13 May 2016

Responding to the needs of the growing numbers of people with complex, chronic illnesses is making new and testing demands of health systems worldwide. This discussion paper looks at emerging evidence from Europe and offers ten reflections for policymakers.


It is hard to understate the scale of the challenge facing Europe in relation to the growth of complex conditions. Although chronic diseases often start in younger age groups, their symptoms dominate older populations. Our understanding of what ‘best practice’ might look like for people with complex conditions is still in its infancy, and there are no uniquely European answers to the problems facing health systems globally. 

Given the rapidly evolving challenge to meet the needs of people with complex conditions, it is increasingly apparent that the clinical models of both acute care and single chronic disease management may be ill equipped to respond. 

Amongst other reflections, the paper concludes that new models of care will need to be intelligently coordinated and based on patient preferences. Although they have the potential to reduce costs and generate savings, high expectations about reduced hospital use from these inventions will have to be carefully managed. 

This discussion paper was originally prepared as a working paper for the Nuffield Trust and the Commonwealth Fund’s 15th international meeting on improving the quality and efficiency of health care, designed to provoke and inform debate. This paper is one of three UK papers commissioned for the meeting and subsequently prepared for publication by the Nuffield Trust.


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