Réorganisation des systèmes hospitaliers: leçons tirées de l’Europe de l’Ouest

In many countries in Europe policy-makers are undertaking major restructuring of hospital systems, but with little evidence on which to base their decisions. This paper draws on a recent study of the role of the hospital in Europe undertaken by the European Observatory on Health Care Systems. Hospitals must take account not only of their role in treating patients but also their position as centres of teaching and research, and their responsibilities to the wider society. We characterise the pressures that hospitals face under three headings: population health needs; changes in health care; and wider societal and economic factors.
Hospitals have changed as more people are admitted for active medical treatment but stay for shorter periods. The additional demands of growing numbers of ambulatory procedures make hospitals much busier than previously.
Many countries have successfully reconfigured hospital systems, some more successful than others. Success is likely where a whole system approach is taken; granting autonomy to individual hospitals makes change less likely; while planning strategies have been more successful than market-based strategies. Change often requires new facilities. Increasingly
rapid change in health care forces hospitals to adapt much more quickly than in the past, requiring a long-term programme of sustained and stable investment.