Tuesday, 1 September 2009

Interview State Secretary Mrs Karin Johansson Swedish Ministry for Health and Social Affairs

Tomorrow in the ENVI committee of the European Parliament Swedish Minister for Health and Social Affairs Mr Göran Hägglund will present his visions for the presidency. I recently interviewed his State Secretary Mrs Karin Johansson. We had a good an open meeting where we talked about co-operation cross borders, swine flu and why the Swedish presidency have not chosen any particular disease area to put a focus on.

The reason for the last Q originates from my interest in how the policy agenda is set. I know both industry and NGO representatives aiming at getting their causes on the Swedish presidency agenda without success. Mrs Johanssons explanation where simply that when planning the agenda it was already quite loaded so they had to really focus on key concerns meaning the structural issues. It still doesn’t really put an end to my curiosity since all others also inherits heavy agendas but still seems to really want to make one or another disease their signum. How these disease areas become so important is still to be investigated. Is it mere personal experience or is it giving in to national interest or just that they are more receptive for clever lobbyist arguments than the Swedes?

Well the Swedes resistance and focus on structural issues can also be seen in their work finding out what incitements are needed to find new antibiotics. Here they even tried hard to get the bilateral discussions between the EU and the US going since they realise that it’s not possible for the EU alone to succeed.

On the other hand admittedly the most concrete issue they are dealing with is the swine flu (not the least because several of the civil servants in the Swedish ministry of health actually have been hit) but it’s not within her responsibilities. Still Mrs Johansson underlines that the ECDC, WHO and EU have different recommendations with regards to the swine flu raising the obvious question how a member state relates to these different recommendations. Her conclusion is therefore that there is from the Member States a clear need of getting the international players to synchronise their work. She explained that this goes also for other areas like rare diseases. I wonder what this will mean for the system and structures if it will include HTA and definition of what equal care for all EU citizens means?

In principle I must say I’m proud of what my current government does in the area of healthcare. They are quite pro patient choice and empowerment also when it means actually lessen the governmental control over the healthcare system. I think it will in the long term pay off with better outcomes and better value for money.

One of the time I noticed this was after Mrs Johansson pointed out that healthcare becomes more and more specialised leading to a smaller and smaller patient base resulting in a need for further co-operation cross border. So far most would agree - in principle. The interesting thing with the current Swedish administration is that this insight also has implications on the application of policy positions and conclusions with regards to how international co-operation needs to be managed practically. Mrs Johansson admits that this is inevitably leading to a more integrated view of healthcare in the EU but the development needs to take its time due to the budget constrains – but she also points out that in the end nothing is more important than the delivery of good healthcare so this issue cannot be impossible to solve!

One of the more surprising statements was probably that she sees competition in itself as a force for development meaning that it’s positive that the different healthcare systems are being put through competition! In Sweden they are working on enabling this on the regional level and of course this is something that also should be achieved on an international level.

This naturally led my thoughts to the current debate on the directive for patient rights across borders. Now it turns out that the Swedish presidency sent out a compromise proposal the last week of July. Negotiations will start in September. As reported earlier on this blog commissioner Vassialou has made it clear that this is a majority decision. So I had to ask if Mrs Johansson thought that Spain really will be overruled. Here she hesitated pondering if given how watered down the proposal in its current version is if it’s not better to just let it be and instead let case law develop. As the Council was not even prepared to take a discussion on the rather compromise friendly decision of the European Parliament one must wonder if she isn’t right.

Of course in this directive the pre-authorisation process is what’s really troublesome beside the issue of how far reaching the co-operation should be. With a smile she adds when I ask that it seems that those with the most problems with the right that the directive gives patients with regards to choice seems to be the same as those that have the least problems with the chapter 4 enabling various ways of co-operation between member states. And of course it’s an issue of who decide of the allocation of recourses etc. Now this means power and not many are willing to give up power.

When it comes to access to medicines as a key - partly as a follow up of the Pharmaceutical forum and the topic for one of their seminars - they try to establish a test case for international co-operation. The structures for co-operation need to be developed in real life situations in order to be robust. She also expects some proposals at the next council meeting on how to move forward with Pharmaceutical Forum 2.0

And by now we was at the end and could just contemplate that even if they are very much pro a more liberal legislation with regards to patient information this is an area where there is no way forward. Strangely enough. But maybe Mr Hägglund while in the European Parliament can convince some of the sceptics – one live on hope. Given the tone and the answers I gotten from Mrs Johansson I actually do have hope for the cross border care directive as well as actually the patient information issue.

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