The reform of health care systems in Europe: reconciling equity, quality and efficiency

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The reform of health care systems in Europe: reconciling equity, quality and efficiency
Recommendation 1626 (2003)

Doc. 10206
8 June 2004

Reply from the Committee of Ministers
adopted at the 886^th meeting of the Ministers’ Deputies (3 June 2004)

1.         The Committee of Ministers welcomes Parliamentary Assembly Recommendation 1626 (2003) on the reform of health care systems in Europe: reconciling equity, quality and efficiency and has brought it to the attention of member states.

2.         The Committee of Ministers notes with satisfaction the recognition of the considerable achievements of the Council of Europe in the health field. It considers that the right to protection of health is a human right and an essential component of social cohesion and democratic stability. The Committee of Ministers, through the European Health Committee, aims at proposing to member states policies which ensure equitable access to good quality health care, as well as the full and responsible participation of patients and citizens. The Council of Europe will continue to play an important role in assisting member states to incorporate the ethical, social and human rights dimension in health policies and in reforms of their health care systems. Continuing attention will be paid to access for the vulnerable and in finding a new balance between curative, preventive and promotive health care. The 7th Conference of European Health Ministers (June 2003 in Oslo) on “Health, Dignity and Human Rights – The role and responsibility of Health Ministers in meeting the challenges of the changes in society and new technology at the beginning of the third millennium” has further underpinned the Council of Europe’s strategy in the health field.

3.         The Committee of Ministers would like to inform the Assembly that the questions related to the development of the Council of Europe work in the area of public health were discussed in the context of consideration of a strategic paper “Council of Europe’s public health and related activities: towards a strategic approach” submitted by the Netherlands, as Chair of the Committee of Ministers. The Committee of Ministers has welcomed the proposals by the Netherlands and has entrusted the CDSP to make proposals on the conditions and mechanisms necessary for making the objectives operational in the light of the opinions of and in further consultation with the relevant expert committees. The Committee of Ministers will be informed of action taken so that decisions can be adopted before the end of this year. The Parliamentary Assembly will be kept duly informed.

4.         The Committee of Ministers has communicated the Assembly’s Recommendation to the European Health Committee; its comments are appended to this reply. It will take the Assembly’s Recommendation into consideration in its future work.”

Appendix to the reply

European Health Committee (CDSP)’s Opinion on Parliamentary Assembly Recommendation 1626(2003) on the reform of health care systems in Europe: reconciling equity, quality and efficiency

1.         The CDSP welcomes the Parliamentary Assembly Recommendation 1626 (2003) as valuable and well documented contribution to the Council of Europe’s continuous efforts to assist member states in making their health systems more equitable, efficient and of high quality. The CDSP draws attention to the fact that for many years its program has been based on a strategy for incorporating the ethical, social and human rights dimension into health care. Its components are perfectly in line with the spirit of the Parliamentary Assembly Recommendation, namely:

Equity in access to health care and health promotion;

High health care quality standards;

To enhance the citizen’s role in health: participation and individual responsibility.

2.         The CDSP noted with satisfaction that the Parliamentary Assembly Recommendation recognised the impact of the most recent Committee of Ministers Recommendations prepared under the responsibility of the CDSP. Indeed, some of the latter Recommendations mentioned offer immediate reply to the concerns raised by the Parliamentary Assembly, e.g.:

“to study the trends in member states’ health policies that may have the effect of reducing equality of access to health care” – the Recommendation No. R (99) 21 on criteria for managing waiting lists and waiting times in health care and the Recommendation Rec(2001)12 on the adaptation of health care services to the demand for health care and health care services of people in marginal situations;

“to strengthen respect for patients’ rights and to support the role of citizens and patients in health care systems, to preserve and consolidate the patient’s right to free choice of physician, health facility and health insurance, encourage greater access to information for patients and reinforce the patient’s capacity to make decisions and take responsibility for them” – the Recommendation No. R (2000) 5 on the development of structures for citizen and patient participation in the decision-making process affecting health care.

3.         The CDSP fully shares the Parliamentary Assembly emphasis on “the need to systematically promote the implementation by the member states of these and other recommendations of the Committee of Ministers in the health field, as well as those of the conferences of European health ministers, the latest of which was held in Oslo on 12 and 13 June 2003 and was entitled “Health, Dignity and Human Rights”. Within its limited financial and staff resources available, the CDSP continues the practice to link the final meetings of the Expert Committees with regional seminars on the relevant topics, thus promoting the policy guidelines developed by the Committees of Experts. The assistance programs are guided by the Recommendations and where possible, an international conference launching the Recommendation is organised, e.g. in Cracow, Poland, 2003, on the methodology of developing clinical practice guidelines. This confirms the wish of the CDSP to “step up its assistance programmes in the health field with a view to strengthening the implementation of its Recommendations to the governments of member states”.

4.         The issue of “recruitment of medical staff” is currently being considered by the Expert Committee on mobility of health personnel, with a view to developing a Recommendation by the end of 2004. With regard to the request to “the appropriate committee to pursue its work on the revision of Articles 11 and 13 of the European Social Charter with a view to widening their scope”, the CDSP has accepted the principle of reviewing the European Social Charter with a view of communicating its conclusions to the Governmental Committee of the Social Charter for further action as soon as possible.

5.         In conclusion, the CDSP fully supports the content and rationale of the Parliamentary Assembly Recommendation 1626 (2003) on “The reform of health care systems in Europe: reconciling equity, quality and efficiency” and is willing to participate in its implementation and developing further necessary policy measures to address the issues therein.

6.         The CDSP, while developing its future work programme, will take into consideration the topics suggested by the Parliamentary Assembly Recommendation, in particular:

to reaffirm the role of the state in regulating health care systems;

to take as the main criterion for judging the success of health system reforms the effective access to health care for all, without discrimination, as a basic human right and, as a consequence, the improvement of the general standard of health and welfare of the entire population;

to give greater priority to primary health care and to the role of general practitioners in order to reduce costs and to improve the general health and welfare of the population.