ESI Funds for health investments Portuguese national workshop - - PowerPoint PPT Presentation

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ESI Funds for health investments

Portuguese national workshop

Lisbon 5th November 2014

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Workshop agenda

I. Workshop opening (9:00 - 9:15)

• II. Introduction of the project and project output

(9:15 – 10:00)

• III. ESIF investment critical success factors (10:00 – 11:00)

IV. Specifics of complex project management and implementation (11:15 – 12:00)

• V. Principles of effective project application assessment

and relevant indicators (12:00 – 13:00)

• VI. Health funding potential in 2014-2020 PP

(14:00 – 14:30)

• VII. Group activity (14:30 – 15:45)
• VIII. Discussion on effective follow up

(15:45 – 16:00)

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• I. Introduction of workshop participants

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• II. Introduction of the project and outputs

(i) Project and its context

[Project introduction and disclaimer]

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Project objectives

► The project is aimed at providing assistance in the area of

healthcare to EU Member States in the programming and implementation of European Structural and Investment Funds (ESIF) in the new programming period 2014 - 2020, more concretely:

► To support the Member States and their efforts to tap into the potential

• f ESIF 2014 - 2020 for health investments and to manage ESIF

support for health in a better and more effective way

► To promote effectively implemented actions in the health sector which

will have a major positive impact on the wider population’s access to quality and sustainable healthcare in EU Member States

► To build knowledge of the implementation of ESIF for health in the new

programming period 2014 - 2020

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Project background

► The project builds on two key documents:

► Toolbox for effective structural funds investments in health

2014-2020 as developed by Subgroup 2 of the Reflection Process

• n modern, responsive and sustainable health systems that was

conducted in the Council of the EU under the auspices of the Working Party on Public Health at Senior Level

[Electronic version in various languages available at the website of the Council of the European Union] ► Policy Guide for Health Investments by European Structural

and Investment Funds 2014-2020, developed by the European Commission (DGs SANCO, REGIO, EMPL)

[Electronic version in English available at the DG REGIO website]

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Workshop objectives

1. Inform the workshop participants about the project and outputs developed

►

Introduce the project and main outputs

2. Share lessons learned from implementation of health projects under EU SF from 2007 - 2013

►

Share examples of good practices and recommendations to various investment life- cycle stages

►

Discuss good practice in implementation of complex projects in health

►

Share recommendations for effective project application assessment and selection of relevant indicators in health projects

3. Identify all possible health investments under Operational Programmes adopted in Portugal

►

Link specific Thematic Objectives with possible health issues/investments

►

Discuss specific possibilities to support health under specific Operational Programmes developed for 2014-2020 programming period

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Disclaimer

► Please be aware that the workshop (as well as the project itself) are NOT

part of the negotiations between the Commission and the Member States

►

EY has been contracted by DG SANCO, not DGs directly involved into negotiations

►

EY provides consultations based on its professional judgment, analysis of documents and analysis of situation in all Member States

►

Information provided in the project outputs and in this presentation should serve as supportive material for discussion and reflection

►

Suggestions presented further do not reflect the Commission's position, but EY’s professional opinion and good practice examples gathered during this project

The presentation does not reflect the Commission's position and the way implementation of ESIF will be finally delivered is still being negotiated with the European Commission

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• II. Introduction:

(ii) Project outputs

[EY outputs introduction]

• II. Introduction of the project and outputs

(ii) Project outputs

[Project scope]

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Project outputs

WP 1: Mapping report Implementation of SF in health in all EU Member States

► Overview of 2007 - 2013

period

► Planned implementation

• f ESIF for funding

health priorities in 2014 - 2020 based on Partnership Agreements and OPs

WP 2: Guide Guidance on effective health investment from ESIF

► Recommendations for

Ministries of Health and managing authorities on practices that lead to efficient health investment funded from ESIF

► Roles of MoH and MA and

ways of their cooperation to achieve effectiveness

► Lessons learned (Do’s and

Don’ts)

WP 3: Toolkit Set of technical and managerial tools to accompany the Guide

► ESIF instruments and

mechanisms in 2014-2020

► Calls for proposal

management

► Set of indicators ► Sustainable and efficient

models & concepts in HC

► Manual on capital

investment

► Investment appraisal

methods

WP 4: Roll out to Member States: Website, country visits, regional workshops

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• III. ESIF investment critical success factors

(i) ESIF investment effective lifecycle

[Topic covered by the project outputs]

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ESIF investment effective lifecycle

Critical success factors

Critical success factors Strategy development Investment sustainability Capacity building Procurement management Financial planning Partnership building Monitoring & Evaluation 01 07 02 06 05 03 04

WP2

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Critical success factors

Discussion topics

Q1: Based on introduction of critical areas, where do you think are Hungarian:

• i. Strong areas, i.e. areas that could be shared with other Member States as a good

practice example.

• ii. Weak areas, i.e. areas where would Portugal appreciate support in a form of a good

practice example from other Member States. Q2: Would you name any other critical success factor that has not been mentioned here and is worth mentioning?

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• III. ESIF investment critical success factors

(ii) Practices and recommendations to various investment life-cycle stages [Topic covered by the project outputs]

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• 01. Strategy development

►

Lack of real public health strategy

►

Absence of clearly defined priorities

►

Investments are not focused on achievement of clear objectives (duplicities and overlapping of funding)

►

Investments do not generate any tangible results (there are no health gains and no improved cost efficiency of health sector)

►

Unsustainability of the investments

►

Lack of project progress or project disruption in case of changes in political environment

►

Lack of coordination in strategy development

►

On various levels of public administration

►

For different types of health care (outpatient x hospital care; primary x specialized care)

►

On cross-regional and cross-border level

Problems

Inefficient use of public resources Obstacles to systemic changes

► Develop an overarching public health strategy

based on evidence and centered around a patient

• riented approach [Ministry of Health]

► Coordinate the strategy-making process with

stakeholders to make the strategy broadly accepted and relevant [Ministry of Health]

► Identify & involve stakeholders ► Know other existing and developing strategies ► Ensure balanced and complementary approach

to maximize investment effects [Ministry of Health]

► Infrastructure development ► Human resources development ► Prevention and health promotion campaigns ► Identify financial resources and select priorities

to be financed from ESIF [Ministry of Health, Managing Authorities]

Recommendations

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Example of insufficient strategy development Hungary, programming period 2007 - 2013

Context

►

The implementation of ESIF for health infrastructure in Hungary in PP 2007-2013 was the largest of all EU Member States (approx. 1,3 bn. EUR allocated over the 7 years, which represents 5,5 % of whole ESIF allocation)

►

Lack of strategic planning in the field of health and coordinative management of resources

►

Political instability contributed to insufficient funding coordination Consequences

►

Spending driven approach in preference for project lacking evidence base, rather than a strategic

• ne taking into account sustainability considerations

►

Insufficient attention given to health gains when deciding on where to direct the funding

►

Lack of coordinative management function caused inefficiencies in a way that projects addressing various levels of care provision are not complementary and loose (at least partially) their benefits

►

Potential effects limited by insufficient coordination of Structural Funds projects and other development efforts, on regional level no strategy planning:

►

Investments into regional hospitals were not coordinated with investments in outpatient primary care

►

Infrastructure investments in specialized oncological centers were not coordinated with development of regional hospitals

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• 02. Partnership building

►

Insufficient involvement of relevant partners in development of strategies:

