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An Assessment of the Transition in Health Care Provision across the Big 5 Western European Countries : Assessing Health Care Provision in an Era Marked by Changing Patient Demographics and Fiscal Austerity

Europe’s Big 5 health systems are in transition. Rapidly ageing populations and budget cuts have forced governments to place greater emphasis on the efficiency of care provision. As part of this efficiency drive, the landscape of care provision in these countries will continue to evolve to meet the dual challenges of limited budgets and changing patient demographics. This research service will assess the evolution of these health systems to understand if changes in care provision reflect sound policy-making or are a knee-jerk response to changing external factors.

Key Findings

Efficiency

- Although efficiency is the buzz word, it has not become the key driver in health care systems transition as yet; however, this trend is likely to change over the next few years.
- IT has to move from care settings to cloud-based platforms to support care continuum. By 2020, the adoption of IT to support this objective will reach its peak.
- The solutions proposed by national governments are short-term or issue-driven and do not represent a holistic approach in terms of transforming care provision.

Service Provision

The primary care segment will not be a profitable area of focus for device/equipment manufacturers until 2025.
- With a shortage of GPs across countries, virtualisation should be the logical first step. Care continuum should follow suit; however, most governments have not proposed this solution.
- The discussion about the shift from hospitals to primary care and LTC/HC is still on paper and has not become a reality. This is because such a shift requires regulatory oversight and, most importantly, fund transfers, which have not happened.
- The establishment of a true LTC/HC system is yet to happen – the current set up is largely focussed on elderly care; however, a move to include chronic disease care is also required.

Private Sector
- At present, private insurance and private hospitals are of minimal significance in the care system in transition. Notable exceptions include the privatisation of hospitals in Germany and the compulsory employer private health insurance (PHI) in France.
- The impact of the private sector on health care will be felt post-2020, with better co-ordination between public and private stakeholders.




Table Of Contents

An Assessment of the Transition in Health Care Provision across the Big 5 Western European Countries 
1 EXECUTIVE SUMMARY

Executive Summary
1 Research Methodology
2 Research Methodology
3 Key Findings
4 Despite the Disproportionate Spending on Secondary Care, the Focus Should be on Improving Primary and LTC/HC Services
5 Virtualisation of Primary Care, Medication Adherence, and Digital Health Care Hold the Key for the NHS
6 Improvements in Hospital Efficiency Will Catalyse the Shift of Patients to Primary Care and LTC/HC Settings
7 The Shift of Chronic Care Patient Management to LTC/HC is Critical in Terms of Improving the Efficiency of Care Provision
8 The Reduction in the Number of Hospital In-patients Will Shift Care Provision to Primary Care and LTC/HC Settings
9 The Focus is on the Adoption of Technologies that will Better Enable the Transition of Care from Hospitals

2 UNITED KINGDOM

United Kingdom
1 Out-of-Pocket Spending on Health Care is Growing as PHI Coverage Decreases
2 The Enhanced Role of Primary Care is Not Suitably Supported by an Increase in Funding as a Share of the Total Expenditure
3 The Shift in Funding from Secondary to Social Care is Paving the Way for New Models of Care Provision
4 With a Declining Nurse-to-In-patient Ratio, it is Critical to Adopt Systems that will Improve Care Efficiency
5 Primary Care Provision will Evolve from GP Recruitment to Efficiency in the Management of GP Services
6 Gatekeeping on Hospital Re-visits is the Only Solution to Shift PoC Outside the Secondary Care System
7 Enhancing the Role of Primary Care is the Ideal Long-term Solution for the NHS
8 NHS will Shift to a Model of Integrated Social/Primary Care Provision to Improve the Cost-effectiveness of Care
9 Role Revisions—Pressure Points
10 Role Revisions—Outcomes
11 Role Revisions—Past, Present, and Future
12 Primary Care will Assume the Overall Responsibility for the Management of Post-acute, Elderly, and Chronic Patients
13 Ranking of Key Stakeholders in Terms of Influence—2015 and 2025
14 Key Stakeholders—2015 and 2025
15 NHS Blueprint 2020
16 The Adoption of Portable Diagnostics and Technology that Enable Care Virtualisation will Drive Efficiency
17 IT Solutions Providers and Medical Device Manufacturers Have the Best Opportunities

