Financing of Care in the Social Assistance System
Maria Carmen Agnello
Specialist in Health law, University of Bologna, Bologna, Italy
Corresponding author
Maria Carmen Agnello, Specialist in Health law, University of Bologna, Bologna, Italy.
ABSTRACT
In a context of scarcity of resources and competitiveness, the approach aimed at improving assistance implies the optimal use of funding, also through a comparison between existing structures at national, European and international level. The implementation of the above implies implementing the financing through the rationalization and simplification of the collection and management of funds. This article pursues the objective of exposing the prospects for the development of assistance in the medium and long term through the analysis of the legislation and programs relating to European funding. From a perspective of resilient development of social and healthcare assistance, the transversal potential of financing will be highlighted as well as the integrated actions to overcome the current critical issues in the management of financing.
Keywords: European Funding, Programming, Transversal Measures, Integrated Actions, One Health Approach
The Transversal Role of European Programming in Favor of Healthcare Resilience
Europe intends to improve health protection through uniform access to care and coordinate preventive and proactive measures through greater involvement of EU countries.
Structural funds for health aim to reduce disparities between Europe’s regions through projects that finance health infrastructure, e-health and health promotion programmes. Direct grants that finance, projects intended to improve people’s health and help establish innovative and sustainable health systems. These loans are part of European programming relating to the 2021-2027 timeframe. The new European legislation supports the preparation of healthcare systems in facing the growing healthcare challenges, also through a better valorisation of what already exists.
The regulations for the 2021-2027 programming govern the structural and investment funds (ESIF), for a value of over 330 billion euros corresponding to almost a third of the budget and use the regulatory instrument of the regulation which governs eight funds managed by the States and by the Commission and identifies the application scope of each fund [1].
The post-covid health crisis has revealed the fragility of health systems and disparities between population groups, demonstrating the relevance of coordinating states through programs capable of addressing health challenges, through resilient and accessible health systems. This programming constitutes the main reference of the financing systems of the individual states in order to guarantee uniformity of care and avoid disparities in access to financing.
The Programs are funding lines managed by the European Commission which, through the General Directorates and/or Executive Agencies, publishes the programmatic lines and selection notices, develops projects, monitors and disburses the funds to the beneficiaries, in order to intervene in various areas. Most of the European sectoral financing programs to be adopted at the beginning of 2021 have been applied retroactively from the first day of the same year [2].
Since 2003, European health programs have generated knowledge and evidence underlying the development of measures and actions, practices, tools and methodologies that have produced positive effects both for the health sector (improvement and support for Member States in defining national action plans against cancer, strengthening patient care) [3].
Digital programming is transversal to the objectives set out above of equal access and resilience of health systems. The Digital Europe funding program aims to spread digital technology in entrepreneurial activities, citizens and public administrations, in favor of recovery through the areas: supercomputing, artificial intelligence, cybersecurity, digital and advanced skills and a broad use of digital technologies. In this path, the Digital Europe program offers funding opportunities to promote digital innovation and improve social and health care services. The European Health and Digital Executive Agency - HaDEA manages actions in the field of artificial intelligence, advanced digital skills, in order to spread the use of digital technologies (implementation, better use of digital capabilities and interoperability) [4].
The EU4Health Path and the One Health Approach: Objectives, Actions and Projects
The European regulation of 03.24.2021 of the European Parliament and of the Council established a health action program for the period 2021-2027, EU4HEALTH, in response to the post Covid-19 pandemic crisis. The core is made up of the results obtained by the Health Program identified in previous programming periods [5]. In continuing the actions of the previous programming EU4HEALTH intends to strengthen crisis management, support for the action plan for Europe against cancer and the pharmaceutical products strategy. It constitutes the largest health program implemented for economic resources made available (with an endowment of 5.1 billion euros), in favor of the EU, to health and non-governmental organizations. With the support of the European Commission’s activity, the following health priorities are pursued: strengthening health systems to address epidemics and long-term challenges, making medicines and medical devices available and affordable, as well as promoting medical and pharmaceutical innovation. Compared to the previous programme, EU4Health presents a greater level of investment and breadth of funding, in supporting and integrating national health policies, optimizing synergies and the added value of the European contribution. In response to the complexity of health issues, EU4Health will support several actions and initiatives within the following “strands”: crisis preparation; disease prevention; healthcare systems and personnel; digital.
The method pursued by EU4Health is the “One Health” approach, which recognizes a link between human and animal health and the environment, through the extension of potential beneficiaries, including international organizations, national institutions, active organizations and businesses. in the medical, healthcare, hospital and pharmaceutical sectors.
The Art. 3 identifies the specific objectives pursued, in improving health and ensuring a high level of health protection, in line with the “One Health” approach: improving and promoting European health by reducing the burden of communicable and non-communicable diseases, supporting health promotion and prevention, reducing health inequalities, promoting access to healthcare. The second objective is to protect against serious cross-border health threats and strengthen the response capacity of health systems and coordination between States to address cross-border health threats. The third macro objective is to improve the availability, accessibility of medicines and medical devices and relevant products and to support innovation [6]. Another objective is to strengthen health systems by improving their resilience and developing resource efficiency, supporting integrated and coordinated activity; implement best practices and promote data sharing; strengthen healthcare personnel; addressing the implications of demographic challenges; and driving digital transformation forward.
