Centralization in Surgery in European Countries

European countries are challenged by the growing costs of their health care systems. The issue is complex due to numerous factors and perspectives involved in a market which includes various players and conflicting interests. High quality of health care at reasonable cost is the target of all accountable health care systems, but the definition of quality remains vague and therefore subject to versatile interpretation. An important question is how to provide high quality complex procedural care with policies ranging from unregulated free markets to centralization (regionalization) in a single national referral center. Centralization is a process of concentration of resources, which include infrastructure, staff, material, knowledge, and research. This process is believed to lead to improved quality of care and ultimately to enhanced financial efficiency. How centralization should be implemented remains a controversy and in many countries the focus rests on the centralization of complex surgical procedures. Today, many elements have been established in the surgical field that are associated with incremental improvements in the quality of surgical care. One repeated observation is that high-volume institutions are associated with improved outcome through appropriate and better indications, surgical procedures, and postoperative management.