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Health care systems across the European Union face a common challenge: the high cost of health care. Governments strive to ensure that cost pressures do not undermine values such as universal coverage and equitable financing and access. Focusing on the three health care financing functions - collection pooling and purchasing - as well as on coverage this book analyses the organization of health care financing in the Member States of the European Union discusses the principal financing reform trends of recent years and assesses their capacity to help ensure fiscal sustainability. The book includes a useful annex detailing the health care financing systems of each of the 27 Member States of the European Union. It will inform the deliberations of policy- and decision-makers both within and beyond the European Union faced with reconciling rising costs with equitable and sustainable health care.

Emerging challenges related to socio-demographics and economics require new approaches for academics, politicians, hospital management, clinical staff, public institutions, and firms doing business in the healthcare industries. This book provides valuable insights for understanding modern and complex healthcare market configurations in Europe. Taking a unique cross-country perspective the authors figure out critical success factors for relevant stakeholders. Mario Glowik is Professor of International Strategic Management at the Berlin School of Economics and Law. He holds a Doctorate in Business Administration from the Freie Universität Berlin in Germany and gained his habilitation (post-doctoral qualification) at the Vienna University of Economics and Business, Austria. Slawomir Smyczek is Marketing Professor at the University of Economics in Katowice (Poland), where he earned his Ph.D. In 2010, the Polish Prime Minister awarded his habilitation thesis as the best in the field of economics in the entire country.

Following the transition from central planning toward market-based economies, the formerly communist states of Central and Eastern Europe introduced a number of reforms in the finance, management, and organization of the health sector. While health sector reforms in these countries have involved deep structural changes, they have generally been less successful in improving efficiency, enhancing equity in healthcare financing and delivery, and managing clinical quality of health services. Total health expenditures have increased in almost all countries, especially in recent years, and with revenues not keeping pace, huge debts have accumulated in the health sector. Efficiency gains have been few and far between, and with the dynamic nature of technology and demographic changes increasing the complexity of health services and the health marketplace, further reforms are becoming even more difficult. This report takes stock of recent trends in health expenditure aggregates in the public sector and identifies specific areas of health expenditure reform consistent with the objectives of stabilizing the fiscal situation in these countries (the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia) without adversely affecting the production, delivery and utilization of health services.

Health care systems across the European Union face a common challenge: the high cost of health care. Governments strive to ensure that cost pressures do not undermine values such as universal coverage and equitable financing and access. Focusing on the three health care financing functions - collection pooling and purchasing - as well as on coverage this book analyses the organization of health care financing in the Member States of the European Union discusses the principal financing reform trends of recent years and assesses their capacity to help ensure fiscal sustainability. The book inclu

Background Although health technology assessment (HTA) systems base their decision making process either on economic evaluations or comparative clinical benefit assessment, a central aim of recent approaches to value measurement, including value based assessment and pricing, points towards the incorporation of supplementary evidence and criteria that capture additional dimensions of value. Objective To study the practices, processes and policies of value-assessment for new medicines across eight European countries and the role of HTA beyond economic evaluation and clinical benefit assessment. Methods A systematic (peer review and grey) literature review was conducted using an analytical framework examining: (1) 'Responsibilities and structure of HTA agencies'; (2) 'Evidence and evaluation criteria considered in HTAs'; (3) 'Methods and techniques applied in HTAs'; and (4) 'Outcomes and implementation of HTAs'. Study countries were France, Germany, England, Sweden, Italy, Netherlands, Poland and Spain. Evidence from the literature was validated and updated through two rounds of feedback involving primary data collection from national experts. Results All countries assess similar types of evidence; however, the specific criteria/endpoints used, their level of provision and requirement, and the way they are incorporated (e.g. explicitly vs. implicitly) varies across countries, with their relative importance remaining generally unknown. Incorporation of additional 'social value judgements' (beyond clinical benefit assessment) and economic evaluation could help explain heterogeneity in coverage recommendations and decision-making. Conclusion More comprehensive and systematic assessment procedures characterised by increased transparency, in terms of selection of evaluation criteria, their importance and intensity of use, could lead to more rational evidence-based decision-making, possibly improving efficiency in resource allocation, while also raising public confidence and fairness.

This review analyses the current regulatory procedures for plant biostimulants, both at an EU level and beyond the EU, and explores the future regulation of these substances in the EU. Plant biostimulants are defined as products that stimulate plant nutritional processes regardless of the product’s nutrient content, with the sole aim of improving one or more of the following characteristics of the plant and the plant rhizosphere or phyllosphere: the efficiency of nutrient use, tolerance to abiotic stresses, crop quality traits, availability of confined nutrients in the soil and rhizosphere, humification and degradation of organic compounds in the soil. This definition is reported in the proposals for new rules to regulate making CE-marked fertiliser products available on the market. This regulation, which includes a plant biostimulants category, will repeal the existing Fertilisers Regulation (EC) No. 2003/2003. This category of compounds is also used in non-European countries. Currently, as there are different market conditions and different national regulation requirements for plant biostimulants in different countries, the non-harmonised regulatory processes can lead to unfair competition between operators. The assessment of plant biostimulants should be harmonised as far as possible, to avoid fragmentation and ensure a level, reliable playing field. It is essential that a common market is created for these substances.

