Public expenditure on health care in the European Union (EU) could jump from 8% of Gross Domestic Product (GDP) in 2000 to 14% by 2030, and continue growing beyond that date, according to a World Bank estimate quoted in a new study.

Health care costs in Europe are rising faster than countries' ability to pay for them, says the report, which is produced by the Economist Intelligence Unit (EIU). The main reasons for this are: ageing populations and the related rise in chronic disease; - costly technological advances; - patient demand, driven by increasing knowledge of options and by poorer health habits; and - legacy priorities and financing structures for the health care system which are ill-suited to today's requirements, it notes.

The study identifies the following seven trends which it believes will shape health care generally over the next two decades:

- health care spending will continue to rise, not only as a result of inflation but also because of growing recognition by policymakers that improved health is linked with greater national wealth;

- maintaining the universal health care model will require rationing of services and consolidation of health care facilities, as public resources fall short of demand;

- general physicians will become more important as gatekeepers to the system and as coordinators of treatment for patients with multiple health issues;

- more effective public health measures and fundamental shifts in attitude will be necessary to promote healthy behaviours and discourage those which are not healthy;

- European governments will need to find a way to improve the collection and transparency of health data in order to prioritise investment decisions;

- patients will have to take more responsibility for their own health, treatment and care; and

- governments will need to tackle bureaucracy and liberalise rules restricting the roles of health care professionals, in order to help control costs.

So how should governments respond to these challenges?  In order to sharpen focus on the policy alternatives and to fuel debate, the EIU authors offer the following five contrasting scenarios of the European health care sector in 2030:

- technology triumphs and cures chronic disease, while e-health takes a prominent role in the management of healthcare;

- European nations join focus to create a single, pan-EU health care system;

- preventive medicine takes precedence over treating the sick;

- European health care systems focus on vulnerable members of society; and

- European nations privatise health care, including its funding.

These five scenarios make clear that, although there may be great debate across Europe on the details of health care reform, what is needed most is adaptability, say the report's authors.

They add that although no single scenario is likely to come true, this examination of possible futures may help to clarify the current debate on health care reform, which they say is now being driven in large measure by "self-interested factions" such as insurers, physicians and government bureaucracies. However, they believe that, over time, "citizens may succeed in shifting the discussion so that it focuses where it should - on the best ways to maximise the health and wellbeing of Europe's population."