Rt 1 How to ensure universal coverage of occupational health services
Connecting Health and Labour Global Conference Organized by the World Health Organization in collaboration with TNO Work and Health and the Dutch Government with support from the World Organization of Family Doctors (Wonca) and the International Commission on Occupational Health (ICOH) 29 November - 1 December 2011, The Hague, The Netherlands How to ensure universalcoverage of occupational health services? Prof. Jorma Rantanen, MD, PhD Chairman of the Board, University of Jyväskylä, Finland Past President of ICOH
OPENING THE DOOR TO BETTERHEALTHCARE ACROSS EUROPEProposal for a Directive of the European Parliamentand of the Council on the application of patients’ rightsin cross-border healthcare Council Conclusions on Common values and principles in European Union Health Systems SOCIAL PROTECTION FOR INCLUSIVE DEVELOPMENT A NEW PERSPECTIVE IN EU CO-OPERATION W AFRICA
Coverage of OHS in Finland % of workers+ self- Number of employees employed covered by OHS >100 100 100- 50 97 10 – 49 91 1-9 64 Farmers 50 Total 85.1126 million enterprises in the world. 97% of them are small companies.
Informal workers of the world most in need of OHS Total number ~ 1.6 billion Region Women Men Self- employed North Africa 43 NA 62 SSA 83 63 70 Latin 58 48 60 America Asia 60 60 59 World 60 ~ 65 (Source: Chen, DESA Working paper No. 46, 2007)
Gaps in occupational health services• Policy gap• Regulation gap• Implementation gap• Coverage gap• Risk gap• Content gap• Relevance gap• Resource gap• Gap in effectiveness and impactILO COnvention N0. 161 ratified by 30 Countries.
Basic Occupational Health Services, BOHS• Full coverage• Publicly provided• Primary health care approach• Still competent OHS• Supported by expert institutions• Low-cost solutions• Adapted to local conditions• Part of USP
The BOHS cycle Workers health Orientation and planning Evaluation Surveillance of WE Record keeping Surveillance of Individual workers health health record Worker General Assessment of WE Risk Assessment health service individuals health riskEmergencypreparedness First aid Health education Dg of ODs and healthAccident prevention and WRDs information Information Prevention of Education OH hazards InitiativesWork environment Work Organization
Model Normative basis Source of funding Service Examples of provision countries/Area”Public health”, Health care Government health budget Public service AlbaniaGeneral health legislation provision units, Kosovobudget model primary health Thailand care China, India”Employer” model Legislation or Individual employers pay all the Own OHS or Sweden voluntary costs of services they use external public or Netherlands privateHealth insurance Legislated health Contributions by employers. The Often public Sloveniamodel insurance covers the Fund pools the contributions and Former Croatia costs pays back on capitation basis before 2008Special Special law on OH Contributions by the employers Public Croatia sinceoccupational insurance + solidarity principle 2008health insuranceAccident Accident insurance or Employers pay a premium which Own or external Austriainsurance model workmens may be either flat or experience- Germany compensation law based (reflecting the risk of France accidents in the company or in the Spain sector)Combined Law on income Employer pays primarily the costs Own or external, Finland“Employer” + insurance + Law on but gets reimbursements under either public orPublic health + occupational health certain conditions private providerHealth insurance services Farmers get the occupationalmodel hygiene services free of charge (financed from government budget)Association or OSH Law just Member fees by Association or Group service Sweden, FinlandCooperative defining employers Cooperative members model Tanzania,financing obligations Netherlands
Economic appraisal: A SEE Country (Rantanen 2010)Total GDP 33 Bill €Total health expenditure HE 2.70 Bill € 8.2% of GDPTotal loss by occupational 1.32-1.97 4-5.9% of GDPaccidents and diseases Bill € ~ 50-73% of HETotal cost by 500 OHPS 4.68 mill € 0.014%and 500 OHNs + 30% of GDPdriving costs 0.17% of HE
Activity ongoing either as pilotBOSH activities in the World project or permanent activity Activity planned Finland NW Russia Baltic Balkan Turkey East AfricaBrazil ChinaMexico India Thailand Vietnam Indonesia