1. Health services

The health sector (N 85.1) represents an extremely complex and varied environment for the application of information and communication technologies (ICTs). Whereas ICT systems and services supporting primarily administrative, logistic and to some extent also individual professional activities are routine applications in many health care establishments, applications in fields related to medical information exchange, communications amongst health organisations and with patients/citizens, and remote delivery of health care services have generally not progressed beyond the experimental and pilot stage. Considering this situation and the wide variety of health service providers, the analyses will focus on the two key actors in this field:

a) Hospitals (85.11):

Hospitals are essentially large organisational/business enterprises. There are about 15,000 hospitals in Europe, of which about 8,000 are acute/general hospitals, 6,000 are long-term/rehabilitation hospitals and 1,000 are psychiatric hospitals. They vary widely in size. The "average" hospital has about 200 beds, with 4 or 5 departments and more than 30 doctors and 100 nurses. There are a lot of small hospitals (about 40% have fewer than 100 beds and a further 21% have between 100 and 199 beds) and many of these are in rural areas. The majority of hospitals are publicly owned and/or publicly financed (87%), with a growing minority of private hospitals (13%).

b) Doctors' (GPs') offices, primary care centres (85.12):

Office-based doctors (and other non-hospital services) are typically small or even micro enterprises. Outside of the hospital sector there are in Europe almost 350,000 GPs; organised into about 190,000 GP practices, and 8,000 primary care centres as well as more than 120,000 specialist practices.

Only limited attention is paid to Dentists' offices (85.13), other types of health services not mentioned above (85.14) and to Veterinary medicine/services (85.2).

2. Social services

Social services (N 85.3) is an extremely heterogeneous and diverse sub-sector which splits into a wide variety of institutions and types of services, many of which have little economic relevance. As the European population is ageing, and because this is the fasted growing sub-sector, we focus on organisations providing social (care) services to or at the client's home. These services comprise a wide and growing selection of service components like support within the home environment, support outside the home environment, consultancy, nursing, emergency call centres etc. The decision to focus on home care providers is based on the following reasons:

• Home care is the most prevalent form of social service delivery in Europe.
• The home care sector is growing in all European countries. Almost all European Member States pursue a policy which explicitly prefers home care to institutional care. Some countries have even implemented a moratorium with regard to building new institutional homes for older people.
• In the case of home care, services need to be delivered at dispersed geographic locations (i.e. the clients' homes), and IST can be of particular importance when geographic distances need to be overcome.

European associations:

• EHTEL - European Health Telematics Association. Maison Européenne de la Protection Sociale; 50, Rue d'Arlon, B-1000 Brussels. Phone and fax: ++ 33 1 3969 0327, www.ehtel.org. EHTEL is a neutral, not for profit association of all healthcare actors for the promotion of telematics solutions in healthcare across Europe.
• U.E.M.S. - Union Européenne des Médecins Spécialistes. Av. De la Couronne, 20, 1050 Brussels, Belgium, Phone: ++32-2-6495164, Telefax: ++32-2-640-3730, www.uems.be. The statutory purpose of the UEMS is the harmonisation and improvement of the quality of medical specialist practice in the European Union (EU).
• EACHH - European Association of care and Help at Home; Av Adolphe Lacomblé 69, B-1030 Brussels; Tel: 32-2-736-7972, Fax: 32-2-736-7498