►

Health care strategy

►

Partnership Agreement

►

Operational programmes

►

Insufficient involvement of all relevant partners

►

Public

►

Experts

►

Foreign partners

►

Shortcomings in management of partners in implementation of strategies, programs and projects

►

Insufficient consultation and information sharing processes set-up

►

Unclear roles and responsibilities

►

Inflexible decision-making process

► Gain wide range of relevant partners in

preparation of key strategic documents through their careful identification and invitation [Ministry of Health]

►

Introduce formalized system for cooperation among partners, which will be consensually adopted [Ministry of Health]

►

Clearly delimit the roles and responsibilities

• f individual partners

►

Decide on the decision making process, favouring flexible forms ensuring at the same time wide acceptance

►

All key decisions and changes consult with partners and try to find consensus [Ministry of Health]

► Designate a responsible for stakeholder

management [Ministry of Health]

► Learn to understand individual partners’ and group

• f stakeholders’ needs [Ministry of Health]

Problems Recommendations

High risk of delay or refusal of a program / project realization Limitation or blocking of expected outcomes

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• 03. Capacity building

►

Lack of qualified human resources for efficient programme implementation at the Ministry of Health, especially when it plays the role of intermediate body:

►

Inadequate knowledge of relevant OP(s)

►

Inadequate skills in project and financial management

►

Lack of experience with health strategies implementation

►

High fluctuation rate of employees

►

Lack of information and guidance for applicants and beneficiaries

►

Insufficient information about publishing a call for proposals among potential health sector applicants

►

Insufficient support of applicants in the phase of project preparation and implementation

► Secure qualified and skilled MoH capacities

capable to support managing authorities in the area

• f health expertise [Ministry of Health]

► More extensive use of technical assistance

resources for education [Managing Authority, Ministry of Health as an Intermediate Body]

►

Standard staff education

►

Preparation of standard educational plans for capacities of Ministry of Health, MAs, intermediate bodies in the field of: Structural Funds, health policy, project and financial management

►

Exchange of experience and cooperation with foreign partners

►

More active role of MoH in building absorption capacity among potential beneficiaries [Ministry of Health]

►

Personal contact with beneficiaries and the staff of intermediate body/managing authority [Ministry of Health]

Problems Recommendations

Insufficient absorption capacity Limited quality and value added of funded projects Possible ineligibility of projects

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• 04. Financial planning

►

Insufficient detail of a project business case

►

Inappropriate use of various techniques for financial planning and investment appraisal

►

Cost-benefit analysis, cost-effectiveness analysis

►

Health technology assessment

►

Health impact assessment

►

Incorrect evaluation of project applications for funding where even project applications with insufficient detail and low value added of investments were accepted for funding

►

Project costs overruns which might seriously threaten project sponsor’s ability even to finish the project

►

Problems with ensuring project sustainability in case the operational costs during the sustainability phase were not planned for or identified properly

►

Require use of evidence-based approach:

►

Put emphasis on detailed and evidence based needs assessment

►

Support benchmarking where possible

►

Clearly set the main principles of financial planning and investment appraisal [MA, possibly MoH as an Intermediate body]

►

Set criteria for project applications evaluation and selection to ensure only financially realistic, achievable and cost-efficient projects are supported [MA, possibly MoH as an Intermediate body]

►

Monitor the financial performance data periodically to be able to identify any possible problems in time [MA, possibly MoH as an Intermediate body]

►

Ensure capacities with adequate knowledge and expertise in the field of financial planning of health projects and health investment appraisal methods through the capacity building process [Ministry of Health]

Problems Recommendations

Failure to achieve expected benefits Support of unsustainable projects

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• 05. Procurement management

►

Too complex and frequently changed procurement laws, disparities across OP

►

Erroneous procurement (typically in case of health instrumentation / technology purchases):

►

Discriminatory conditions

►

Not enough specific conditions

►

Unsuitable scope of the tender

►

Too broadly defined contract, combining unrelated items (excludes specialized suppliers)

►

Subdivisions of contract

►

Insufficient knowledge and experience with public procurement of contracting authorities and suppliers

►

Insufficient support of beneficiaries – contracting authorities from the side of administrative capacities

• f managing authorities / intermediate bodies

►

Define clear, concise and easy-to-follow programme-specific procurement rules, coordinated across all country’s Ops [Managing Authority]

►

Provide administrative support to beneficiaries acting as a contracting authority in form of guidebooks, templates, forms, tutorials and trainings [MA, possibly MoH as an Intermediate Body]

►

Set up sufficient administrative capacity Consider ex-ante reviews of tender specifications if sufficient expert capacities are available

►

Engage health care experts (as well as IT experts, engineers etc.) in preparation and/or review of the technical specifications [MoH as beneficiary, possibly even as an Intermediate Body, MA]

►

Require estimated value in an evidence-based manner, supported by market research and involve experts to consider the usual market prices [MoH as an Intermediate Body]

►

Avoid subdivision of related items into separate tenders, but do not link large contracts with various components into one tender [MoH as an Intermediate Body]

Problems Recommendations

Delays in project implementation Ineligibility of expenses Disruption of project implementation Loss of unrecoverable funds

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Example of consequences of erroneous procurement

Slovenia – „eZdravje“

Context of the project

►

National eHealth project has been implemented in 2007-2015

►

Procurement of technological implementation of eHealth portal funded from ESF Main problems

►

Procurement took significantly longer than expected

►

Scope of the tender defined too broadly, which excluded potential smaller and specialized suppliers

►

Scope of the tender was not specific enough, or on the contrary too discriminative with focus on a single technology to deliver services

►

Insufficient involvement of IT stakeholders in formulating procurement rules

►

Preliminary checks of tender specifications delayed significantly procurement due to insufficient capacities delayed significantly

►

Main tenders were legally challenged

Implementation of the project of major national importance is delayed with increased costs.

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• 06. Evaluation and monitoring

►

Lack of data or their insufficient quality to monitor progress made

►

Unclear definitions of indicators and resulting inconsistency in data makes it impossible to evaluate the real impact of the intervention

►

Untargeted support or support of measures, which do not lead to objective achievements

►

Inner inconsistency of supported measures

►

Inexistent identification of causes of negative consequences and of insufficient outcomes of interventions

►

Insufficient information for qualified decision- making

►

Involve Ministry of Health representatives and

• ther health care expert into the monitoring

committee [Managing Authority]

►

Select relevant and unambiguous indicators for monitoring [Managing Authority with MoH, possibly MoH as an Intermediate Body]

►

Use evaluation not only for OPs, but also for assessment of:

►

Health strategies

►

OPs’ priority axes and calls for proposal relevant for health

►

Health programs and projects [Managing Authority with MoH]

►

Improve the quality of evaluators [MA, possibly MoH as an Intermediate Body]

►

Set up the objectives of each evaluation, relevant timing and methods; evaluation should take place in all stages of the investment process [Managing Authority with MoH, possibly MoH as an IB]

►

Design measures to take in reaction to the evaluation results [Ministry of Health]

Problems Recommendations

Lack of information for projects evaluation and for better results achievement of interventions in future.

