Intended for healthcare professionals


BMJ extends its European reach

BMJ 2010; 341 doi: (Published 01 September 2010) Cite this as: BMJ 2010;341:c4681
  1. Tessa Richards, assistant editor,
  2. Trish Groves, deputy editor
  1. trichards{at}

    By working with academic partners to further cross country learning

    Throughout the world, the recession is forcing governments to introduce reforms aimed at containing costs and increasing the efficiency of their health systems. As they consider policy options and implement reforms, interest in learning from other countries’ experience is growing.

    To further this, the BMJ has established a formal link with the European Observatory on Health Systems and Policies ( and will publish a series of articles based on their work. The observatory was set up 12 years ago, as a partnership hosted by WHO, to promote cross country learning through comparative analysis of health system reforms. Its mission is to help politicians and policy makers base their reforms on the best available evidence.1

    One way it does this is to generate and collate evidence in briefing papers which support the meetings held by the six monthly rotating presidencies of the European Council. The presidency provides member state’s health ministries with the opportunity to set (as well as steer) the European health agenda. In the articles we commission from the observatory’s portfolio we seek to widen discussion of the issues raised.

    Belgium currently holds the presidency (, and its meeting next week will focus on how to sustain and increase the productivity of Europe’s ageing, predominantly female and increasingly part time, workforce. A recent estimate from the European Commission’s health directorate suggests that by 2020 the European Union will be short of one million skilled health professionals, and that as a result around 13% of “necessary” care may not be covered.2

    Discussion at the meeting will extend well beyond numbers. The cost of the workforce (around two thirds of most national health budgets) is also concentrating minds on “skills mix,” as countries experiment with extending the role and responsibilities of nurses and new cadres of health workers. Future planning must also take account of the European “brain drain.” Data from the ongoing Prometheus project show appreciable movement of health workers across EU borders and an east-west flow, which has left some poorer member states struggling to maintain essential services.3

    In an article on (doi:10.1136/bmj.c4687) based on the observatory’s work, Horsley and colleagues look at the measures countries have taken to maintain the competence of their workforce. Requirements for revalidation and continuing medical education vary, and the authors argue for a more harmonised approach.4

    In a second article from the observatory, Thomson and colleagues (doi:10.1136/bmj.c3759) look at the European and US experience with user charges to raise revenue and dissuade people from accessing “low value” care. They conclude that the United Kingdom should think twice before reaching for this policy instrument.5

    Research is central to cross country learning on policy and clinical matters alike, and this year we established a second important link with mainland Europe by appointing a European research editor Wim Weber, associate professor of neurology at Maastricht University. Wim has joined a team that includes BMJ research editors in Zagreb, Vienna, Paris, and Belfast, as well as those in mainland UK and the United States ( His particular focus will be on helping European researchers to meet their needs better and increase submissions of high quality clinical research and analysis in clinical medicine, public health, health policy, and health systems.

    We already have many strong contributions: around a fifth of original research papers published by the BMJ each year are from non-UK Europe, as were four of the 10 papers that were most accessed within two months of online publication last year.6 7 8 9

    A third initiative the BMJ has taken is to become the media partner for the European Health Forum Gastein (, one of Europe’s most influential forums for exchange between health policy makers, health professionals, the commission’s health and research departments, and patient and consumer groups.

    Cross country learning is not easy. The success or failure of any initiative depends on a wide range of highly context specific factors. It is also bedevilled by a serious lack of high quality, comparable, up to date data. In their recent study of temporal trends in breast cancer mortality in 30 European countries, Autier and colleagues acknowledged the limitations of using routinely collected national data to compare outcomes.10 But exchange of information and careful cross country analysis can provide valuable insights and identify potentially transferable lessons. We already have active and committed readers and contributors in mainland Europe and we would like more, to help us extend international debate on how best to tackle shared health challenges.


    Cite this as: BMJ 2010;341:c4681


    • Analysis, doi:10.1136/bmj.c3759
    • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: no support from any organisation other than their employer for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

    • Provenance and peer review: Commissioned; not externally peer reviewed.


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