The changing role of the hospital in Europe: causes and consequences

The United Kingdom, faced with a legacy of long-term under investment, has embarked on a major programme of hospital development. This raises many questions. What factors influence the work of the hospital? How can hospitals continue to adapt to changing circumstances? This paper draws on a recent study of the role of the hospital in Europe. It identifies major gaps in information about what hospitals do and how they are changing. International comparisons are especially difficult because of differences in definitions. The challenges that hospitals face can be categorised under three broad headings: the health needs of the population; opportunities and constraints they face in providing care; and the consequences of wider societal and economic factors that shape their environment. Health needs reflect the composition of the population (births, ageing, and migration), changes in risk factors, and changes in public expectations. Hospitals gain opportunities, but also face constraints as a result of changes in the workforce on which they draw and the technology that is available to them. They must also work within the constraints imposed by wider societal developments, such as the economy. Hospitals must also take account of their role as centres of teaching and research, as well as their responsibilities to the local community. Hospitals across Europe have changed considerably in the 1990s, with more people being admitted but staying for shorter periods. With the additional demands created by growing rates of day care and outpatients, hospitals are currently much busier places than in the past. There have also been considerable reconfigurations of hospitals in many countries. Some have been more successful in implementing change than others. Successful change is more likely where a whole system approach to health care is taken. Granting managerial autonomy to individual hospitals makes change less likely. Planning approaches are more successful than market-based ones. Change often requires construction of new facilities. The increasingly rapid pace of change in health care means that hospitals will have to adapt much more quickly than in the past. This will require a long-term programme of sustained and stable investment.