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• 07. Investment sustainability

►

Higher operational costs than expected in investment planning:

►

Too high treatment costs for using the new technologies and equipment

►

Insufficient pool of patients requiring treatment with the new thus more expensive equipment

►

Medical personnel not properly trained to use new equipment, eHealth and treatment and diagnostic methods

►

Investments do not reflect the current mid- and long- term trends in health care

►

Little attention is given to health promotion and prevention programs

►

Measure and monitor sustainability of health investment before its implementation [Managing

Authority with MoH]

►

Assess future operating costs of investment actions

►

Prioritize investment actions according to their sustainability - include “sustainability” into project selection criteria [Managing Authority

with MoH]

►

Assess sustainability in terms of availability of qualified and adequately trained human resources [Managing Authority, possibly MoH as

an Intermediate Body]

►

Promote projects aimed at:

►

Monitoring healthcare effectiveness

►

Adopting healthcare guidelines and standards (i.e. for prescriptions)

►

Reduction of unnecessary use of specialists

►

Health prevention and promotion

Problems Recommendations

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Good practice example

Sustainable investment in Finland

►

Finnish population over 75 years is expected to double by 2030 causing the current health system financially unsustainable

►

With the help of ERDF funding, an innovative and far reaching health reform model has been developed with following objectives:

►

Save at least 10 % in current operating costs of the acute hospital service

►

Double the numbers at present of the delivery of a ‘care for elderly’ service with no increase in

• perating (staff) costs

►

Key components of reform:

►

Integrate special / acute and primary care and some social services

►

Reorganize service structures within hospitals to improve effectiveness and efficiency

►

Rebuilding age care residential accommodation to provide better support and promote healthy ageing

►

Improve rehabilitation services

►

Invest in illness prevention wherever possible

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Critical success factors

Q&A

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COFFEE BREAK

11:00 – 11:15

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• IV. Specifics of complex projects management

and implementation

[Topic covered by the project outputs]

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Areas for improvement

Complex projects

Introduction

► Complex = integrated, interconnected, interdependent ► Complex projects are those that: ► Are characterized by uncertainty, ambiguity, dynamic

interfaces, and significant political or external influences; and/or

► Can be defined by effect, but not by solution

Programmes implemented under national strategies

(eHealth, reforms etc.)  Regarding the characteristics of complex projects listed above, complex projects require different management approach

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Areas for improvement

Complex projects management framework

5DPM approach introduction

►

Cost = quantifying of the scope in monetary terms

►

Project costs estimates

►

Risk assessment

►

Identification of cost drivers & constraints

►

Schedule = time factors that needs to be managed to deliver a complex project in time

►

Time schedule addressing:

►

Scope of work and sequence of work

►

Project milestones

►

Critical path and path of execution

►

Risks identified regarding schedule

►

Schedule change process

►

Key procurement and submittals ►

Quality = project overall design and set up

►

Scope of work

►

Form and composition of the project team

►

Contracts & procurement set up

►

Technical solution

►

Context = identification of all external factors impacting the project

►

Stakehoders

►

Other issues such as environmental, legal, global as well as local

►

Financing = identification of financing sources

►

Public vs. private sources of funding

►

Eligibility for funding under ESIF

Traditional three-dimensional project management Five-dimensional project management

Schedule Cost Quality / Technical Schedule Cost Quality / Technical Context Financing

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Areas for improvement

Implementation of complex projects

Main principles

►

Strategic context

►

Framework for the programme set up and financing

►

Financial planning

►

Funding scheme

►

Long-term investments VS annual budget requirements

►

Tools such as cost-effectiveness analysis (CEA), Data envelopment analysis (DEA), HTA, sustainability analysis

►

Proper project definition

►

Action plan for each priority

►

Introduction of risk management

►

Project management framework & capacities

►

Project team selection & maintaining

►

Management principles set up

►

Project management structure (project managers, working groups, Steering committee)

►

Coordination of activities

►

Overall coordination of project activities designated to one coordinator

►

Relevant indicators for proper monitoring

►

EU level indicators

►

Specific indicators reflecting national specifics

►

Appropriate timing

►

Periodical monitoring of project status

Capital investment planning Capital investment implementation

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Complex projects implementation

Lessons learned from Slovenia

►

Research of previous projects

►

Lesson learned from them

►

Possible use of their components or follow- up

►

Project based on specific documentation developed prior to its start (nation eHealth strategy, feasibility study)

►

Partnership principle

►

Funding agreement as part of a long term plan of needs put together by the main stakeholders

►

Special project management framework designed to advance the project

►

Project management framework developed to feature consultation and decision-making among key stakeholders

►

Collaboration between ministries in operating eHealth network

►

Precise time framework

►

Procurement process took much more time than originally planned

►

Attract stakeholders from all areas involved

►

Lack of a fuller engagement with the IT industry as a stakeholder

►

Set project management priorities

►

Create sufficient team

►

Prepare realistic tenders not of too large scope, with clear specification

►

Secure qualified staff to manage the project and subject matter experts

Areas for improvement Successful steps Areas for improvement

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Complex projects implementation

Lessons learned from Hungary

►

Critical factor perspective applied

►

Evidence based approach used in project preparation

►

Flexibility to improve project efficiency

►

Broad scale assessment of projects

►

Coordination tools introduced

►

Need of a broadly accepted and well-known health care strategy logged into the political process

►

Do not underrate sustainability studies, quantitative modelling

►

Capacity planning

►

Coordination between the projects addressing the various care provision levels

►

Strategic planning should not be vulnerable to disruptions caused by changes in political direction

Successful steps Areas for improvement Successful steps Areas for improvement

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• V. Principles of effective project application

assessment and relevant indicators in health projects

[Topic covered by the project outputs]

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Project application assessment

General background

►

Assessment is a process in which submitted applications are checked and evaluated against a set of criteria in aim to select projects:

►

Eligible for funding under a given call

►

With sufficient certainty regarding the ability of the recipient to implement the project

►

Contributing to the OP’s objectives

►

Four types of evaluation should be covered by an assessment process:

►

Administrative check (formal requirements)

►

Eligibility check (compliance with the goals of the call)

►

Quality assessment (project necessity, cost appropriateness, effectiveness, sustainability, management capacities, relevance of indicators)

►

Risk assessment (analysis and incorporation of mitigation actions)

►

Two types of assessment model taking into account the size and type of a project:

►

Single step assessment for small and easy- to-assess projects (e.g. in case of a large number of similar projects)

►

Two- or multi-steps assessment which is more demanding on time and expertise of evaluators

►

Expertise and quality of evaluators for assessment:

►

Administrative and eligibility check to be done by people skilled in specifics of the OP (European Funds department of MoH)

►

Quality and risk assessment shall be conducted by experts with relevant experiences with the field of the project scope

►

Exclusion, eligibility and evaluation criteria could support evaluators in the whole process

►

Selection of projects based on a degree of fulfillment of each of the criterion. Their importance should be projected into the weights.

Definition and types Important factors

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►

Put emphasis on properly conducted need assessment:

►

Introduce formalized practices how to prove necessity of the project

►

Require long/term prognoses of key factors to ensure long-term sustainability of the project (especially important in health care projects)

►

Develop methodology on needs assessment relevant for the field of investments (call) and develop guideline for project applicants

►

Assign relevant weight to this criterion in overall scale

►

Require detailed feasibility study proving sustainability of the solution

►

Expert assessment of quality of the study shall be essential

►

Assess competencies of nominated project team

►

Project management, financial management, expert knowledge etc.

