Bridging the Gap Between Inpatient and Outpatient Care: A Shift in European Healthcare Policies

The healthcare landscape in Europe is undergoing a significant transformation. Several nations have identified a gap between inpatient and outpatient care as a potential barrier to ensuring equitable and affordable access to medicines.

With an aim to bridge this gap, countries are optimising reimbursement and procurement policies for a more integrated and coordinated approach. However, there is a dearth of evidence on the impact of these policies at the interface of inpatient and outpatient sectors on access to medicines.

Over time, policy-makers have increasingly shifted their focus towards medicines used in hospitals. They have introduced policies in the inpatient sector that were previously only used in the outpatient sector, including tools to support evidence-based decision-making (e.g., Health Technology Assessment – HTA). This shift can be seen as a response to developments in the pharmaceutical sector.

With the advent of highly specialised medicines with high price tags for small patient populations that are mainly used in the hospital setting, such as gene therapies, it is crucial to scale up capacity and policy action in the hospital sector.

While these policies aim to ensure affordability and financial sustainability of high-priced medicines in hospitals, another motivation is to address the impact of hospital prescribing of medication initiated during a patient’s hospital stay on outpatient use.

The treatment of chronic diseases often requires continuous medication for years. Increased use of therapeutically equivalent but less expensive alternatives, such as generic and biosimilar medicines, would ease the burden on public budgets without compromising quality of care, thus enhancing patient access.

These challenges can be addressed through appropriate demand-side measures, such as generic substitution or prescribing by the International Non-Proprietary Name (INN) in the outpatient sector.

However, the road to bridging the inpatient-outpatient gap is not without challenges. It requires institutional and organisational changes, and the establishment of new institutions and committees, with representation from both sectors.

Despite the importance of the topic, it is still a relatively new research area lacking an accepted terminology and taxonomy. Yet, the shift in focus towards bridging the inpatient-outpatient gap is a promising development in the European healthcare landscape.