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Web-economic-crisis-health-systems-and-health-web

Web-economic-crisis-health-systems-and-health-web Web-economic-crisis-health-systems-and-health-web

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18.06.2015 Views

Country profiles of health system responses to the crisis | Spain 491 that are to be reimbursed the difference between retail price and patient copayment for prescriptions; the pharmaceutical industry providing drugs directly to hospital pharmacies; as well as the medical goods and devices industry that services primary health centres and hospitals. Delays have ranged from 6 to 12 months, cumulating a debt that, for small business such as pharmacies, amounted to risk of default. In 2012, the central government implemented a specific fund for public administrations to borrow money to meet their pending debts with private providers. Overhead costs: restructuring the Ministry of Health and purchasing agencies • Creation of a national centralized purchasing platform for medical goods aimed at fostering economies of scale (2012). Provider infrastructure and capital investment • Implementation of the following changes in provider structure at the regional level (2010 onwards in Catalonia; 2011 and 2012 onwards in the other regions): àà àà àà total or partial closure of facilities (both primary care and hospitals); plans for intensive implementation of private partnerships in the form of cession of full exploitation rights of hospitals and primary care centres to private insurers (notably in Madrid); and further externalization of certain clinical and complementary services, often centralizing the provision for a given area. • Regarding capital investment, based on estimated budgets there has been a 16.5% reduction in investment in 2011 compared with 2010 and figures for 2012 show an additional 35.3% reduction in investment. Priority setting or protocols to change access to treatments, coordination of care and patterns of use • At the regional level, revised service hours are intended to eliminate evening and overnight walk-in services in urban areas and emergency wards in rural areas (Catalonia in 2010; other regions 2012 onwards). Waiting times • Criteria established for regions to regulate maximum waiting times for surgical procedures through Royal Decree 1039/2011 (2011). Enforcement still pending in many parts of the country at the beginning of 2013. Health promotion and prevention • Sharp increases in tobacco taxes (2011 and 2012).

Sweden Anders Anell and Fredrik Lennartsson Economic trends • Sweden's real per capita GDP contracted in 2009 by 6.0% but returned to positive growth in 2010. Government spending as a share of GDP remained well above the European mean through 2011. • Ten-year bond rates declined through the 2008 to 2011 period. • Health spending as a share of government expenditure was relatively unchanged from 2008 to 2011. Per capita health expenditure growth patterns diverged in 2010 for public and OOP sources of funds, with public expenditure slowing and OOP expenditure accelerating; expenditure growth rates converged again in 2011 (Sweden: Figs 1 and 2). Policy responses Changes to public funding for the health system • Health spending did not slow down in response to the crisis. • The central government increased its funding for local governments (including county councils, who spend most of their revenue on health) to compensate for reduced local tax revenues and prevent redundancies among public sector workers (2009, 2010) and introduced a permanent annual increase (2011). Changes to health coverage Population (entitlement) • Undocumented migrants given the same entitlement to subsidized health care as asylum-seeking migrants. • Adult asylum seekers given entitlement to emergency care, maternity care, care when seeking termination of pregnancy and advice on contraception. • Children of asylum seekers given the same entitlement to health care as resident children (2013). The benefits package • No response reported.

Sweden<br />

Anders Anell <strong>and</strong> Fredrik Lennartsson<br />

Economic trends<br />

• Sweden's real per capita GDP contracted in 2009 by 6.0% but returned<br />

to positive growth in 2010. Government spending as a share of GDP<br />

remained well above the European mean through 2011.<br />

• Ten-year bond rates declined through the 2008 to 2011 period.<br />

• Health spending as a share of government expenditure was relatively<br />

unchanged from 2008 to 2011. Per capita <strong>health</strong> expenditure<br />

growth patterns diverged in 2010 for public <strong>and</strong> OOP sources<br />

of funds, with public expenditure slowing <strong>and</strong> OOP expenditure<br />

accelerating; expenditure growth rates converged again in 2011 (Sweden:<br />

Figs 1 <strong>and</strong> 2).<br />

Policy responses<br />

Changes to public funding for the <strong>health</strong> system<br />

• Health spending did not slow down in response to the <strong>crisis</strong>.<br />

• The central government increased its funding for local governments<br />

(including county councils, who spend most of their revenue on <strong>health</strong>)<br />

to compensate for reduced local tax revenues <strong>and</strong> prevent redundancies<br />

among public sector workers (2009, 2010) <strong>and</strong> introduced a permanent<br />

annual increase (2011).<br />

Changes to <strong>health</strong> coverage<br />

Population (entitlement)<br />

• Undocumented migrants given the same entitlement to subsidized <strong>health</strong> care<br />

as asylum-seeking migrants.<br />

• Adult asylum seekers given entitlement to emergency care, maternity care, care<br />

when seeking termination of pregnancy <strong>and</strong> advice on contraception.<br />

• Children of asylum seekers given the same entitlement to <strong>health</strong> care as<br />

resident children (2013).<br />

The benefits package<br />

• No response reported.

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