3 FRANCE

France
1 Compulsory Employer-driven PHI Could Double PHI Spending in the Coming Years
2 Compulsory Employer-driven PHI will Alter the Health Care Market Landscape
3 31% of Health Care Spending is on Procurement and Administrative Services
4 Compulsory Employer PHI will Drive the Adoption of TPPs
5 The Efficiency Drive to Improve Hospital Care is Shifting Patients Towards Ambulatory and LTC/HC Settings
6 Elderly Care is Being Transitioned from Hospitals to LTC/HC Settings To Reduce Un-necessary Admissions and Costs
7 An Optimal Finance Mechanism and Provider Skill Mix Allows MGPs to Provide Quality Care
8 Role Revisions—Pressure Points
9 Role Revisions—Outcomes
10 Role Revisions—Past, Present, and Future
11 Key Stakeholders—2015 and 2025
12 Ranking of Key Stakeholders in Terms of Influence—2015 and 2025
13 France Blueprint 2020
14 Increased PHI Spending and Efficient GP Service Provision will Enable the Shift of Care from Hospitals to LTC/HC
15 IT Adoption will Drive Connectivity and Data Sharing between Primary, Secondary, and Community Care Providers
16 Medical Device and Medical Imaging Manufacturers Have the Best Opportunities

4 GERMANY

Germany
1 PHI Adoption will be Driven by Elderly Patients Seeking Care in LTC/HC Settings
2 The Emphasis is on Robust Out-patient Services, which Accounts for 50% of the Total Health Spending
3 The Health Budget Surplus will be Used to Increase Physician Fees, Lower Contribution Rates, and Reduce Co-payments
4 The Rise in Germany's Nurse Population Has Been Unable to Meet the Growing Demand for Geriatric Care Nurses
5 Despite the Rising Number of In-patients, Hospital Privatisation Has Decreased Bed Occupancy Rates and the Average Length of Stay
6 Germany will Set up an e-health Council to Aid in the Interoperability between Different Health Care Provider-used IT Systems
7 Role Revisions—Pressure Points
8 Role Revisions—Outcomes
9 Role Revisions—Past, Present, and Future
10 Key Stakeholders—2015 and 2025
11 Germany Blueprint 2020
12 PHI Adoption will Drive the Demand for Elderly Care and Chronic Disease Management in LTC/HC Settings
13 Ranking of Key Stakeholders in Terms of Influence—2015 and 2025
14 Germany will Focus on the Adoption of Technologies that will Aid in Interoperability between Multiple IT Platforms
15 BDA will Play a Key Role in Germany'sPrivatisation and Efficiency Improvement Drive

5 ITALY

Italy
1 Hospital Budget Cuts and Upgraded Benefit Packages will Shift the Model of Care from Interventional to Management
2 While Total In-patient Numbers Continue to Decline, Nursing Shortages Persist, Especially in LTC/HC Settings
3 GP Shortages Prevent Italy from Completing the Shift to a Primary Care-centric Model of Care Provision
4 Italy has Launched a Slew of Measures to Improve Care Efficiency through Better Accountability and Transparency
5 Role Revisions—Pressure Points
6 Role Revisions—Outcomes
7 Role Revisions—Past, Present, and Future
8 Key Stakeholders—2015 and 2025
9 Ranking of Key Stakeholders in Terms of Influence —2015 and 2025
10 Italy Blueprint 2020
11 The Emphasis on Prevention, Early Diagnosis, and Enhanced Primary Care is Expected to Reduce the Cost Burden
12 Italy is in the Process of Adopting Technology that will Enable Greater Monitoring and Sharing of Health Care Data
13 Enhancements to the Benefits Package (LEA) will Drive the Adoption of Medical Devices and Data Analytics

6 SPAIN

Spain
1 Private Health Spending Has Increased in Response to the Budget Cuts Forced by the Autonomous Community Deficits
2 The Decrease in Public Health Spending Warrants Efficiency Optimisation to Support Health Care Provision
3 Primary Care Spending as a Percentage of Absolute Spending has Reduced, Putting a Strain on Care Provision
4 Primary Care Has Witnessed a Decrease in Patient Numbers Due to Reduced Funding; However, Care Efficiency Has Improved
5 To Cope With the Reduction in Nurse Numbers, the Role of Nurses is Set to Change
6 The Non-renewal of Contracts Due to Budget Cuts Has Led to the Emigration of Doctors, Thereby Exacerbating the Existing Shortages
7 Role Revisions—Pressure Points
8 Role Revisions—Outcomes
9 Key Stakeholders—2015 and 2025
10 Role Revisions—Past, Present, and Future
11 Ranking of Key Stakeholders in Terms of Influence—2015 and 2025
12 Spain Blueprint 2020
13 In an Era of Fiscal Austerity, Increased PHI Spending is Expected to Drive the Demand for Health Care
14 The Spanish Government is in the Process of Adopting IT Platforms to Monitor Health Care Provision
15 For the Judicious Allocation of Limited Resources and Funding, the Available Care Services Must be Mapped
16 Legal Disclaimer

7 APPENDIX

Appendix
1 Definitions of Key Terms

8 THE FROST and SULLIVAN STORY

The Frost and Sullivan Story
1 The Frost and Sullivan Story
2 Value Proposition: Future of Your Company and Career
3 Global Perspective
4 Industry Convergence
5 360º Research Perspective
6 Implementation Excellence
7 Our Blue Ocean Strategy

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