►

Sufficient knowledge and experience in relevant areas

►

Require risk analysis and assess detail of the analysis conducted and mitigation actions suggested by the analysis

►

Improve evaluation of project sustainability:

►

Especially in case of large and important investments, consult experts from practice

►

Formalize approach to project sustainability assessment by developing methodology for proving and assessing project sustainability

►

Consider sustainability also from long term point of view [five years horizon is not sufficient especially in strategic health projects]

►

Assign relevant weight to project sustainability, so that it reflects importance of this criterion

►

Support applicants in the process of project (application) development:

►

Provide consultations to potential beneficiaries

►

Review applications before submitting especially procurement set up and financial adequacy [applicable especially on large and strategic projects]

Project application assessment

Recommendations

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►

Fund-specific indicators

►

Financial indicators relating to expenditure allocated

►

Output indicators relating to the operations supported (per priority axes).

►

Result indicators relating to the priority concerned

►

Programme-specific indicators

►

Should the fund-specific indicators be insufficient to measure supported actions they can be completed with programme-specific output indicators

►

Common specific indicator for ERDF actions specifically defined for health:

►

Population covered by improved health services [persons, no multiple counting]

►

Specific indicators to monitor health care actions to evaluate health investments in a more focused way. They list can be developed based on:

►

ECHI – European Core Health Indicators (indicators aiming to create a comparable health information and knowledge system to monitor health at EU level)

►

Eurostat database

►

WP 3 (3): Set of indicators useful for final evaluation of actions

Relevant indicators in health projects

Types of indicators

►

Output indicators

►

Limited set of indicators defined at fund level

►

A list of common output indicators is defined for both ERDF and ESF, and the indicators used in OPs are to be chosen primarily from this list

►

Programme-specific indicators designed by the Member States and Managing Authorities

►

Result indicators

►

Result indicators express the change sought by a specific objective

►

For each specific objective, one or a few result indicators are defined

Indicators to monitor health care actions

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Indicators per main categories of health actions

Access to healthcare

Category / Indicator Measurement unit

Hospital care

Proportion of people (all population) with self-declared unmet needs for healthcare services due to either financial barriers, waiting times or travelling distances % of population Proportion of people whose highest level of education is ISCED 0, 1, or 2 with self-declared unmet needs for healthcare services due to either financial barriers, waiting times or travelling distances % of population with highest level of education is ISCED 0, 1, or 2 Proportion of people in the first quintile of equalized income (20 % lowest income group) with self-declared unmet needs for healthcare services due to either financial barriers, waiting times

• r travelling distances

% of population in the first quintile of equalized income Proportion of people (all population) with self-declared unmet needs for dental care services due to either financial barriers, waiting times or travelling distances % of population % of women aged 50 - 69, whose highest level of education is ISCED class 0, 1 or 2 (lower secondary), reporting a mammography in the past two years % of women with highest level of education is ISCED class 0, 1 or 2 Percentage of persons (aged 50-74), whose highest level of education is ISCED class 0, 1 or 2 (lower secondary), reporting a colorectal cancer screening in the past two years % of population with highest level of education is ISCED 0, 1, or 2 Waiting time for certain types of surgeries Cancer treatment delay

Access to primary care

Number of inhabitants per one general practitioner, by region Number of inhabitants Number of women per one gynecologist, by region Number of women Number of inhabitant per one dentist, by region Number of inhabitants

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Indicators per main categories of health actions

Health infrastructure & community based care

Category / Indicator Measurement unit

Hospital care

Standardized rate of hospitalization Number of hospital admissions per 100 000 inhabitants In-patient average length of stay in days, all diagnosis Average duration in days of a single episode of hospitalization in a hospital per discharged in-patient In-patient average length of stay in days, for individual diagnosis groups Average duration in days of a single episode of hospitalization in a hospital per discharged in-patient

Hospital care capacities

Hospital beds per 100 000 inhabitants Number of beds Long-term hospital beds per 100 000 inhabitants Number of beds Psychiatric hospital beds per 100 000 inhabitants Number of beds Acute care hospital beds per 100 000 inhabitants Number of beds

Transition to community-based care, development of long-term care and after care

Persons, to whom care has been provided in a community / at home / in a nursing house* Number of persons Percentage of persons discharged from hospital who are readmitted within 30 days Percentage of discharged persons

Primary and ambulatory care

Percentage of ambulatory physicians on total number of physicians % of physicians Percentage of general practitioners in outpatient care % of physicians Percentage of ambulatory specialists in outpatient care % of physicians Percentage of illness cases where the first point of contact is a general practitioner % of illness cases

* To monitoring of transition or change, also indicators expressing change in demand could be used.

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Indicators per main categories of health actions

Health workforce

Indicator Measurement unit

Practicing physicians Number per 100 000 inhabitants Practicing nurses Number per 100 000 inhabitants Percentage of physicians aged 35 years and younger % of physicians, all specializations Percentage of physicians aged 55 years and older % of physicians, all specializations Percentage of nurses aged 35 years and older % of nurses Percentage of nurses aged 55 years and older % of nurses Average age of general practitioners Average age in years Number of jobs created in health care sector Equivalent of full time jobs Number of jobs created in health care sector for qualified workforce holding post- secondary degree Equivalent of full time jobs Shortage of physicians (nationwide, regional) Vacancy rate Percentage of care not covered Shortage of dentists Vacancy rate Percentage of care not covered

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Indicators per main categories of health actions

Health status

Indicator Description / measurement unit

Life expectancy at birth (total population, men / women) Average number of years of life remaining at birth Life expectancy at 65 years of age (total population, men / women) Average number of years of life remaining at the age of 65 Healthy life years Expected remaining number of years, lived from a particular age without long-term activity limitation Infant mortality rate Ratio of the number of death of infants per 1000 live births Diabetes incidence % of persons with diabetes diagnosed in the past 12 months Cancer incidence Incidence per 100 000 inhabitants Acute myocardial infarction incidence Incidence per 100 000 inhabitants Depression incidence Proportion of people reporting diagnosed chronic depression in the past 12 months General musculoskeletal pain Proportion of people reporting to experience general musculoskeletal pain Long-term activity limitations Proportion of people reporting to have long term restrictions in daily activities Self-perceived health Proportion of people who assess their health to be good or very good

Page 41

Indicators per main categories of health actions

eHealth

Category / Indicator Measurement unit

ICT infrastructure

Physicians using a computer % of physicians Physicians using a computer during consultation (to display a patient's file, to get supporting information when making treatment or medication decisions) % of physicians Physicians with broadband connection with speed above 50 MBps % of physicians Physicians having a website % of physicians Physician using email to communicate with patients % of physicians

Use of eHealth applications

Physicians with an electronic appointment booking system % of physicians Physicians using electronic storage of patient’s data % of patients Use of electronic networks for transfer and exchange of patient medical data (i.e. exchange of clinical information, laboratory results, medication information etc.) % of physicians / % of patients Use of electronic networks for transfer and exchange of patient administrative data (i.e. for reimbursement purposes between care providers and health insurance companies) % of physicians / % of patients Physician with integrated system to send electronic discharge letters % of physicians Physicians with an integrated system for tele-medicine (tele-radiology, tele-homecare/tele-monitoring services to

• utpatients)

% of physicians Physicians monitoring patients remotely at their home % of physicians Physicians using electronic networks to transfer prescriptions electronically to dispensing pharmacist (ePrescribing) % of physicians

Data security

% of physicians using coded data to store and exchange information % of physicians % of physicians using e-signatures % of physicians

