title: Uncomfortable realities: the challenge of creating real change in Europe's consolidating hospital sector.
abstract: This article examines uncomfortable realities that the European hospital sector currently faces and the potential impact of wide-spread rationalization policies such as (hospital) payment reform and privatization.
  
  
  
  Review of relevant international literature.
  
  
  
  Based on the evidence we present, rationalization policies such as (hospital) payment reform and privatization will probably fall short in delivering better quality of care and lower growth in health expenses. Reasons can be sought in a mix of evidence on the effectiveness of these rationalization policies. Nevertheless, pressures for different business models will gradually continue to increase and it seems safe to assume that more value-added process business and facilitated network models will eventually emerge.
  
  
  
  The overall argument of this article holds important implications for future research: how can policymakers generate adequate leverage to introduce such changes without destroying necessary hospital capacity and the ability to produce quality healthcare.
authors.affiliation: Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands. Patrick.Jeurissen@radboudumc.nl.|Ministry of Health, Welfare, and Sports, The Hague, The Netherlands. Patrick.Jeurissen@radboudumc.nl.
authors.forename: Patrick
authors.initials: P
authors.lastname: Jeurissen
authors.affiliation: CEO AIIDMHealthSeville, Sevilla, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Duran
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Saltman
mesh_terms: D002204:Capitation Fee / Q000639:trends; D054976:Clinical Governance / Q000191:economics / Q000592:standards; D017046:Cost Savings; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards; D004469:Economics, Hospital / Q000639:trends; D005060:Europe; D018166:Health Care Reform / Q000191:economics / Q000639:trends; D006291:Health Policy; D061889:Healthcare Financing; D006739:Hospital Administration; D006761:Hospitals / Q000639:trends*; D006801:Humans; D011332:Privatization; D011787:Quality of Health Care / Q000191:economics / Q000639:trends; D012051:Reimbursement Mechanisms / Q000191:economics / Q000639:trends; D012052:Reimbursement, Incentive
keywords: Cost-containment; European hospitals; Governance; Hospital business models; Hospital management; Payment reform; Privatization