Abstract

How are public health services in Europe organized and financed? With European health systems facing a plethora of challenges that can be addressed through public health interventions, there is renewed interest in strengthening public health services. Yet, there are enormous gaps in our knowledge. How many people work in public health? How much money is spent on public health? What does it actually achieve? None of these questions can be answered easily.

This volume brings together current knowledge on the organization and financing of public health services in Europe. It is based on country reports on the organization and financing of public health services in nine European countries and an in-depth analysis of the involvement of public health services in addressing three contemporary public health challenges (alcohol, obesity and antimicrobial resistance).

The focus is on four core dimensions of public health services: organization, financing, the public health workforce, and quality assurance. The questions the volume seeks to answer are:

• How are public health services in Europe organized? Are there good practices that can be emulated? What policy options are available?
• How much is spent on public health services? Where do resources come from? And what was the impact of the economic crisis?
• What do we know about the public health workforce? How can it be strengthened?
• How is the quality of public health services being assured? What should quality assurance systems for public health services look like?

This study is the result of close collaboration between the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe, Division of Health Systems and Public Health. It accompanies two other Observatory publications: Organization and financing of public health services in Europe: country reports and The role of public health organizations in addressing public health problems in Europe: the case of obesity, alcohol and antimicrobial resistance.

Contents

• List of figures, tables and boxes
• List of contributors
• Acknowledgements
• 1. Introduction
  Bernd Rechel, Elke Jakubowski, Martin McKee, and Ellen Nolte.
  • What this book aims to achieve
  • How we approached the work
  • Structure of the book
  • References
• 2. Conceptual framework
  Bernd Rechel, Elke Jakubowski, Martin McKee, and Ellen Nolte.
  • Introduction
  • Public health
  • Public health operations
  • Public health services
  • Financing for public health
  • Conclusion
  • References
• 3. Organization of public health services
  Elke Jakubowski, Hans Kluge, and Bernd Rechel.
  • Introduction: why look at structures?
  • The organization of public health services: clarifying meanings
  • Who provides public health services?
  • Institutional mandates and roles
  • Principle forms and features of organizational design
  • Organizational and institutional change
  • Conclusions
  • References
• 4. Financing of public health services
  Bernd Rechel.
  • Introduction
  • Total expenditure on public health
  • Expenditure categories and breakdown
  • Sources of financing for public health
  • Conclusion
  • References
• 5. The public health workforce
  Robert Otok, Erica Richardson, Katarzyna Czabanowska, and John Middleton.
  • Introduction
  • Key challenges
  • Developing the public health workforce
  • European policy responses
  • Conclusions
  • References
• 6. Assuring the quality of public health services
  Gemma Williams and Ellen Nolte.
  • Introduction
  • Defining quality in health systems
  • Strategies to promote and assure the quality of public health services in Europe
  • Conclusion
  • References
• 7. Key policy lessons
  Bernd Rechel, Elke Jakubowski, Martin McKee, and Ellen Nolte.
  • Public health services are poorly financed
  • The public health workforce needs to be strengthened
  • Little is known about the quality and performance of public health services
  • The need for coordination mechanisms
  • The role of the regional level
  • Ways to support regions in their public health policies
  • Reforming organizational structures in line with population health goals
  • Implementing public health policies and reforms
  • Final words
  • References

The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy issues.

The European Observatory on Health Systems and Policies is a partnership between the WHO Regional Office for Europe; the Governments of Austria, Belgium, Finland, Ireland, Norway, Slovenia, Sweden, Switzerland, the United Kingdom and the Veneto Region of Italy; the European Commission; the World Bank; UNCAM (French National Union of Health Insurance Funds); the London School of Economics and Political Science; and the London School of Hygiene & Tropical Medicine. The Observatory has a secretariat in Brussels and it has hubs in London (at LSE and LSHTM) and at the Berlin University of Technology.

All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

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