Page 42

Indicators per main categories of health actions

Prevention, promotion and healthy aging 1/2

Category / indicator Description / measurement unit

Prevention

Brest cancer screening % of women aged 50 - 69 reporting a mammography in the past two years Cervix cancer screening % of women aged 50 - 69 reporting a cervix cancer screening in the past two years Colorectal cancer screening % of persons (aged 50-74) reporting a colorectal cancer screening in the past two years Influenza vaccination in elderly Proportion of persons aged 65 and over reporting to have received one shot of influenza (flu) vaccine during the last 12 months Vaccination coverage in children Percentage of infants reaching their first birthday in the given calendar year who have been fully vaccinated against diphtheria, tetanus, pertussis, poliomyelitis, haemophilius influenza type b or Hepatitis B and those reaching their second birthday in the given calendar year who have been fully vaccinated against measles, mumps and rubella

Preventive health determinants

Regular smokers Proportion of persons aged 15+ reporting to smoke cigarettes daily Alcohol abuse Liters of pure alcohol consumer per persons aged 15+ per year Physical activity Proportion of persons aged 15+ reporting practice of daily physical activity Obesity: Body mass index Proportion of adult persons who are obese, i.e. their body mass index is equal or bigger than 30. Blood pressure Proportion of persons reporting diagnosed high blood pressure (hypertension) in the last 12 months

Occupational health

Work injuries Standardized incidence rate of accidents at work per 100 000 workers Work-related health problems Percentage of workers reporting work-related health problems in the past 12 months Workers off work at least 1 month due to accidents at work and work-related health problems in the past 12 months Sick leave Number of sick leave cases per 100 000 workers Average length of 1 episode sick leave in days Work safety Number of employed persons who would stay longer at work if their workplace was healthier and/or safer

Page 43

Indicators per main categories of health actions

Prevention, promotion and healthy aging 2/2

Category / indicator Description / measurement unit

Active and healthy ageing

Employment rate of workers aged 55-64 Proportion of people aged 55-64 in employment. Population with health-related restrictions Proportion of people reporting to have long-term restrictions in daily-activities Physical activity Proportion of persons aged 55+ reporting practice of daily physical activity Dementia / Alzheimer incidence Incidence per 100 000 inhabitants Influenza vaccination in elderly Proportion of persons aged 65 and over reporting to have received one shot of influenza (flu) vaccine during the last 12 months Promotion programmes* Policies of healthy nutrition N/A, under development Policies and practices on health lifestyles N/A, under development Integrated programmes in workplace, schools, hospitals N/A, under development

* Indicators under this category are currently being developed as a part of the ECHI initiative

Page 44

LUNCH BREAK

13:00 – 14:00

Page 45

• VI. Health funding potential in 2014-2020

programming period

(i) Introduction of ESIF implementation structure in Portugal

[EY understanding]

Page 46

Key areas of our interest:

• 1. General introduction of ESIF implementation structure (system of MA, IBs,

Certifying Authority, Audit bodies etc.)

• 2. Introduction to existing coordination tools/mechanisms in between development &

implementation of OPs

Introduction to ESIF implementation structure in 2014-2020

Page 47

Implementation structure and MoH involvement

Factual background

► There are four national Operational Programmes and seven

regional Operational Programmes in Portugal

►

Five mainland regional programmes

►

Two OPs for autonomous regions of Azores and Madeira Q1: What is the specific role of MoH with respect to preparation and implementation of the above mentioned OPs? Q2: What national Operational Programme does directly address health care issues? Q3: Are there any health related issues reflected in the regional OPs?

Page 48

• VI. Health funding potential in 2014-2020

programming period (ii) Health specifics in 2014-2020 programming period [EY interpretation]

Page 49

2014-2020 health context 1/2

ESIF level

► Health is eligible for funding under 2014 – 2020. However there is

no thematic objective exclusively dedicated to health.

► Health related issues could be identified in most of the 11 thematic

• bjectives

►

Direct investments

►

Investments directly targeted on health care (HC) issues and reforms;

►

Eligibility for funding has been formally approved;

►

within direct investments MoH is usually formally involved in implementation.

►

Indirect investments

►

Investments not directly targeted on HC, i.e. health care is not considered as the main beneficiary, but health care subjects might apply for funding from them;

►

MoH usually has no formal competencies in implementation of this group.

Page 50

2014-2020 health context

Scheme of 2014-2020 health investment framework

TO 1 National strategic framework

European strategic framework

EUROPE 2020 EU policies TO 2 TO 3 … TO 10 TO 11 TO 9 Ministry of Health Hospitals General practitioners Medical universities Providers of specialized care Emergency service Medical R&D institutions Medical staff OP 1 OP2 OP 3 OP 7 OP 8 OP 6 TO 4 TO 5 MoH

Illustrative scheme

Page 51

2014-2020 health context 2/2

ESIF level The aim of the Ministries of Health (resp. of Ministries of Social affairs where applicable) shall be to maximize utilization of ESIF

• pportunities for health care under legal conditions (EC Guidelines,

3E) and with respect to Europe 2020 as well as national strategic framework (incl. Partnership Agreement).

Page 52

• V. Principles of effective coordination:

(i) Role of MoH as a coordinator of health care

[Topic covered by the project outputs]

• VI. Health funding potential in 2014-2020

programming period (iii) Potential health issues under thematic objectives

Page 53

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

TO 1 Strengthening research, technological development and innovation

►

Innovation in health

►

Research in development of new detection methods and treatments

►

Collaborative research in rare diseases

►

Support research and related IT infrastructures including support to health information systems

Potential health issues under TO 1?

►

Enhancing research and innovation (R&I) infrastructure and capacities to develop R&I excellence, and promoting centers of competence, in particular those of European interest

►

Promoting business investment in R&I, developing links and synergies between enterprises, research and development centres and the higher education sector, in particular promoting investment in product and service development, technology transfer, social innovation, eco-innovation, public service applications, demand stimulation, networking, clusters and open innovation through smart specialisation, and supporting technological and applied research, pilot lines, early product validation actions, advanced manufacturing capabilities and first production, in particular in key enabling technologies and diffusion of general purpose technologies

Investment priorities under given thematic objective:

Page 54

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

TO 2 Enhancing access to and, use and, quality of information and communication technologies

►

Strengthening ICT applications for e-Health (investment priority)

►

e-Health solutions compatible with EU standards ensuring (cross-border) interoperability of IT systems

►

Use of uniform electronic health care information system

►

Creation of legal basis for e-Health

►

Improvement of IT Tools for coordination of response to health threats

►

Development of ICT based solutions and services for needs of an ageing population

Potential health issues under TO 2?

►

Extending broadband deployment and the roll-out of high-speed networks and supporting the adoption of emerging technologies and networks for the digital economy

►

Developing ICT products and services, e-commerce, and enhancing demand for ICT

►

Strengthening ICT applications for e-government, e-learning, e-inclusion, e-culture and e-health

Investment priorities under given thematic objective:

Page 55

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

TO 3 Enhancing the competitiveness of SMEs

►

Promote awareness among SMEs on “white sector” business opportunities and know-how

►

Support SMEs' businesses addressing the needs of old people, or 'age-friendly' businesses (e.g. providing personalised care, assisting in functional physical or cognitive decline, improving old people's health literacy), including senior start-ups and entrepreneurship

►

Encourage private and public enterprises to play a larger role in public-private partnerships in 'age- friendly' areas

Potential health issues under TO 3?

