www.euregio3.eu
Research methods
SF funding periods
The EUREGIO III programme looked at two SF funding cycles: 2000/6 and 2007/13. This raises immediate issues of comparability of SF aims and objectives between the two funding cycles and the two main beneficiary groups. The 2000/6 programme was dominated by Mediterranean countries where SF investment focus was largely on health service modernisation, but with a significant bias towards improving health facilities. Notable was the Portuguese Saude programme for its inclusive whole systems balance; it is the exception. Most SF investments tend to be stand alone projects.
The 2007/13 programme is largely focused on the new (12) member states. SF priorities reflect the considerable legacy of the Semashko healthcare system (reliant on a hospital-centric care model and centrist planning regimes). Hospitals are poorly configured (seen in the context of contemporary healthcare) and generally in poor condition; a problem compounded by decades of underinvestment in infrastructure and clinical technologies. There is also a considerable shortage of primary care and community based facilities. The scale of the legacy may tend to shift projects towards tactical easement of immediate problems potentially at the expense of strategic (whole systems) transformational change. This creates the danger of perpetuating a hospital centric model of care delivery.
Study design
Our study had two components. The first began with a review of academic and grey literature on hospital planning and design, supplemented by informal interviews with key informants and professional associations, and by internet searches. This enabled us to identify a series of capital projects and related initiatives from across Europe, each illustrating innovative approaches to hospital planning and design. The issues addressed included flexible design, a focus on clinical pathways, integrated regional planning and integration of models of care into design. The final selection of case studies was based on the potential to learn generalizable lessons, while maintaining geographical diversity.
The second component of our project was a “thematic analysis” of the key issues identified in the first stage, based on a review of published literature and the findings of the case studies. This analysis was supplemented with a series of reviews of how the national or regional context shaped the implementation of developments; these included the diverse approaches to capital investment in Europe, the emergence of new models of care, developments in thinking about how to use capital assets to provide solutions to specific health service challenges, new capital financing models, the application of lifecycle economics, experience with facility management, and innovations in sustainable design.
The following formed part of the Euregio III series of case study and thematic reference information to help guide those states and regions interested in and concerned with planning EU structural fund investments with a health focus, as follows:
- EU wide capital related case study projects that have been completed or have made significant planning and or construction progress – these are intended to provide translatable insight and understanding in general terms
- Thematic analysis of key issues drawn from the case studies and as described above, again in general terms
- Progressively developed new case study information drawn from a wider ranging (capital asset, public health, training and other) specific SF projects from the 2000/6 programme and the current 2007/13 cycle. The review of the current cycle will be in the form of ongoing action research
- Interim and final thematic analysis of how the SF process has worked in the context of assisting investment within the health sector
