Cross border health care in the European Union

1 Cross - border health care IN THE European UNIONMAPPING AND ANALYSING PRACTICES AND POLICIESE dited by Matthias Wismar, Willy Palm, Josep Figueras, Kelly Ernst, Ewout van GinnekenCross- border health care has become a much more prominent phenomenon in the European Union . When in need of medical treatment, patients increasingly act as informed consumers who claim the right to choose their own providers, including thosebeyond borders. Patients are supported and encouraged by several factors, including theInternet and more internationally-trained health professionals. Even if the willingness totravel for care varies widely among Member States as well as within social groups, patientmobility is often motivated by dissatisfaction with health care provision in the home stateand experienced deficiencies in the local health system.

2 Some competent authorities andhealth insurers are contracting with health care providers abroad for specific proceduresto ensure the timely treatment of their patients or they inform them about options andprocedures. Cross - border health care is not only restricted to patients. Medical doctors and nurses goabroad for training, to temporarily provide services or to establish themselves in anotherMember State. Increasingly, individual doctors and hospitals in different Member Statescooperate with each other. In some cases, rather than patients or providers, even healthservices move across borders through telemedicine. Cross - border health care can alsoinclude the collaboration between providers and competent financing book explores such trends and also looks at the legal framework for this activity aswell as examining some of the legal uncertainties surrounding rights, access, reimbursement, quality and safety.

3 It examines different approaches to these concernsand takes a look at methodologies which can be used to ease or resolve some of these issues. It marks an important step in the continuing debate on a legal framework forcross- border health care . The information and analysis presented in the study will be ofconsiderable use to policy-makers and those with an interest in key aspects of Cross - border health editorsMatthias Wismaris Senior health Policy Analyst, European Observatory on HealthSystems and Palmis Dissemination Development Officer, European Observatory on HealthSystems and Figuerasis Director, European Observatory on health Systems and Policies and Head of the WHO European Centre for health Ernstis Research Officer, European Observatory on health Systems and van Ginnekenis Researcher, Berlin University of Technology, Berlin, and analysingpractices and policies Edited byMatthias WismarWilly PalmJosep FiguerasKelly ErnstEwout van Ginneken22 Observatory Studies Series No.

4 22 22 Cross - border health care in the European UnionObservatory Studies SeriesCover_WHO_nr22:Mise en page 1 3/9/11 4:35 PM Page 1 Cross - border health care in the European UnionThe European Observatory on health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy European Observatory on health Systems and Policies is a partnership between the World health Organization Regional Office for Europe, the Governments of Belgium, Finland, Ireland, the Netherlands, Norway, Slovenia, Spain, Sweden and the Veneto Region of Italy, the European Commission, the European Investment Bank, the World Bank, UNCAM (French National Union of health Insurance Funds)

5 , the London School of Economics and Political Science, and the London School of Hygiene & Tropical health care in the European UnionMapping and analysing practices and policies Edited byMatthias Wismar, Willy Palm, Josep Figueras, Kelly Ernst, Ewout van GinnekenThis report has been produced with the financial assistance of the European Community ( health & Consumer Protection Directorate-General; grant agreement 2006 WHO05). The views expressed herein are those of the authors and can therefore in no way be taken to reflect the official opinion of the European :DELIVERY OF health care organization and administrationEMIGRATION AND IMMIGRATIONQUALITY OF health CAREHEALTH SERVICES ACCESSIBILITYHEALTH POLICYINTERNATIONAL COOPERATIONEUROPEAN Union World health Organization 2011, on behalf of the European Observatory on health Systems and PoliciesAll rights reserved.

6 The European Observatory on health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on health Systems and Policies concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the European Observatory on health Systems and Policies in preference to others of a similar nature that are not mentioned.

7 Errors and omissions excepted, the names of proprietary products are distinguished by initial capital reasonable precautions have been taken by the European Observatory on health Systems and Policies to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the European Observatory on health Systems and Policies be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the European Observatory on health Systems and 978 92 890 0221 9 Printed in the United KingdomCover design by M2 MAddress requests about publications to: Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen , , complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site ( ).

8 Foreword by the editors viiForeword ixAcknowledgements xiList of tables, figures and boxes xiiiList of abbreviations xviiList of contributors xixChapter 1 The health Service Initiative: supporting the construction of 1a framework for Cross - border health careMatthias Wismar, Willy Palm, Ewout van Ginneken, Reinhard Busse, Kelly Ernst and Josep FiguerasChapter 2 Towards a renewed Community framework for safe, high-quality 23 and efficient Cross - border health care within the European UnionWilly Palm, Matthias Wismar, Ewout van Ginneken, Reinhard Busse, Kelly Ernst and Josep FiguerasChapter 3 Access to health care services within and between countries 47of the European UnionReinhard Busse, Ewout van Ginneken and Markus W rzChapter 4 Benefit baskets and tariffs 91 Reinhard Busse, Ewout van Ginneken, Jonas Schrey gg and Marcial Velasco GarridoContentsviCross- border health care in the European UnionChapter 5 Quality and safety 121 Helena Legido-Quigley, Irene A.

9 Glinos, Kieran Walshe, Benno van Beek, Cule Cucic and Martin McKeeChapter 6 Mapping national practices and strategies relating to patients rights 159 Herman Nys and Tom GoffinChapter 7 Cross - border collaboration 217 Irene A. GlinosChapter 8 Past impacts of Cross - border health care 255 Rita BaetenChapter 9 Cross - border health care data 289 Ewout van Ginneken and Reinhard BusseChapter 10 Annexes to Chapter 5 and Chapter 6 341 Foreword by the editorsThis book presents an analysis of the broader context related to Cross - border health care in the European Union (EU). It was written to support the European Commission in developing a directive on patient rights in Cross - border health care . The original manuscript of this book was submitted in July 2007. We have decided to publish this study now, with only minor modifications, as it is still unique in its approach.

10 It covers analytically policy-relevant aspects of Cross - border health care that emerged out of a long dialogue between stakeholders, policy-makers and researchers in Europe, starting in the late 1990s as a reaction to the Kohll and Decker rulings. The book presents a rich and detailed Cross - European analysis of different dimensions that determine the scope and policy of Cross - border care : access to health care , benefits and tariffs, quality and safety, patients rights, Cross - border collaboration and Cross - border health care data. The analysis of the book is still timely and correct, although for some of the chapters more recent data would now be hope that the book can further inform the political debate on the future of Cross - border health care in the EU, a debate that will continue even after the final adoption of a proposed directive in early 2011.