►

Promoting entrepreneurship, in particular by facilitating the economic exploitation of new ideas and fostering the creation of new firms, including through business incubators

►

Developing and implementing new business models for small and medium-sized enterprises (SMEs), in particular with regard to internationalisation

►

Supporting the creation and the extension of advanced capacities for product and service development

►

Supporting the capacity of SMEs to grow in regional, national and international markets, and to engage in innovation processes

Investment priorities under given thematic objective:

Page 56

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

TO 4 Supporting the shift towards a low-carbon economy in all sectors

►

Support energy efficiency of health care facilities

►

Assisting low-income communities and the elderly with energy efficiency improvements

►

Support actions to help reduce the use of domestic solid fuels (coal and wood) which create indoor air pollution and negatively effects health

Potential health issues under TO 4?

►

Promoting the production and distribution of energy derived from renewable sources

►

Promoting energy efficiency and renewable energy use in enterprises

►

Supporting energy efficiency, smart energy management and renewable energy use in public infrastructure, including in public buildings, and in the housing sector

►

Developing and implementing smart distribution systems that operate at low and medium voltage levels

►

Promoting low-carbon strategies for all types of territories, in particular for urban areas, including the promotion of sustainable multimodal urban mobility and mitigation-relevant adaptation measures

►

Promoting the use of high-efficiency co-generation of heat and power based on useful heat demand

►

Promoting research in, innovation in and adoption of low-carbon technologies

Investment priorities under given thematic objective:

Page 57

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

TO 5 Promoting climate change adaptation, risk prevention and management

►

Increase investments in risk prevention and management, including protection, preparedness, response and recovery that have positive impact on human health

►

Creation of early warning systems and health care investments for disasters and climate-related events and adaptation

►

Support water efficiency in health care buildings to reduce water scarcity

►

Investments to reduce flooding of health care facilities

Potential health issues under TO 5?

►

Supporting investment for adaptation to climate change, including ecosystem-based approaches

►

Promoting investment to address specific risks, ensuring disaster resilience and developing disaster management systems

Investment priorities under given thematic objective

Page 58

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

TO 6 Preserving and protecting the environment and promoting resource efficiency

►

Investing in waste sector management to support protection from dangerous medical waste

►

Increase actions that reduce potential health risks of contaminated sites

Potential health issues under TO 6?

►

Investing in waste sector to meet the requirements of the Union's environmental acquis and to address needs, identified by the Member States, for investment that goes beyond those requirements

►

Investing in the water sector to meet the requirements of the Union’s environmental acquis and to address needs, identified by the Member States, for investment that goes beyond those requirements

►

Protecting and restoring biodiversity, soil protection and restoration and promoting ecosystem services, including Natura 2000 and green infrastructures

►

Taking actions to improve the urban environment, revitalisation of cities, regeneration and decontamination of brownfield sites (including conversion areas), reduction of air pollution and promotion of noise-reduction measures

►

Conserving, protecting, promoting and developing natural and cultural heritage

►

Promoting innovative technologies to improve environmental protection and resource efficiency in the waste sector, water sector and with regard to soil, or to reduce air pollution

►

Supporting industrial transition towards a resource-efficient economy, promoting green growth, eco-innovation and environmental performance management in the public and private sectors Investment priorities under given thematic objective:

Page 59

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

TO 7 Promoting sustainable transport and removing bottlenecks in key network infrastructures

►

Improve connectivity (e.g. through infrastructure) and mobility to enhance access to health services

►

Gain health benefits through enhanced safety levels of transport networks

►

Support greener infrastructure to reduce obesity and create healthier lifestyles, particularly for the youth

Potential health issues under TO 7?

►

Supporting a multimodal Single European Transport Area by investing in the Trans-European Transport (TEN-T) Network

►

Developing and improving environmental-friendly (including low-noise) and low-carbon transport systems, including inland waterways and maritime transports, ports, multimodal links and airport infrastructure, in order to promote sustainable regional and local mobility

►

Developing and rehabilitating comprehensive, high quality and interoperable railway systems, and promoting noise-reduction measures

►

Enhancing regional mobility by connecting secondary and tertiary nodes to TEN-T infrastructure, including multimodal nodes

►

Improving energy efficiency and security of supply through the development of smart energy distribution, storage and transmission systems and through the integration of distributed generation from renewable sources

Investment priorities under given thematic objective

Page 60

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

TO 8 Promoting employment and supporting labour mobility

►

Access to employment for job- seekers and inactive people, including the long-term unemployed and people far from the labour market, also through local employment initiatives and support for labour mobility

►

Sustainable integration into the labour market of young people, in particular those not in employment, education

• r training, including young people at risk of social exclusion and young people from marginalised communities,

including through the implementation of the Youth Guarantee

►

Self-employment, entrepreneurship and business creation including innovative micro, small and medium sized enterprises

►

Equality between men and women in all areas, including in access to employment, career progression, reconciliation

• f work and private life and promotion of equal pay for equal work

►

Adaptation of workers, enterprises and entrepreneurs to change

►

Active and healthy ageing

►

Modernisation of labour market institutions, such as public and private employment services, and improving the matching of labour market needs, including through actions that enhance transnational labour mobility as well as through mobility schemes and better cooperation between institutions and relevant stakeholders

►

Supporting the development of business incubators and investment support for self-employment, micro-enterprises and business creation

►

Supporting employment-friendly growth through the development of endogenous potential as part of a territorial strategy for specific areas, including the conversion of declining industrial regions and enhancement of accessibility to, and development of, specific natural and cultural resources

►

Supporting local development initiatives and aid for structures providing neighbourhood services to create job

►

Investing in infrastructure for employment services Investment priorities under given thematic objective:

Page 61

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

TO 8 Promoting employment and supporting labour mobility

►

Supporting adequate and qualified health workforce in all areas through adaptation and training and promotion of labour mobility

►

Active and healthy ageing measures

►

Health and human capital - supporting employment through healthy workers

►

Promotion of healthy life style and disease prevention

►

Health at the workplace

►

Supporting healthy and safe working conditions and prevent work-related injuries Potential health issues under TO 8?

Page 62

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

TO 9 Promoting social inclusion and combating poverty

►

Active inclusion, including with a view to promoting equal opportunities and active participation, and improving employability

►

Socio-economic integration of marginalized communities such as the Roma

►

Combating all forms of discrimination and promoting equal opportunities

►

Enhancing access to affordable, sustainable and high-quality services, including health care and social services of general interest

►

Promoting social entrepreneurship and vocational integration in social enterprises and the social and solidarity economy in order to facilitate access to employment

►

Community-led local development strategies

►

Investing in health and social infrastructure which contributes to national, regional and local development, reducing inequalities in terms of health status, promoting social inclusion through improved access to social, cultural and recreational services and the transition from institutional to community-based services

►

Providing support for physical, economic and social regeneration of deprived communities in urban and rural areas

►

Providing support for social enterprises

►

Undertaking investment in the context of community-led local development strategies

Investment priorities under given thematic objective:

Page 63

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

►

Active inclusion improving employability

►

Integration into the labour market of people with disabilities, mental disorders, chronic disease

►

Enhancing access to affordable, sustainable and high-quality services, including health care (reducing inequalities in terms of health status)

►

Equitable access to affordable care and medication

►

Promote active involvement of patients and their empowerment

►

Access to acceptable standards of housing and hygiene

►

Investing in health and social infrastructure

►

Contributing to cost-effectiveness and sustainability of health systems

►

Supporting specialization and concentration of hospital care

►

Transition of hospital based care to community based care

►

Strengthening of primary and ambulatory care

►

Deinstitutionalization of long-term care, after care and mental care / home care strengthening

TO 9 Promoting social inclusion and combating poverty

(Potential) Health issues under TO 9?

