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The Future of Social Health Insurance in Europe: Quo Vadis?


Pursuing its innovative tradition in the study of health systems and policies in Bulgaria and Europe, and the dissemination of knowledge on their development, Medical University - Varna sent its representatives to an international conference, entitled "The Future of Social Health Insurance in Europe: Redefining the Principles of Solidarity and Responsibility", which was held in Brussels on 21st  March 2014.

The conference was dedicated to the 50th anniversary of the adoption of the Belgian mandatory health insurance law, and it was organized by the Belgian Institute for Health Insurance, the European Social Observatory and the European Observatory on Health Systems and Policies. The only representative from Bulgaria at this prestigious international forum, were the representatives of Medical University-Varna - Assoc. Prof. Antoniya Dimova and Chief Assist. Prof. Mariya Rohova from the Department of Economics and Healthcare Management.

The leading participants at the conference, including representatives of the European Commission and the Organization for Economic Cooperation and Development, professors and leading researchers in the field of health policy from the European Observatory on Health Systems and Policies, universities in France and Belgium, representatives of health ministries and directors of health insurance organizations in Belgium, Germany, Slovenia, Austria, Estonia, France, the Netherlands discussed the role of the European Union for healthcare system organization, the necessity of reconsidering the basic paradigms of Beveridge and Bismarck - systems, the balance between solidarity and responsibility, and the future of health insurance in Europe.

The main objective of the conference was to outline the guidelines for development of social health insurance in the European Union, seeking answers to the questions: How should we develop the model of social health insurance in the following 50 years; what are the challenges confronting social health insurance and how will they affect the principles of solidarity and responsibility in the health systems of EU countries. The conference participants unanimously agreed that the strategic decisions for future reforms in healthcare systems in Europe need to be consistent with the major changes concerning the ageing of the population and the increase in chronic diseases. Care for chronically ill patients, for people with mental health problems and prolonged medical services will be the predominant types of medical care in the future. This will increase the need for better integration of health services, as well as focusing the attention on the unhealthy lifestyle and other health determinants. In addition, funding contracting and distribution of expensive technological innovations can also have a significant impact on the health insurance organizational model, the way health services are purchased and paid, the insurance coverage, the ratio between public and private health services and the use of competition and market mechanisms to encourage efficiency. This raises not only technical issues about efficiency and effectiveness, but also political and ethical debates about the right balance between the choices of citizens and the responsibility of the participants in the system, on the one hand, and the public purposes and solidarity, on the other hand.

Despite the various types of healthcare systems in EU countries and the variety of problems they face in order to respond to the new realities, they all should take into consideration the need for changes in the approaches for organizing health systems and providing health care:

  • from passive to strategic purchasing of health care services;
  • from cost reimbursement to payment by results;
  • from insurance to public healthcare and disease management;
  • from competition to partnership in the system;
  • from fragmented to integrated healthcare;
  • reconsidering the balance between free and administrative patient choice and selective contracting;
  • from data accumulation to awareness and transparency.
There is a clear trend towards the increase of the role of the European Union and in particular the European Commission in the health reforms in the Member States. The so-called European Semester, a cycle of economic and fiscal coordination policies in the EU, focuses on reforming the national health systems after 2011, when three member states of the EU received specific recommendations for their healthcare systems. In 2013 the number of countries which received specific recommendations regarding their healthcare systems was already sixteen. In June 2014 the EC is expected to be ready with the ensuing recommendations for the development of healthcare systems in the European Union.

If political consensus for a healthcare system reform in Bulgaria is missing, then the required changes will be imposed by the trends already launched on a European scale.