Plans are afoot to set up centralised European centres of excellence to handle acute illnesses, according to Professor Andre Knottnerus, at the University of Maastricht.

He indicates that the Dutch Ministry of Health is pushing on with informal talks with other European partners. He adds: "Take heart transplants for children - there is a great centre of excellence at Giessen in Germany. Why shouldn't we here in the Netherlands use it? We simply don't do the volume of operations to match the expertise the Germans have built up."

He says that an international organisation of top level clinical care may soon be formed. Knottnerus sees other engines for reform, such as the European healthcare directive, which will ultimately give all Europeans the same healthcare rights. He also points to increasing cross-border cooperation and the need for small countries to access specialist skills. 

He also points to the Eurotransplant International Foundation, bringing together all transplant hospitals in Benelux, Germany, Austria, Slovenia and Croatia. 

Knottnerus forecasts that Europe will have an integrated healthcare system in 10 to 15 years.

Above all, he sees a growing political consensus across Europe on the importance of the private sector and the need to integrate it into public systems.