Page 64

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

TO 10 Investing in education, skills and lifelong learning

►

Reducing and preventing early school-leaving and promoting equal access to good quality early-childhood, primary and secondary education including formal, non-formal and informal learning pathways for reintegrating into education and training

►

Improving the quality and efficiency of, and access to, tertiary and equivalent education with a view to increasing participation and attainment levels, especially for disadvantaged groups

►

Enhancing equal access to lifelong learning for all age groups in formal, non-formal and informal settings, upgrading the knowledge, skills and competences of the workforce, and promoting flexible learning pathways including through career guidance and validation of acquired competences

►

Improving the labour market relevance of education and training systems, facilitating the transition from education to work, and strengthening vocational education and training systems and their quality, including through mechanisms for skills anticipation, adaptation of curricula and the establishment and development of work-based learning systems, including dual learning systems and apprenticeship schemes

►

Investing in education, training and vocational training for skills and lifelong learning by developing education and training infrastructure

►

Tertiary education delivering workforce sufficient in numbers as well as in qualification, reflecting the shortages of certain specializations (i.e. General Practitioners)

►

Adjustment of education system to deliver sufficient nursing staff (sufficient numbers as well as with sufficient qualification to provide certain types of care independently)

►

Lifelong training to adjust workforce skills – eHealth, new treatment and diagnostic methods

Potential health issues under TO 10?

Investment priorities under given thematic objective

Page 65

Health funding potential under specific thematic

• bjectives in 2014 – 2020 programming period

TO 11 Enhancing institutional capacity and ensuring an efficient public administration

►

Capacity building in health administration: actions to support institutional and management capacities of health administration

►

Actions to increase efficiency of health administration in particular to design and deliver health system reforms and increase its efficiency, quality and sustainability

►

Actions to enhance cross border cooperation of MS in health area

Potential health issues under TO 11?

►

Enhancing institutional capacity of public authorities and stakeholders and efficient public administration through actions to strengthen the institutional capacity and the efficiency of public administrations and public services related to the implementation of the ERDF, and in support of actions under the ESF to strengthen the institutional capacity and the efficiency of public administration

►

Enhancing institutional capacity of public authorities and stakeholders and efficient public administration through actions to strengthen the institutional capacity and the efficiency of public administrations and public services related to the implementation of the Cohesion Fund

►

Investment in institutional capacity and in the efficiency of public administrations and public services at the national, regional and local levels with a view to reforms, better regulation and good governance

►

Capacity building for all stakeholders delivering education, lifelong learning, training and employment and social policies, including through sectoral and territorial pacts to mobilise for reform at the national, regional and local levels Investment priorities under given thematic objective

Page 66

VII. Group activity

Page 67

►

Activity objective:

►

Complex mapping of health investments potential under ESIF and beneficiaries that can be supported through individual priority axes of the Operational Programme for Cohesion Policy Funds 2014-2020.

►

Activity description:

►

The activity is designed for three groups.

►

Each group will get selected OP/OPs with their Priority Axes names and based on the previous presentation shall develop a list of:

►

Which health activities can be supported under individual priority axes?

►

Who are potential beneficiaries of every identified activity? ►

Timing:

►

25 minutes to discuss group solutions

►

• Approx. 45 minutes for presentation & discussion

►

Based on the presentation of each group, we expect to open discussion on wide range of possible health investments that could be supported in 2014-2020 programming period.

Group activity

Page 68

Group activity - handout

Group 1

OP Competitiveness and Internationalization

2 5 6 7

9 10 11

4 8 3 1

PA 1 – Strengthening research, technological development and innovation PA 2 – Strengthening the competitiveness of SMEs including reducing public costs

Operational Programme, Priority Axis TC Health areas with funding potential Beneficiaries

PA 3 – Promoting sustainability and quality of employment PA 4 – Promoting sustainable transport and removing bottlenecks in key network infrastructures PA 5 – Strengthening the institutional capacity of public authorities and stakeholders and efficiency of public administration

Page 69

Group activity - handout

Group 2

2 5 6 7

9 10 11

4 8 3 1

Operational Programme, Priority Axis TC Health areas with funding potential Beneficiaries OP Human Capital

PA 1 – Promoting educational success, combating school dropout and enhancing the skills of youth for employability PA 2 – Strengthening the higher education and advanced training PA 3 – Enabling lifelong learning and increasing employability PA 4 – Quality and innovation in education and training system

OP Sustainable Development and Efficient Use of Natural Resources

PA 1 – Supporting the transition to a low carbon emissions in all sectors PA 2 – Adapting to climate change, prevention and management of risks PA 3 – Protecting the environment and promoting resource efficiency

Page 70

Group activity - handout

Group 3

OP Social Inclusion and Employment

2 5 6 7

9 10 11

4 8 3 1

PA 1 – Promoting sustainability and job quality PA 2 – Youth Employment Initiative

Operational Programme, Priority Axis TC Beneficiaries

PA 3 – Promoting social inclusion and combating poverty and discrimination

Health areas with funding potential

Page 71

Introduction to group activity solution

Page 72

► Seven regional Operational Programmes in Portugal:

►

Only OP Azores will support activities from all thematic objectives

►

All regional OPs will support activities from TO 8: Promoting sustainable and quality employment and supporting labour mobility and TO 9: Promoting social inclusion, combating poverty and any discrimination

►

None of regional OPs (except of OP Azores) will focus on Enhancing access to, and use and quality of, ICT (TO2) Q1: What are the main health topics in the regions? Q2: What are other possible health areas in the regions? Q3: Why none but one OP focuses on thematic objective 2 (ICT)?

Follow up to the group activity

Page 73

• VIII. Feedback and conclusion

Page 74

Discussion on possible follow up

What are the possible follow up activities to the session today?

Page 75

Thank you for your participation!

Dagmar Svobodova Senior consultant, Advisory services Dagmar.Svobodova@cz.ey.com

Romana Smetankova Senior manager, Advisory services Romana.Smetankova@cz.ey.com

Page 76

Appendices

Page 77

Appendix 1: Project outputs

Page 78

WP1 Mapping report

Mapping report

WP1

►Objective:

► Give a complete picture of health investment under Structural Funds / ESIF in EU Member States for the period 2007 – 2013 and the period 2014 – 2020 (planned actions) ► Provide entry information for the Guide, the Toolkit and the Roll-out phase

►Activities:

►Collect information on health investment under SF made in 2007 – 2013 in individual Member States, including total allocations of SF for health investment and examples of concrete projects ►Interviews with MAs / Ministries of Health representatives on past investment as well as future priorities ►Analysis of draft Partnership Agreements when available ►Analysis of draft operational programmes when available

►Deliverable:

► Report summarizing areas of health investment under SF / ESIF, identifying main categories of investment in 2007 – 2013 and main priorities for 2014 – 2020 ► Country sheets describing health investment in individual Member States



The mapping report is still in a draft version and updated on an ongoing basis – based on developments in negotiations with the EC and information gathered during national workshops.



The final version shall become publically available on February 2015.

Page 79

WP2 Guide for effective ESIF investments in health

Guide

►Objective:

► Elaborate a practical Guide for Member States’ authorities that will enhance effectiveness of investment in health in the programming period 2014-2020

►Activities:

► Analysis of a set of case studies on health investment ► Interviews with managing authorities and Ministries of Health on successful and even unsuccessful projects and their experience ► Identification of critical success factors ► Summary of lessons learned (Do’s and Don’ts) ► Design of a set of recommendations

►Deliverable:

► Recommendations on practices that lead to efficient setup of actions in health area financed from ESI Funds under the new programming period 2014 - 2020

WP2



The guide is a live document updated based on expert reviews and information gathered during national workshops.



