Post on 18-Jan-2015
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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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