Background In the European Union and European Economic Area only 38% of multidrug-resistant tuberculosis patients notified in 2011 completed treatment successfully at 24 months’ evaluation. Socio-economic factors and patient factors such as demographic characteristics, behaviour and attitudes are associated with treatment outcomes. Characteristics of healthcare systems also affect health outcomes. This study was conducted to identify and better understand the contribution of health system components to successful treatment of multidrug-resistant tuberculosis. Methods We selected four European Union countries to provide for a broad range of geographical locations and levels of treatment success rates of the multidrug-resistant tuberculosis cohort in 2009. We conducted semi-structured interviews following a conceptual framework with representatives from policy and planning authorities, healthcare providers and civil society organisations. Responses were organised according to the six building blocks of the World Health Organization health systems framework. Results In the four included countries, Austria, Bulgaria, Spain, and the United Kingdom, the following healthcare system factors were perceived as key to achieving good treatment results for patients with multidrug-resistant tuberculosis: timely diagnosis of drug-resistant tuberculosis; financial systems that ensure access to a full course of treatment and support for multidrug-resistant tuberculosis patients; patient-centred approaches with strong intersectoral collaboration that address patients’ emotional and social needs; motivated and dedicated healthcare workers with sufficient mandate and means to support patients; and cross-border management of multidrug-resistant tuberculosis to secure continuum of care between countries. Conclusion We suggest that the following actions may improve the success of treatment for multidrug-resistant tuberculosis patients: deployment of rapid molecular diagnostic tests; development of context-specific treatment guidance and criteria for hospital admission and discharge in the European context; strengthening patient-centred approaches; development of collaborative mechanisms to ensure cross-border care, and development of long-term sustainable financing strategies.

AbstractDeveloped countries are increasingly dependent on international trade to meet seafood requirements, which has important social, environmental, and economic implications. After becoming an independent coastal state following Brexit, the UK faces increased trade barriers and changes in seafood availability and cost. We compiled a long-term (120-year) dataset of UK seafood production (landings and aquaculture), imports, and exports, and assessed the influence of policy change and consumer preference on domestic production and consumption. In the early twentieth century, distant-water fisheries met an increasing demand for large, flaky fish such as cod and haddock that are more abundant in northerly waters. Accordingly, from 1900 to 1975, the UK fleet supplied almost 90% of these fish. However, policy changes in the mid-1970s such as the widespread establishment of Exclusive Economic Zones and the UK joining the European Union resulted in large declines in distant-water fisheries and a growing mismatch between seafood production versus consumption in the UK. While in 1975, UK landings and aquaculture accounted for 89% of seafood consumed by the British public, by 2019 this was only 40%. The combination of policy changes and staunch consumer preferences for non-local species has resulted in today’s situation, where the vast majority of seafood consumed in the UK is imported, and most seafood produced domestically is exported. There are also health considerations. The UK public currently consumes 31% less seafood than is recommended by government guidelines, and even if local species were more popular, total domestic production would still be 73% below recommended levels. In the face of climate change, global overfishing and potentially restrictive trade barriers, promoting locally sourced seafood and non-seafood alternatives would be prudent to help meet national food security demands, and health and environmental targets.

Abstract WHO Member States adopted the Global Code of Practice on the International Recruitment of Health Personnel 10 years ago. This study assesses adherence with the Code’s principles and its continuing relevance in the WHO Europe region with regards to international recruitment of health workers. Data from the joint OECD/EUROSTAT/WHO-Europe questionnaire from 2010 to 2018 are analyzed to determine trends in intra- and inter-regional mobility of foreign-trained doctors and nurses working in case study destination countries in Europe. In 2018, foreign-trained doctors and nurses comprised over a quarter of the physician workforce and 5% of the nursing workforce in five of eight and four of five case study countries, respectively. Since 2010, the proportion of foreign-trained nurses and doctors has risen faster than domestically trained professionals, with increased mobility driven by rising East-West and South-North intra-European migration, especially within the European Union. The number of nurses trained in developing countries but practising in case study countries declined by 26%. Although the number of doctors increased by 27%, this was driven by arrivals from countries experiencing conflict and volatility, suggesting countries generally are increasingly adhering to the Code’s principles on ethical recruitment. To support ethical recruitment practices and sustainable workforce development in the region, data collection and monitoring on health worker mobility should be improved.