1. © Nuffield Trust The organisation of hospital services in Europe: Recent trends and strategic choices Dr Rebecca Rosen Senior Fellow The Nuffield Trust 20 th -21st Jan 2014

2. © Nuffield Trust 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

3. © Nuffield Trust 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

4. © Nuffield Trust 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

5. © Nuffield Trust 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)

6. © Nuffield Trust Variation in current funding and supply Total per capita healthcare spending, US$PPP, 2011 Based on (OECD, 2013).

7. © Nuffield Trust Variation in current funding and supply Acute Care Beds per 100,000 population: EU15+Switzerland, 1998-2008 (EHHF, 2011)

8. © Nuffield Trust Variation in current utilisation Average length of stay and percentage of day cases: malignant neoplasms of trachea bronchus and lung, 2008 (EHHF, 2011

9. © Nuffield Trust 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

10. © Nuffield Trust 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

11. © Nuffield Trust 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

12. © Nuffield Trust Defining the ‘space’ for Eurosummit discussions Health system funding and policy Public need, demand and expectation (co-morbidity, ageing, access quality etc) Hospital financial context and strategy 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

13. © Nuffield Trust 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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