From the Strategic Pediatric Alliance, Padova, Italy; European Confederation of Primary Care Pediatricians–Conf ed eration Europ eenne de P ediatrie Ambulatoire, Lyon, France; Strategic Pediatric Alliance, Secretariat, Great West House, Great West Road, Brentford, United Kingdom; European Paediatric Association–Union of National European Paediatric Societies and Associations, Berlin, Germany; Department of Pediatrics, University of Foggia, Foggia, Italy; European Academy of Paediatrics–European Union of Medical Specialists, Brussels, Belgium; Clinica Pediatrica, Universita’ degli Studi, Udine, Italy; Maccabi Health Services, Tel Aviv, Israel; European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom; and Children’s Hospital, Hannover Medical School, Hannover, Germany E P A ising indebtedness has refocused the debate around European healthcare reform to focus on costsaving. Will reforms enable Europe’s healthcare systems to tackle the challenges of demographic and epidemiologic changes, rising demand for healthcare, and an increasing focus on quality improvement? Or will the pressures to deliver more for less inevitably drive costcutting, more rationing, and risk declines in quality and access of care? How can we reshape the debate on European health care reform to encourage a new vision of health? These and other key questions were raised and debated at a recent forum convened by The Economist Conferences in Geneva in March 2011. The alarming conclusions later published by The Economist in a report entitled, “The Future of Health Care in Europe,” paint a very bleak picture (Figure). The pressure on European healthcare systems is likely to have a differentially greater effect on vulnerable groups such as children. Yet children feature very little in a forum like The Economist Conferences and in general health systems debates throughout Europe. European health care systems need to adapt to ongoing financial pressures, while at the same time evolving better to suit changing health care needs of children as chronic conditions become increasingly dominant problems. For example, in response to current global economic pressures, many countries are considering changing from a pediatriciandelivered primary care system to a general practitioner model as a cost-cutting exercise, rather than in response to evidence about quality. Different possible “extreme scenarios” have been described in response to the likelihood that substantial changes in health care will unfold for European healthcare in the next 20 years. Three of these scenarios include: (1) European nations joining forces to create a single panEuropean healthcare system; (2) preventive medicine taking precedence over acute care for sick patients; and (3) European healthcare systems focusing on vulnerable members of society. The first scenario we judge to be unlikely, given the diversity of primary care systems for children in Europe. The second scenario focuses on prevention, already an integral part of a pediatrician’s principal function. The third possibility should include the elderly patients and the very young as the most vulnerable members of society. Unfortunately, children and their unique needs are all too often forgotten in wider health systems discussion and policy planning.