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POLICY: EUROPEAN DEVELOPMENT
Equal future prospects for
all hospitals in Europe?
Trends in development
within the European Union
DR BURGHARD ROCKE
DISTRICT MAGISTRATE OF STEINBURG AND VICE-PRESIDENT OF THE GERMAN HOSPITAL ASSOCIATION
Abstract
The Common Market does not stop at the national health systems of the European countries. Hospital systems are
no longer compared only among themselves, but they increasingly affect each other and become closely connected.
This development concerns the personnel level as well as the exchange of patients. The former president and now
vice-president of the German Hospital Association draws a summary of European hospital development over
the last few years.
In jurisprudence, there is a subject called ‘comparative
law’; it deals with the phenomenon that comparable
cultures develop comparable life circumstances which –
in principle – find similar solutions, even if they do not
know anything about each other. This is a result of human
logic and intellect. Therefore, one is always well advised –
particularly in the European Union countries – to look
beyond national borders in order to draw conclusions for its
own future. This has to be taken into account, if the health
service system is on the verge of a profound reform.
Equal political goals in the European Union
Recently and, once again, the German health system was
reformed ‘comprehensively’. This idea is not new, as such
attempts were undertaken in each electoral term over the last
two decades. The durability of such diverse and extensive
reforms is becoming increasing unsustainable. This leads to
the development of a cycle of reforms that hospitals find
themselves struggling to survive. leading to a situation as
described by Darwin as one in which the battle for: ‘The
survival of the fittest has begun’.
Politicians of all European countries are trying to get their
health systems into order. The current problems and the
introduced measures are nearly all the same: everywhere, the
crucial issue is about consolidation of expenditure, cuts in
welfare assistance, increases in efficiency and improvement
of quality. With an ageing population, the European Union
has, since 1960, witnessed an eight year rise in life
expectancy. This trend continues. Regarding the low birth
rates, the number of old and very old people among the total
population will increase within the next decades. This is the
reason for the increased necessity of medical and nursery
supply. At the same time, economic recovery in the
European Union has been slow the impact of which is
reflected in earning capacity of the national welfare systems
and for tax revenues. On the other hand, advances in
medicine and medical technology are opening new and
often more expensive possibilities of treatment, which is
another reason for the increase in health care expenditure.
These trends have given rise to key questions such as:
➜ What is their anticipated impact on health services, in
particular on hospitals?
➜ What challenges will the hospitals need to face in the
coming years?
The increasing argument for competition
In the area of public health policy, the arguement in favour
of competition is gaining in importance. Amongst the liberal
proponents of competition in academic circles the arument
seems to be in favour of its use as a miracle cure for all
problems and by which progress will automatically be
achieved.
More competition by purchasing models
An important process which takes place both in countries
with public health services and those with health insurance
systems, is the development of purchasing models. These
are systems in which the financier buys defined service
ranges from service companies described in special
contracts.
In the United Kingdom, this has led to a separation of the
national health service into Purchasers (buyers) and into
Providers (service providers). Meanwhile, other countries,
such as Italy and Portugal, with public health services have
Vol. 40 No. 4 | World Hospitals and Health Services | 15