The European Semester 2015-2018: themes and progress of country specific recommendations on health

Abstract

using 3 large scientific databases using a combination of search terms following the PRISMA methodology and a standard set of items used to report on systematic reviews. Based on the predefined inclusion and exclusion criteria, a total of 118 publications were used for data extraction. It is important to note, that in almost all of the sources identified, the following cross-cutting factors were described as influencing access to healthcare: Continuity of Information, how it relates to policy, how it differs between health services and across-borders. Furthermore, the organizational coordination among social and health care providers in the host country determinates the successful access to healthcare of migrants/refugees. Language & Communication takes into consideration both the healthcare service and its provision of translators and cultural mediators, and the host country language proficiency of the migrant/refugee. Organizational improvement of access and delivery of health care services for migrants and refugees in addition to Cultural Competence of the healthcare providers meaning the ability to maximize their sensitivity in the service of care to culturally diverse groups. Health literacy understood as the motivation and compe-tences of the migrant population to access, understand, appraise, and apply health information. Additionally, the health issues of particular importance for migrants/refugees as emerged from the systematic review, including mental health, maternal/child health, health promotion , NCDs and chronic diseases, Oral/|Dental health, and Vaccinations should be included in planning future needs and healthcare access. Predictions concerning the use of health care services in Europe by migrants/refugees and the Mig-HealthCare Roadmap & Toolbox Based on the multiple levels of research conducted within the project the consortium developed a roadmap & toolbox which includes the following categories: Continuity of information, Language Culture & Communication, Mental Health, Vaccinations, Maternal/child health, Health promotion, Oral health/Dental Care and NCDs while the Toolbox contains tools on these categories in different languages. The roadmap & toolbox is accessible through the project website. In addition, different scenarios, giving a comprehensive picture of the foreseen situation and the evidence-based policies and actions needed to maximize the effective delivery and sensitivity in the service of care to culturally diverse population groups were developed focusing on mental health, chronic disease management and oral health. Refugees and migrants tend to have a higher prevalence of mental distress compared to non-refugees. For the challenge of lack of recording mental health of migrants/refugees, improving the collaboration between 'migrant-specific' organizations is needed. Health care systems in Europe will have to accommodate the high demand for health care services for chronic conditions among migrants/refugees in the coming years. Implications such as the impact of poverty, level of health literacy and/or the cultural adaption of the measures need to be considered when planning to address future trends related to non-communic-able diseases including diabetes among migrants/refugees. The provision of oral care presents great variability across the European countries, but in most cases, it is characterized by high cost and restricted range of services if offered within the state health systems. Migrants /refugees will not be able to meet the high cost of private dental care. Local community interventions have been proven very effective. Malta Contact: timo.clemens@maastrichtuniversity.nl Background: The European Semester (ES) is a policy coordination and scrutiny framework at EU-level for surveillance of fiscal and macroeconomic policies in Member States. Health systems have not evaded that scrutiny. The analysis focusses on how health systems reforms are being endorsed in Country Specific Recommendations (CSRs) and how the ES process links to planning and implementation of national health system reforms over the period 2015-2018. Methods: A descriptive content analysis of CSRs with a search for the keywords and phrases 'health', OR 'healthcare', OR 'long-term care' was performed for the years 2015-2018. Furthermore, CSRs addressing health systems were classified according to whether they were targeting access, quality or sustainability; and categorized regarding organisation and governance, financing, physical and human resources, and provision of services. Finally, implementation progress on the health CSRs was rated according to EC's own evaluation scheme derived from the preceding year's country report. Results: CSRs with health system recommendations have featured continuously in the ES process each year and have stabilised in number. The themes of health CSRs are still dominated by financial sustainability, cost-effectiveness and of financing, although other health system goals and domains, particularly access, are increasingly addressed. There is a high degree of consistency on the content of health CSRs over the years for each country addressed. Progress with implementation of health CSRs is disappointing so far, based on the EC evaluations. No clear link between discontinuation of health CSRs and evidence of progress in implementing the CSR can be discerned. Conclusions: The results uncovered some of the links between national and European institutions leveraging the ES to push health system reforms. However, a more balanced and long-term view is needed for the ES to contribute solidly to complementing national efforts in a complex reform context. Key messages: Health CSRs are still dominated by financial sustainability considerations while other health system goals and domains are increasingly addressed. Progress with implementation of health CSRs is disappointing so far, although a longer-term perspective is needed to pay tribute to the complex reform environment of health system reforms.