The final version shall become publically available on December 2014.

Page 80

Guide for effective ESIF investments in health

Structure

Part I: Theoretical background

► Today’s EU health systems ► Challenges ► Sustainable concepts ► Health funding

in 2014 - 2020 PP

► Funding principles ► Health actions under

thematic objectives

Part II: ESIF programming & implementation

► Models of MoH involvement in

the operational programmes

► Intermediate body ► Subject matter expert

► MoH involvement in OP

delivery:

► Calls for proposals ► Projects preparation and

delivery

► Evaluation & monitoring

Part III: Lessons learned

► Main causes of investment

inefficiency

► Recommendations in areas

considered as critical success factors based on case studies, interviews and EY’s experience

► Case studies summary WP2

Page 81

WP3 Technical toolkit

Technical toolkit

► Objective:

► Develop a set of tools supporting the national authorities in achieving sustainable and effective investments in health under ESI Funds, which accompany the Guide

► Deliverable:

► Set of documents providing a technical advice on key issues related to investments in health under ESI Funds

► Technical areas covered by the Toolkit:

► Introduction of 2014 – 2020 instruments & mechanisms and evaluation of their relevance for health area ► Reference checklist on calls for proposals for officials involved in managing 2014 – 2020 funding in health ► Useful indicators for objective evaluation of projects/actions in healthcare ► Compendium of new concepts and models in healthcare ► Capital investment management manual ► Appraisal techniques and evaluation of their relevance for health investment evaluation



The Toolkit documents are still in a draft version, open to updates based on information and MS requirements identified during national workshops.



The final version shall become publically available on December 2014.

WP3

Page 82

WP3 Technical toolkit 1/6

Categorization of instruments and mechanisms for 2014-2020 PP

WP3

Instruments

► Forms of support under ESIF

► Grants and prizes ► Financial instruments

► Specific territorial approaches to

development under ESIF

► Integrated approach to territorial

development (CLLD, ITI, Integrated Sustainable Urban Development)

► European Territorial Co-operation

► Community programmes

► Horizon 2020 ► Health Programme

Mechanisms

► Funding mechanisms

► Delivering the Europe 2020 strategy

goals

► Synergies, coordination and

complementarities

► Thematic concentration ► Strong result orientation ► Performance reserve based approach

► Cohesion policy principles

► Concentration ► Programming ► Partnership ► Additionality

Page 83

WP3 Technical toolkit 2/6

Reference checklist: Success factors for calls for proposals

WP3

Management of calls for proposals

► Preparation of an indicative timetable

for calls

►

OP Performance framework, milestones values

►

Absorption capacity

►

Synergies and complementarities ► Set-up and public announcement of

individual calls

►

Use targeting on specific health themes

►

Raise awareness among heath entities about funding possibilities ► Evaluation of calls

►

Reassessment and update of calls timetable and their focus

Project applications assessment

► Assessment process

►

administrative check

►

eligibility check

►

quality assessment ► Design of quality assessment criteria

►

Impact on cost-efficiency and sustainability

►

Capacity to reduce inefficiencies in access to care and health status

►

Need for the project (relevance)

►

“Value for money”

►

Feasibility ► Risk analysis ► Selection of projects for funding ► Award of funding

Page 84

WP3 Technical toolkit 3/6

Set of indicators for final evaluation of action

WP3

Indicators in ESIF context

► Operational Programmes indicators

►

Financial indicators

►

Output indicators

►

Result indicators ► Requirements on Output indicators

►

Common output indicators

►

Programme specific output indicators ► Requirements on Result indicators

►

Responsive to policy

►

Normative

►

Robust

►

Data collection possible in timely manner

Indicators to evaluate ESIF health action

► Indicators per main categories of health

actions eligible for ESI funding*

►

eHealth

►

Health infrastructure & community based care

►

Access to healthcare

►

Health workforce

►

Prevention, promotion and healthy aging

►

Health status

* Indicators based mainly on existing indicators monitored by:

►

Eurostat

►

DG Sanco (European Community Health Indicators - ECHI)

►

National statistical offices

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WP3 Technical toolkit

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Compendium of (new) concepts and models

WP3

Use of information technologies Clinical and prescription guidelines and models Population-oriented concepts Other

► eHealth concepts

►

Electronic health records

►

ePrescription

►

Telehealth & mHealth ► Networking and

knowledge sharing

► DRG model ► Cost-effective use of

medicines

► Deinstitutionalization

►

Cost-effective path

• f care

►

Community-based care, personalized medicine and long- term care

► Active and healthy

ageing

► Health promotion

and prevention

► Patient

empowerment

► Medical tourism ► Cross border care

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WP3 Technical toolkit 5/6

Manual on capital investment

WP3

Strategic investment guide

► Capital investment planning

►

Strategy identification

►

Financial planning

►

Project definition

►

Risk management ► Capital investment implementation

►

Ministry as an Intermediate Body

► Preparing Project Requests and Call for

Proposal

► Reviewing and Prioritizing Project Requests ► Implementation

►

Ministry as a beneficiary

► Project request preparation ► Investment implementation

► Capital investment sustainability

Categorization of financial mechanisms

► Other sources of funding apart from

ESIF

►

Loans / Guarantees

►

Equity / Venture Capital

►

Initiatives of EC

► JESSICA ► JEREMIE ► JASPERS ► JASMINE

►

Combinations of the instruments

►

PPP

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Investment appraisal

WP3

General principles of economic appraisal Key process steps:

1.

Problem identification & definition

2.

Definition of alternatives for problem solution

3.

Assessment of costs and benefits

►

List all the costs and benefits

►

Quantify/describe all the costs and benefits

►

Converse data into value of resources 4.

Calculation which will strongly depend on the type of economic appraisal

5.

Decision-making

Investment appraisal techniques

► Quantitative assessment techniques

applicable to health investments

► Cost Benefit Analysis (CBA) ► Option Appraisal (OA) ► Cost Consequence Analysis (CCA) ► Cost Effectiveness Analysis (CEA)

► Qualitative assessment techniques

applicable to health investments

► Cost Utility Analysis (CUA) ► Health Impact Assessment ► Health Technology Assessment (HTA)

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WP5 Online platform

Online platform (webpage)

►Objective:

► Develop an online platform supporting the roll-out phase by allowing widespread dissemination of the deliverables and tools developed

►Deliverable:

► A single point providing all the necessary information about funding of health from ESIF in 2014-2020 and the most up-to-date versions of project outputs

www. www. .eu eu



Like other project outputs, the webpage is still customized and refined on an ongoing basis.



Official public release is expected on October 2014 giving access to the most up to date versions of outputs presented.

WP5

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WP5 Online platform

Website content & structure

►

News containing information about workshops / updates or most up-to-date issues

►

Project introduction & background information

►

General introduction of EU Cohesion Policy 2014-2020 principles & mechanisms

►

Indicative list of health actions under thematic objectives for the 2014-2020 programming period

►

Downloadable project outputs: > Guide > Toolkit > Training materials from national workshops

►

Frequently asked questions (FAQs)

►

Mapping of implementation of SF/ESIF in health across EU Member States: > areas of health investments in 2007-2013 PP > areas of health investments in 2014-2020 PP

►

Useful contacts

WP5

• I. Website content: