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The organisation of hospital services in Europe:

Recent trends and strategic choices

Dr Rebecca RosenSenior FellowThe 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).

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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

Patient and public

expectation

National policy/ regulation of

hospital sector

New medical and communications

technologies

Aging population with multi morbidity

Growth in use of markets and competition

Hospital organisation and

delivery

Quality and safety

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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

Is national/regional policy responding appropriately to changing demography epidemiology/growing public expectation

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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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