The significance of outcomes within european health sector reforms: towards the development of an outcomes culture

Recently, policy makers, managers and users of health services have focused their attention on questions about service outcomes and effectiveness. However, the stakeholders in health care-communities, patients, clinicians, insurers, purchasers, managers and policy-makers - may, for various reasons, desire different outcomes to be realised over different timescales. Whilst a focus on outcomes forms a key evaluative criteria within the reforms of European health care systems, the significance of information and the priorities given to outcomes vary across Europe. A central tension lies between the pursuit of individual as opposed to population health gain. Other key issues include the need to separate the evaluation tools from their use and the importance of user choice and user involvement. The article outlines a model of the possible roles and needs for outcomes information. It differentiates between the uses of outcomes information at the patient care and population levels and for considering individual and population health gain. The needs to enhance country-based outcomes databases and to aid the development of an outcomes culture across health care systems in Europe are discussed. The article also discusses issues relating to developing an outcomes culture as an essential element of the health care reform process.