The emergence of managed care in Europe. Some thoughts on the politics of healthcare reform.

It is the purpose of this paper to demonstrate that healthcare reform in Europe can be successful only if it leads to more efficient resource use while maintaining a large degree of equity in the system. Globalisation is undermining the social contracts that established Europe's egalitarian societies after World War II. While socialised healthcare will continue to be an essential building block of social cohesion, public expenditures must be contained. The only approach to maintaining equity of access and financing in the face of a mounting resource constraint is to embark upon a radical re-engineering of the entire healthcare supply chain, introducing and adapting proven US managed-care techniques to the European environment. Through enabling legislation, most European countries are in a phase of testing the feasibility, cost effectiveness and quality enhancement potential of managed-care approaches, before applying them more broadly. While political opposition to change on the part of those whose current positions are threatened continues to run high, the practice of medicine can be expected to converge on the basis of standards of care and information technology over the next 10 to 15 years.