- Open Access
Integrating and rationalizing public healthcare services as a source of cost containment in times of economic crises
© Pettoello-Mantovani et al. 2016
- Received: 6 February 2016
- Accepted: 16 February 2016
- Published: 24 February 2016
Serious concern has been raised about the sustainability of public health care systems of European Nations and ultimately about the health of European citizens, as a result of the economic crisis that has distressed Europe since 2008. The severe economic crisis of the Euro zone, which is still afflicting Europe in 2016, has in fact threatened to equally impact public health services of nations presenting either a weak or a strong domestic growth.
On behalf of the European Paediatric Association, the Union of National European Societies and Associations, the authors of the Commentary debates the relationship between the effects of economic instability and health, through the report on an article recently published in the Italian Journal of Pediatrics, which emphasized the importance of integrating existing public health care services, otherwise independently provided by public hospitals, and Primary Care Paediatric networks. The interconnections between the effects of economic instability and health are briefly commented, following the observation that these two factors are not yet fully understood, and that the definition of proper solutions to be applied in circumstances, where health is negatively impacted by periods of economic distress, is still open for discussion.
Furthermore it is noted that the pressure to “deliver more for less” often seems to be the driving force forging the political strategic decisions in the area of pediatric healthcare, rather than social, cultural, and economic sensitivity and competences. Thus, the delivery of appropriate pediatric healthcare seems not to be related exclusively to motivations aimed to the benefit of children, but more often to other intervening factors, including economic, and political rationales.
The conclusions emphasize that local European experiences suggest that positive and cost effective healthcare programs are possible, and they could serve as a model in the development of effective cross-border regional program, not weakening the quality of services provided to children.
- Public healthcare
- Cost containment
Serious concern has been raised about the sustainability of public health care systems of European Nations and ultimately about the health of European citizens, as a result of the economic crisis that has distressed Europe since 2008 . The severe economic crisis of the Euro zone, which is still afflicting Europe in 2016, has in fact threatened to equally impact public health services of nations presenting either a weak or a strong domestic growth .
Although the relationship between the effects of economic instability and health has been the subject of a decades-long research engaging experts since the beginning of the last century, the interconnections between these two factors are not yet fully understood. The definition of problem solving solutions to be applied in circumstances where health is negatively impacted by periods of economic distress is still open for discussion [1–3].
The article recently published by Nigri et al. in the Italian Journal of Pediatrics  offers a substantially new and stimulating contribution to such an open debate, which is of great importance for the European public healthcare services. In fact, this paper describes the Pediatric Ambulatory Consulting Service (PACS) project, developed by an Italian regional Public Health Centers network, in response to the current general situation of economic distress. PACS integrates existing public health care services, otherwise independently provided by public hospitals and Primary Care Paediatric networks, with the purpose to establishing innovative yet efficient managerial solutions able to rationalize the resources, and not weakening the quality of services provided to the pediatric population. In brief it consists in a pediatric ambulatory consulting service, active in hospitals and providing a screening of the clinical conditions of outpatients <18 years old, before they access the Emergency Room (ER) Departments. The key question raised by the article is whether already existing local public health services can be further integrated in a cost-effective manner, while optimizing the efficiency and quality of the services offered to the population.
Europe has been defined as a giant “natural laboratory” for health systems, and a great chance for countries to learn reciprocally . In fact, the health systems of Europe currently represent the greatest collective commitment to health anywhere in the world. However, while nations are all trying to do similar things in the area of healthcare management, they do it in very different ways, often resisting to cooperative proposals and to learning across borders . In this respect, any successful local project which has proven to be cost-effective  should be taken into consideration by policy-makers and should be further studied with a continental perspective, including the economic, legal and social implications, in order to assess whether and in case to what extent they could become part of future cross-border collaboration plans on Euregio level.
Healthcare significantly impacts the annual budget of the European nations. Furthermore there is an urgent need for efficient solutions to allow implementation of high cost innovative technology and medication. Great efforts have been made by national European pediatric societies to contrast local decisions taken by legislators that would have negatively impacted child healthcare. Such local efforts have been strongly supported by the European Paediatric Association, the Union of National European Pediatric Societies and Associations (EPA-UNESA) which represent its member national pediatric societies at European and at the International Pediatric Association-IPA level.
The pressure to “deliver more health for less money” often seems to be the main driving force forging the political strategic decisions in the area of pediatric healthcare, instead of promoting social, cultural, and economic sensitivity and competence. Thus, the delivery of appropriate pediatric healthcare seems not to be related exclusively to motivations aimed at the benefit of children, but more often at other intervening factors including mere economic and political rationale . Local experiences such as the one reported by the PACS project , suggest that positive and cost effective healthcare programs are possible and that PACS could serve as a new model in the development of effective programs in other European nations.
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