Consequences for hospitals resulting from demographic, social and morbidity changes: a European perspective

The last 40 years has been a time of rapid demographic, social and economic change in most countries of the world. In Europe, the ageing of the population, a decrease in household size, and the reduced importance of parasitic and infectious diseases along with an increase in chronic and degenerative diseases are some of the most notable results of industrialization, urbanization and medical progress. These developments lead to changing demands not only for the services of hospitals but upon the health care system at large. Most recently, and in addition, these changes have had to be faced under resource constraints resulting from decreased economic growth. This article focuses on the similarities and differences within and across the health care systems of European countries, and on their efforts to respond to the changes which have taken place and are likely to continue in the near future. In so doing, it relates the various demographic, social and economic changes taking place in these countries to the structural changes noticeable in the hospital sector. The results obtained by statistical analyses of empirical evidence lead us to conclude that demographic and social variables may better explain the differences in hospital use within a given country over longer stretches of time than across countries at a given point in time. In the latter case, economic variables--differences in gross domestic product (GDP) per capita--serve as major explanations of the cross-country differences found. Changes in demographic, social and morbidity factors are also mirrored in the relative importance of hospital departments, at a given point in time and also in changes over time. Major changes have taken place within the health care systems. Hospitals are losing ground to other forms of health care: for instance, to institutions providing pre-hospital and post-hospital treatment. The need for more caring patterns of service, rather than for more curing, accounts for yet another overall trend. Hospitals have started to respond to this need by offering more 'semi-stationary' and part-time health care facilities. These developments go hand in hand with the establishment of closer relations between hospitals and other facilities within the health care system, and with improved non-stationary health care services.