26. 09. 12. - 10:40
Hospital closure the only prescription for an improved health service
The savage cuts being made to Europe's 1bn € health budgets are unnecessary, the result of a failure of organisation, of greedy doctors and vote-hungry local politicians, the founder-president of the European Health Forum Gastein, Austrian-born Prof Dr Günther Leiner, said today.
Speaking ahead of the 15th annual EHFG conference beginning on October 3, Leiner said: "The economic issue will dominate this year's meetings, and what is now obvious to everyone in the health industry is that the problem isn't lack of funds, but of millions of Euros being mis-spent on pointless medico-bureaucratic structures, and drugs and operations which are simply unnecessary."
Leiner, a Salzburg-based internist and former MP, said the culprits for such wrong-headed arrangements were often local and regional politicians. "They especially love building hospitals. Hospitals bring in votes. Local hospitals must be a good thing, mustn't they? No, often the opposite! Lots of them should be closed down and the funds put into the specialised hospitals we actually need."
Austria has 7.7 beds per 1,000 inhabitants, Germany 8.2, the Czech Republic and Hungary 7.1 – all well above the European average, and far more than were to be found in countries which were pioneering reform, Sweden (2.8), Norway (3.3), or the Netherlands (4.7). But there was, Leiner said, no correlation at all with public health: in the annual Euro Health Consumer Index Germany had now fallen from sixth place to 14th, and Austria from fourth to 11th.
"I am not a cynical man, but it is striking that the more decentralised such decision-making, the higher the hospital density," Leiner said. Yet the evidence was that quality of care is no worse in countries which have seen long-overdue hospital closures, mergers, and division of labour coupled with greater specialisation: "The Netherlands is one of the pioneers in reducing the number of hospitals, and the model for many quality indicators, such as fighting hospital pathogens."
Leiner said that from his own experience he took issue with his famous compatriot Leopold Kohr's mantra about small being beautiful. "In medicine it's nonsense. Lots of general hospitals trying to offer everything is the sure-fire formula for wasted resources and ineffectual, sometimes dangerous, treatment – after all, all operations carry a risk. You get proper treatment from specialised hospitals which have plenty of experience of what you are suffering from. It has been proved over and over again. Non-specialist treatment is dangerous if you are seriously ill."
He cited a recent study by Johns Hopkins University which showed that in hospitals where fewer than six heart transplants a year were performed, the mortality risk for patients was 67% greater than in centres performing more than 15 operations a year. Similar statistics applied to heart disease generally.
Leiner also pointed to the ballooning number of MRI and CT scans, often bringing no clear benefit except to those administering them. It was another symptom of the culture of over-treatment and over-diagnosis which needed to be identified and shown the door, he said. "Perhaps we should see the economic crisis as a historic opportunity for European medicine if it provokes the long-overdue reforms we urgently need in Europe".