Global Cardiovascular Strategies

Berislav Skupnjak, MD, Croatia
Liaison Officer, WHO Liaison Office Croatia
WORLD HEALTH ORGANISATION: HEALTH SYSTEM REFORMS - LJUBLJANA CHARTER

 

I. INTRODUCTION

I would venture to start my presentation with the statement that so-called constructive restlessness prevails in all health systems in Europe.

By this I mean the processes of transition in health systems that are usually called the health care reforms (See the cover page – Figure 1).

Why this “reform fever” has spread through all health systems in our continent is quite a justifiable question.

There are several reasons for that. Apart from those classical ones that practically applicable to every country, or at least to the countries of the more developed part of our globe (ageing of population, achievements of medical researches and technologies and their application, increased public expectations) (Box 1 and 1a), some particular reasons distinctive for the European continent are to be taken into consideration as well: namely, not in one part of the world things have reached such a state of dramatic and dynamic changes. Universality of these changes, their dynamism – not to say their vehemence – cannot leave the health systems at rest since for the health system, as a very important human system, also applies the rule that reads: “To live means to adapt”.


Box 1. THREE THE MOST IMPORTANT REASONS FOR THE PERMANENT INCREASE OF HEALTH EXPENDITURES

1. Development (and application) of medical knowledge and technology achievements 2. Ageing of population 3. Higher health consciousness and health expectations of the public

Box 1a. REASONABLENESS FOR THE UNIVERSALITY OF HEALTH REFORMS IN EUROPE

1. Adaptation of health systems to the universality of changes in their surroundings 2. Tendency towards convergence (encouraging global integrations) 3. Fevered endeavour to maintain the proportion of health allocation from GDP

Adapting to what?

Adapting to changes of demographic circumstances; then to changes of political systems, social conditions and circumstances, changed economic potentials, to all possible transitions that, of course, also comprise the changes in health status. (Figure 2).


Figure 2.

UNIVERSALITY OF TRANSITIONS (CHANGES) AND HEALTH SYSTEM REFORM