relevant to Cyprus Dr Dimitrios Florinis Unit Performance of national health systems DirectorateGeneral for Health and Food Safety European Commission 2 New Opportunities for investments in health in Cyprus ID: 744430
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Slide1
Investing in Health: examples relevant to Cyprus
Dr
Dimitrios Florinis
Unit "Performance of national health systems"
Directorate-General for Health and Food Safety
European CommissionSlide2
2
New Opportunities for investments in health in Cyprus
Coming from
recent health system reforms, Acts adopted in June 2017
Build and improve the
know-how
&
capacity
of care authorities to implement reforms/new care models
Mobilising
investments
for implementation of innovative forms of care necessary part of reforms
Use
ALL opportunities
and financing tools for the new models and new services.Slide3
3Slide4
Now in the EU…
Infrastructure
(hospitals)
Medical innovations
(medicines, imaging,
diagnostics, devices…)
New care models
& services
Investments in
Healthcare (old school)Slide5
The investment triangle in health
The future
Infrastructure
(primary care & community care centres)
Medical innovations
(diagnostics, data analytics,
decision support systems,
eHealth/mHealth)
investment
triangle
New care models & services
(patient pathways; workforce skills and roles; governance, financing and reimbursement models, …)Slide6
Where to find further information about concrete project possibilities?
Use previous experience in the EU (ESIF):
-> Read previous guidance and reports.
-> Contact authorities responsible for a given OP implementationContact details under the link:http://ec.europa.eu/regional_policy/en/atlas/managing-authorities/Or in the Mapping:http://esifforhealth.eu/pdf/Mapping_Report_Final.pdf
Getting ideas from
Other toolsSlide7
Organ donation and transplantation:
Increase availability, and strengthen safety and quality, of organs, tissues and cells for transplantation, and of blood for transfusion, including via the promotion of programmes for altruistic donation programmes, among the public and health professionals, and set up a transplant/donor coordinator in every health facility with potential for organ donation.
Promote the use of centres of reference and the exchange of organs between EU MS, develop common methodology and definitions, and use a common accreditation system for organ donation and transplantation programmes.
Develop registers for living donors and organ recipients to evaluate and ensure their health and safety.Available at: http://ec.europa.eu/health/health_structural_funds/docs/esif_guide_en.pdfCommission guide
on
health
investments
through
ESIF
7
Getting ideas from
Other toolsSlide8
"Effective use of European Structural and Investment Funds for health investments in the programming period 2014-2020"
http://esifforhealth.eu/Mapping_report.htm
8
Getting ideas from
Other toolsSlide9
Mapping ICT investments in Operational Programmes
http://s3platform.jrc.ec.europa.eu/
9Slide10
Mapping ICT investments in Operational Programmes
http://s3platform.jrc.ec.europa.eu/
10Slide11
Where to find further practical information for health investments?
-> Information in EC/ DG SANTE website on health.
-> Material from Strategic Investments in Health workshop.
Further details under the link:http://ec.europa.eu/health/investment_plan/events/ev_20170227_en
Looking for Investments
With real valueSlide12
Need for an enabling and encouraging regulatory environment
for investments.
Broad scope
of health investments, not just infrastructure but e-health, service provision and reorganisationLong-term thinking and strategy required, with dual aim (a conditioning b): Reform and delivery of transformed health servicesInvestment planningThere is an opportunity for
smart
investments
to
transform
your
health
systems
for
the better
– the time is now
Strategic Investments for the future of healthcare
27 February 2017 - Main MessagesFurther information:
http://ec.europa.eu/health/investment_plan/events/ev_20170227_en
S
eminar on "Strategic investments for the future of healthcare"Slide13
European Fund for Strategic Investment (EFSI)
The main channel to deliver on the
Investment Plan for Europe
New EU financial instrument (loan-based) – EFSI is a guarantee on lending granted by the European Investment Bank (EIB) and the European Investment Fund (EIF – for SMEs) - addressing market failures and sub-optimal market situations
Budget
(all
fields
,
accross
the EU):
21
bn EUR, now proposed extension to 33,5bn (EFSI II) to mobilise private financing up to 500bn up to 2020;
225bn investment already committed
(August 2017)
Priorities in health:
New models of infrastructure (e.g. primary care)
R&D (incl. medical devices & products)
eHealth and new technologies
Health workforce
SMEs and social enterprises
> 10 major health projects granted EFSI support > 500mEUR
Primary care centres (IE)
Medical equipment & care provision
(IT)
Medical
research
(ES, UK, IE, DE)
Healthcare infrastructure facilities reconfiguration (UK, AT, PL, RO)
+ 2
multi-sector infrastructure
projects incl.
