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General overview of sector

Although the hospital sector in Europe is highly diverse (from small local units to major regional or national hospitals), it faces a number of similar trends and issues: a reduction in bed numbers and the search for alternatives to full hospitalisation, funding problems, health challenges, etc.

According to the World Health Organisation (WHO), there are almost 15,000 hospitals in the European Union, with some 2.8 million beds. The vast majority of these are public-sector hospitals, with the private sector providing less than 20% of all hospital beds in 2004.

European hospitals are organised in many different ways, ranging from cottage hospitals and small local units to regional- or national-scale healthcare institutions, not forgetting secondary care establishments and general hospitals. The public sector is predominant in most Member States; in others the private sector, whether profit-making or not, prevails.

As far as financing is concerned, there are also major differences in sources of funding: taxation, social security contributions, patient contributions, private insurance funds, etc.

Regardless of this diversity, European hospitals are affected by some broad across-the-board trends:

1. funding is public in the main, but over the past thirty years or so there has been a trend towards greater private-sector provision;

2. alternatives to full hospitalisation have recently become increasingly widespread (more outpatient treatment). This has led to a reduction in the number of hospital beds and, consequently, in the hospital sector’s share of health expenditure (which is rising overall).

Another obvious common trend is that all hospitals are facing similar health challenges. For example, according to a European Commission report, there are expected to be almost 50 million people over the age of 80 in 2050 (compared with 18 million in 2004), while the number of dependants is likely to double by 2050.

It is difficult to obtain a precise picture of employment in the sector. As with many other service activities, the staff play a crucial role. But various discrepancies in the way in which hospital staff are counted makes comparisons between Member States awkward, if not impossible. Some countries use the number of individuals employed while others record “full-time equivalents”, without even considering the outsourcing of ancillary services such as maintenance, catering, laundering of work clothing, etc. Public-private partnerships are in fact becoming increasingly widespread, especially for maintenance services.

The European Commission gives a figure of 3 million workers. EPSU says that it organises 3.5 million members. According to a comparative study on the role of hospitals in Europe (“Les hôpitaux dans les 27 pays de l’Union européenne”, Dexia Editions, July 2008, ISBN: 978-2-911065-68-2), hospitals employ more than half of all health workers in many cases, and there are almost 1.5 million staff in the United Kingdom alone, and over a million in France and likewise in Germany.

Hospital staff are highly skilled and, generally speaking, largely feminised. They are also ageing. Contracts in the sector are for the most part permanent, either full-time or part-time. Recently there has been an increase in staff mobility across Member States, but also increasing migration and a brain drain to the benefit of third countries such as the United States, Australia and New Zealand (Green Paper on the European Workforce for Health COM (2008)725 final of 10/12/2008).

ETUI and Observatoire Social Européen (2010) European Sectoral Social Dialogue Factsheets. Project coordinated by Christophe Degryse, online publication available at www.worker-participation.eu/EU-Social-Dialogue/Sectoral-ESD