Abstract
The difficult road for European countries towards a European Union is well-known. A Union which we expect to see become reality within a brief period of time with the introduction of the Euro, the new European currency, beginning in 1999.
With regard to services and in particular health care services, Europe is destined to remain a region with deep heterogeneous characteristics for many years. Next to countries with national health care systems (such as Great Britain shortly after World War II, and more recently, Italy) many countries where health care is essentially based on the free choice of the citizen as well as health care associations adhering to these national programs. A particular emphasis is placed on those who are hired employees. This type of national health care system, still very different under its structural profile (the first are characterized by a more “social” vision of medicine, instead the second are more inspired by an “open” vision of health care) are ever more inspired throughout Europe by the need for state authority intervention. Those authorities who can put a number of management-economic mechanisms into action in order to guarantee the right for health care to all citizens, also taking into consideration the growing phenomenon of third-world immigration.
It is foreseen by all, in this heterogeneity of services the existence of a so-called “Maastricht effect” on the services themselves, seen as a push to the progressive homogenization of health care services, even if this is not yet foreseen by agreements made by European integration. The following will play an important role in this unifying vision:
The progress of Information Technology, technology to which the E.U. has dedicated many efforts in the last several years, including community research.
The ever-more popular conception of “patient's card” or patient's rights card. These cards highlight citizen's rights particularly for the defense of health care.
The acceptance of circulation of professionals within the E.U., a circulation which automatically brings forward a concept of the circulation of patients.
Common to all European countries is the push to improve quality yet at the same time reducing the cost of health care assistance, knowing that it is impossible to provide everything to everyone: we are facing a process of Health Care Process Reengineering which gathers the nature as well as the structure of health care services and most relevant the clinical laboratory.
We must ask ourselves what the role of the medical laboratory should be within this process. The following points can be considered crucial for a progressive homogenization of Laboratory Medicine in Europe:
A convergence towards more uniform management models, with particular benefit for the patient:
The concept of “evaluation of laboratory activity outcome” like in all other diagnostic and therapeutic services, is be coming more and more important in Europe.
The need to bring service closer to the patient will be a determining factor in provoking an evolution in the organization of the laboratory. This should take into consideration the needs of the patient and the possibility to serve him/her when he/she needs it. Under this profile, a wise introduction of “point of care” technology, without indulging in any damaging excess in any form of unqualified laboratory medicine (the doctor's office is a typical example), is destined certainly to influence the future organization of the laboratory with a progressive and stronger connection between laboratory and family doctor.
In front of the many risks that both patients and health care operators face there will be a move towards the concept and practice of security protection for health care operators and patients as well as the growing attention towards patient privacy protection. We must therefore imagine information systems able to provide a dialogue between the operators themselves and an increasingly easier contact with the patient, avoiding in the meantime unauthorized interference.
The capacity of confronting analytical results between different laboratories which are equipped with different technologies and analytical methodologies is another challenge for European laboratory medicine to face up to.
Finally there is the big problem of automation. An automation that certainly must be conceptually in function with the patient's real needs. A clever automation process needs to be realized which truly is able to reduce costs and improve quality: under this aspect unique formulas do not exist, but only a careful approach towards quality. The role of scientific associations (IFCC, International Federation of Clinical Chemistry, FESCC Federation of European Societies of Clinical Chemistry and ALA Association of Laboratory Automation) is certainly very important for this aspect.