The organisation of hospital services in Europe:
Recent trends and strategic choices
Dr Rebecca Rosen
Senior Fellow
The Nuffield Trust
20th-21st Jan 2014
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Hospital services across Europe
HOSPITAL:
‘an institution
providing medical
and surgical
treatment and
nursing care for
sick or injured
people’. (OED)
Diverse range of
institutions with
varied roles in
different countries
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Historic variations in hospital policy & funding
Central and Eastern Europe
• Centrally planned, hospital dominated health tradition in
all countries
• Concentration of diagnostics, treatments and technology
in hospitals
• Financial pressures underlie recent national strategies to
rationalise hospital care using a mix of market forces and
national planning
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Historic variations in hospital policy & funding
Western and Northern Europe
• Wide variation in role of hospitals in delivering specialist care
• Community based specialist care in some countries
• Growing separation of functions between hospitals
(emergency care and acute procedures) and community
services (diagnostics, office based procedures, chronic
disease management, rehabilitation etc)
• Small, physician owned single speciality hospitals in some
countries
• More regional and local planning of hospital services including
local government control of health & social care in
Scandinavian systems
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Recent trends
• Fewer acute hospital serving larger populations
• Increase in day case activity – though rates still
vary widely between countries
• Reductions in length of stay
• Growing number of ‘specialist’ hospitals
• Growing recognition of volume/outcome
relationship with concentration of some services
into larger centres (eg trauma, hyper-acute stroke)
(Edwards et al 2012: Changes in health provision in Europe: Major trends)
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Variation in current funding and supply
Total per capita healthcare spending, US$PPP, 2011 Based on (OECD, 2013).
6000
5000
4000
3000
2000
1000
0
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Variation in current funding and supply
Acute Care Beds per 100,000 population: EU15+Switzerland,
1998-2008 (EHHF, 2011)
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Variation in current utilisation
Average length of stay and percentage of day cases: malignant
neoplasms of trachea bronchus and lung, 2008 (EHHF, 2011
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Multiple drivers of change in hospital care
Constrained
resources and new
payment systems
Growth in use of
markets and
competition
Aging
population with
multi morbidity
New medical and
communications
technologies
Hospital
organisation and
delivery
Quality and
safety
National policy/
regulation of
hospital sector
Patient and
public
expectation
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Concepts of strategic change in hospital care
• Intra-institutional change
• Efficiency
• Quality and safety
• Sustainability
• Culture
• Extra-institutional change
• ‘Connectivity’
• Networks
• Integration
• Growth, mergers and acquisition
• Re-configuration of hospital sector
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Mechanisms for change:
Intra-hospital mechanisms
• Redesign
• Environment (eg buildings, hospitality…)
• Service line redesign (including tools such as lean)
• Organisational structure and culture
• Specialisation
Externally driven mechanisms
•
•
•
•
•
Central planning and payment reform
Ownership, management and market reforms
Strategic purchasing by payers
Connectivity /networks
Integration
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Defining the ‘space’ for Eurosummit discussions
How are individual
hospital strategies
adapting in response
to national & regional
policy, funding &
regulation
How are hospitals
adapting in
response to frailty,
complexity and
changing patient
expectations
Health system
funding and
policy
Hospital
financial
context and
strategy
Is national/regional
policy responding
appropriately to
changing demography
epidemiology/growing
public expectation
Public need,
demand and
expectation
(co-morbidity,
ageing, access
quality etc)
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Challenge for the Euro-Summit
• Can we reach consensus about how hospital strategy should
respond to the changing interface between hospital, political,
payer, and public interests?
Aims of the Euro-Summit
•
To examine the strategic choices available to hospitals, payers and policy makers
•
To explore how these choices are being made, and the factors underlying decisions
•
To learn about promising new organisational models for hospital services emerging
in Europe, in the context of wider changes to health and society
•
To identify the options for policymakers, payers and providers to influence the
future strategic development of hospitals
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