From the above it emerges that the set of planning and application measures revolve around the macro project of building the European Health Union” in guaranteeing greater protection of citizens’ health through greater sharing of the tools necessary to prevent and better deal with possible pandemics and improve the resilience of European health systems.
Financing Models: The Impact of the PNRR in Favor of Social and Health Integration
This paragraph analyzes the Italian financing system to highlight the obstacles and development prospects of the PNRR.
The reorganization of funding intends to improve the integration between the health and welfare component, through a plurality of actions and measures in a system capable of involving different levels of governance within their respective skills, roles and responsibilities.
Following the approval of the European Parliament on 17/12/2020, the Council adopted the regulation establishing the EU’s multiannual financial framework (MFF) for the period 2021-2027. The regulation provides for an EU budget of EUR 1 074.3 billion for the EU-27 in 2018 prices, including the top-up of the European Development Fund. Together with the EUR 750 billion Next Generation EU recovery instrument, it will enable the EU to provide EUR 1.8 trillion in funding to support the recovery from the COVID-19 pandemic and the EU’s long-term priorities in different sectors of intervention. The PNRR, thanks to the European funds of the Recovery Plan intended for the Next Generation EU project, allocates approximately 10 billion to support local medicine. Home Care, Community Homes, Community Hospitals and coordination centers are the axes on which extra-hospital medicine is based with the objectives of greater transversality between hospital and territory. Part of the objectives to be achieved concern the relaunch of intermediate structures such as health homes and the implementation of existing ones such as the Social and Health District provided for by law. n. 833.
The impact of the PNRR on the social welfare system is the start of a reform process.Mission 5 in support of social cohesion is transversal to the other missions envisaged by the PNRR, especially the 6 in the C1 components, pertaining to proximity networks, structures and telemedicine for local healthcare and C2 relating to Innovation, research and digitalisation of the Healthcare System National. This context includes the review and updating of Scientific Hospitalization and Care Institutes, in order to encourage innovation and exchange between structures.
However, at the moment there are application obstacles in the implementation of the PNRR as set out below. For the Health Mission, the “Third Report on the state of implementation of the Pnrr” identified the critical issues with respect to the objectives originally pursued relating to the “Community Home and taking care of the person”, “Community Hospitals” and “Towards a safe hospital and sustainable”. These critical issues concern the increase in costs, the scarcity of resources, the imbalance between supply and demand, and unattractive investments. Other critical issues reported by the “Third Report on the implementation status of the Pnrr concern the failure to comply with national deadlines in the implementation of projects, reporting delays and the negligible amount of funds currently spent (0.5%).
In Mission 6 Health of the PNRR, the presentation of a bill is expected “a new institutional structure for prevention in the health, environmental and climate sectors”, in line with the ‘One-Health’ approach” through the competent use and aware of the digital leverage. One health becomes the paradigm for promoting collaboration between different disciplines and addressing healthcare needs in a systemic way, based on a greater correlation between their health and the environment in which they live.
Following the session of the State-Regions Conference on 06.09.2023, the draft decree was resubmitted which modifies and integrates the decree of 23 January 2023 on the Pnrr resources relating to the investment Mission 6, Component 1, Investment 1.2.1 “Home as the first place of care (ADI)”, following “the need to guarantee the disbursement of ADI resources, as a preview for 2023 to the Regions and Provinces. The implementation of this is subject to the adoption by the latter of specific Plans in achieving the objectives assigned for the years 2023, 2024, 2025.
In this context, the investments in health envisaged by the PNRR, as health expenditure, are one of the priorities to be followed by policy makers through a remodulation aimed at overcoming the critical issues highlighted and exacerbated by the lack of personnel. in a perspective of adequate healthcare growth. This approach implies coherent and priority actions with respect to the evolution towards an integrated system between the need for assistance and personal care with respect to the continuous change in demand for health.
References
- Published in the Official Journal of the European Union L 231 of 30 June 2021 with entry into force from 1 July 2021. European Regional Development Fund, Cohesion Fund, European Social Fund Plus.
- The infographic of the Multiannual Financial Framework 2021-2027 and Next Generation EU.
- The next long-term budget will cover seven spending areas and provide the framework for financing of almost 40 EU spending programs over the next seven years. Source:
- Previous programs are the Third EU Health Program 2014-2020, Second EU Health Program 2008-2013, First EU Health Program 2003-2007.
- The objective of the EU4Health program is the prevention and fight against cancer, through the “European Plan to Fight Cancer”.
- Regulation (EU) 2021/694 of the european parliament and of the council of 29 april 2021 establishing the digital europe program and repealing decision (EU) 2015/224.
