Opening the Debate on Pediatric Subspecialties and Specialist Centers: Opportunities for Better Care or Risks of Care Fragmentation?

Expert specialist care is essential for the diagnosis of rare conditions and for children who require complex investigations and highly technical interventions, such as transplantation. This intensive specialist care often requires deep collaboration between a number of specialists to ensure optimal outcomes. Generally, how this specialist care is planned, organized, funded, and assured has not been fully researched, thus, the result is a huge diversity of provision across Europe. Less well-resourced countries in Eastern Europe face the dilemma of how best to develop specialist care in the future, better resourced countries in Western Europe face the problem of how best to rationalize and co-locate interdependent specialist services to improve outcomes, and small countries must find ways of developing effective cross-border care. Large centers with multiple specialists often are recommended as the best way forward, but this strategy also risks fragmentation and potentially undermines the competence within local hospitals, as well as being inconvenient for families living far away. The Article describes the nature of specialist care, the training of specialists, and the interdependencies between specialist teams and propose networked solutions to overcome some of the concerns, such as the increasing gap between primary and tertiary care.