health
Investment Plan
Examples in HealthcareSlide14
EFSI and the Health Sector (I)
14
This is where EFSI can play
an important facilitating role
. With EFSI acting as a
guarantee
against first losses, the Investment Plan for Europe offers an opportunity for
the public and private sectors to join together in health investments that are deemed
high-risk
. Slide15
EFSI and the Health Sector (II)New facilities, such as primary care and community care centres that will constitute the "hubs" for transformed care services – "infrastructure" investment
ICT systems
that can support the back-end organisation, as well as the implementation of integrated care pathways and decision support systems -
"infrastructure and medical technology" investmentNew service models and new technologies, such as ICT devices and apps (eHealth and mHealth), which can facilitate remote management of chronic patients at their homes, as well as empowering them to engage in self-care – investment on "soft" elements with medical technologies embeddedCapacity-building and "system re-organisation": education of the care workforce in new roles and associated skills (for example, new roles of "care coordinators"), new care pathways, new governance models, new financing and reimbursement models (more linked to performance, quality and coordination) – investment on "soft" elements of organisational change.15Slide16
Case Study:Irish Primary Care Centres PPP
The project
comprises the design, build, finance, maintenance and facilities management of 14 Primary Care Centres located throughout Ireland.
The project is in line with the Irish Government Health Reform to reduce reliance on acute sector and is part of the national programme of establishing around 300 primary care centres, 14 of which are procured as a PPP (the project).16AmountUp to EUR 70 millionMaturity
Up to 27
years
Location
14
different locations throughout
Ireland
Timeline
2016-2018Slide17
The PromoterIreland, represented by the Minister for Health, acting by its agent, the National Treasury Management Agency (NTMA) during the construction phase
As of the service commencement, the agent for the Minister for Health will be the Health Service Executive (HSE)
HSE
defined the Project scope, the output specifications and the budget for the ProjectNTMA is the statutory financial advisor to State authorities for all public investments and it has full responsibility for delivery of most of Ireland’s PPPs (except transport sector)17Case Study:Irish Primary Care Centres PPPSlide18
Conclusions / SummaryThe Project will have a strong demonstration effect for future heath care projects to be financed in the country, but also potentially for primary health care projects to be financed across Europe.
The Irish government specifically requested the Bank to support the project.
The improved project funding costs due to EIB presence will be passed through to the public sector by lowering the availability payment due by the public sector to private operators. The project will facilitate the delivery of accessible, high-quality integrated primary care services aimed at improving the health and well-being of the local population. There is a clear economic benefit because patients can return to the workforce and be more productive as a result of better clinical outcomes and shorter waiting times for treatment. 18
Case Study:
Irish Primary Care
Centres
PPPSlide19
EIAH health sector requests – a case study
MOH request
via the local Jaspers team
EIB general consultant supporting MOH to fulfil EC country conditionalities for accessing ESI funds (8 regional masterplans for health services reorganisation based on the national strategy)EIAH Advisory Services Agreement with the MOH, to support the preparation of three regional hospitals plans and submission of applications for the ESI fundsPotential support for the implementation (through the
EIB Advisory Services
)
Potential loan
to cover the difference between
the available funds and total final costs
19Slide20
Partnerships among payers and providers of care services are needed:
Various models are possible – the local context must be considered
Partnerships preferably
driven by local communitiesRole for a lead provider / service integratorBasic principle of trust and sharing responsibility, risks and benefitsIncentives: payment-for-results, outcome-based payments, value-based contracting etc.Develop new
contractual models for healthcare: no specific "new model" is evidently superior to others - results depend hugely on
relationships
,
financial incentives
,
cultures
and
leadership.
Now is the
opportunity
for
smart
health investments in Cyprus!
Investing in
the
New GESY 2020Slide21
ACCESSIBLE
RESILIENT
DG SANTE Public
Health
:
http://ec.europa.eu/health
Seminar
"Strategic investments for the future of healthcare":
http://ec.europa.eu/health/investment_plan/events/ev_20170227_en
Investment
Plan
for
Europe
http://ec.europa.eu/priorities/jobs-growth-and-investment/investment-plan_en
&
Investment Plan for Europe & health
http://ec.europa.eu/health/investment_plan/policy/index_en.htm
European Fund for Strategic Investments (EFSI)
via the EIB
https
://www.eib.org/efsi & via the EIF http://www.eif.org/what_we_do/efsi/
European Investment Project Portal (EIPP) - project promoters can publicise their projects to European and global investors https://ec.europa.eu/priorities/european-investment-project-portal-eipp_enEuropean Investment Advisory Hub (EIAH) – project promoters can get advice
http://www.eib.org/eiah/about/index