisis. of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. David McDaid Editor © LSE Health 2008. No part of this publication may be copied, reproduced, stored in a retrieval system or transmitted Sherry Merkur Deputy Editor in any form without prior permission from LSE Health. Philipa Mladovsky Deputy Editor Design and Production: Westminster European email: [email protected] Printing: Optichrome Ltd ISSN 1356-1030 Contents Eurohealth Volume 14 Number 1 European Snapshots Anders Anell is Professor, Institute of Economic Research, School of Economics 1 The health system in England and Management, Lund University, Sweden. Seán Boyle Seán Boyle is Senior Research Fellow, LSE 3 The health system in France Health, London School of Economics and Isabelle Durand-Zaleski Political Science, UK. 5 The health system in Germany Reinhard Busse is Professor of Health Care Reinhard Busse Management, Technical University Berlin, Germany. 7 The health system in Denmark Karsten Vrangbæk Isabelle Durand-Zaleski is Professor of Medicine, University de Paris XII, France. 8 The health system in the Netherlands Armin Fidler is Health Sector Manager, Niek Klazinga Europe and Central Asia Region, The World Bank, Washington DC, USA. 10 The health system in Sweden Anders Anell Louis Galambos is Professor of History, Department of History and the Institute for Applied Economics and the Study of Public Health Perspectives Business Enterprise, Johns Hopkins University, USA. 12 What are the prospects for a new golden era in vaccines? Louis Galambos Niek Klazinga is Professor of Social Medicine, Academic Medical Centre, 15 Access to research data in Europe University of Amsterdam, the Netherlands. Philipa Mladovsky, Elias Mossialos and Martin McKee Martin McKee is Professor of European 18 Supporting and using policy-oriented public health research at Public Health, London School of Hygiene & the European level Tropical Medicine, UK. Hans Stein Philipa Mladovsky is Research Officer, LSE Health and European Observatory on Health Systems and Policies, London School Health Policy Developments of Economics and Political Science, UK 23 Celtic Tiger, Health Care Dragon: Fiery debates in the Irish Elias Mossialos is Director and Professor of private health insurance market Health Policy, LSE Health and European Brian Turner Observatory on Health Systems and Policies, London School of Economics and 25 Governance in the pharmaceutical sector Political Science, UK. Armin Fidler and Wezi Msisha Wezi Msisha is Health Specialist, Europe 30 Pharmaceutical policy challenges in Central and Eastern Europe and Central Asia Region, The World Bank, Andreas Seiter Washington DC, USA. Andreas Seiter is Senior Health Specialist, Evidence-informed Decision Making The World Bank, Washington DC, USA. 33 “Bandolier” Moderate activity reduces diabetes risk Hans Stein is based at the European Public Health Centre North Rhine-Westfalia, 34 “Risk in Perspective” Valuing "lives saved" vs. "life-years saved" Germany. Brian Turner was formerly Head of Research/Technical Services at the Health Monitor Insurance Authority and is currently a part- time lecturer and full-time PhD student at the 38 Publications Department of Economics, University College Cork, Ireland. 39 Web Watch Karsten Vrangbæk is Associate Professor, 40 News from around Europe Department of Political Science, University of Copenhagen, Denmark. EUROPEAN SNAPSHOTS The health system in England Seán Boyle Who is covered? amount of prescription drugs. Transport different local contracting possibilities, as Coverage is universal. All those ‘ordinarily costs to and from provider sites are also well as providing substantial financial resident’ anywhere in the United covered for people on low incomes. incentives tied to achievement of clinical Kingdom* are entitled to health care that is and other performance targets. Private largely free at the point of use. How are revenues generated? providers of GP services set their own fee- National Health Service (NHS): the NHS for-service rates but are not generally reim- What is covered? accounts for 86% of total health expen- bursed by the public system. Services: the publicly-funded National diture. It is mainly funded by general Hospitals: these are organised as NHS Health Service (NHS) covers preventative taxation (76%), but also by national trusts directly responsible to the services; inpatient and outpatient (ambu- insurance contributions (19%) and user Department of Health. More recently, latory) hospital (specialist) care; physician charges (5%).3 Apart
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