Potential Benefits of Cross-Border Health Care: the Case of Poland and Germany

Abstract

IntroductionIt is a remarkable feature of the last decades that our world is becoming more integrated, both with respect to economic activities and in a more general sense. While there are many other observations to corroborate this statement, one indicator is that people increasingly tend to move from one country to another, e.g., as commuters or as tourists. It is important to note that this potentially has implications for health care: First, a need for health care may arise while being in a foreign country, either suddenly due to some developing illness or because of a persistent health problem. Second, people may also wish to go abroad in order to obtain health care. Hence, cross-border health care may be a by-product of people working or temporarily staying in another country while its availability may also constitute the prime reason for crossing national boundaries.Basically, cross-border health care will enhance individual choice sets, by providing another option to obtain health care which may either exhibit a better quality or be available at a lower cost in comparison with a purely national provision. From an economic point of view, it would be desirable to have cross-border health care whenever it could reasonably be expected to generate a net benefit to society, i.e., to the countries involved. However, with individual countries relying on their own system of health insurance, a number of barriers may exist which prevent mutually beneficial transactions. In particular, this is true for social health insurance which, due to restrictions on the benefit package and specific ways of financing, naturally involves a focus on care provided within the country for which it has been designed.Turning to the European Union (EU), health policy has not been on the agenda for many years because the founding treaties contain no specific article explicitly referring to it. Moreover, as the Treaty on the Functioning of the European Union acknowledges, every EU Member State is first and foremost responsible for organizing its own health care system. However, the implementation of the European Single Market, one of the EU cornerstones today, has affected the health care sector of the Member States by means of the four fundamental freedoms: These imply free movement of goods (e.g., medicinal products and medical devices), freedom of movement for workers (e.g., mobility of health care professionals), the right of establishment and freedom to provide services (e.g., social and private health insurances), and free movement of capital (e.g., investment in health infrastructure), respectively. In addition, the EU is engaged in the coordination of social security systems, and it also assumes a strong role in improving health in areas such as the environment and the workplace (Greer et al., 2014).For a long time, cross-border health care in the EU for individuals with social health insurance has been based on a Social Security Regulation which took effect in 1971. However, this Regulation has been applied in a rather restrictive manner. As a consequence, the number of patients going abroad in order to receive planned health care remained fairly small. The main reason was that prior authorization had to be obtained from domestic authorities who often refused to grant it on the grounds that the requested health care was also available at home. Over time, several EU citizens have challenged this position, either by complaining about long waiting times at home or by arguing more generally that prior authorization would interfere with their right to choose health care in other Member States.In ruling on these cases, the European Court of Justice with its judgements created case law which has, in effect, enhanced patients' rights considerably with respect to crossborder health care (Palm et al., 2011). In turn, this led to a major revision of the Social Security Regulations which took effect in 2010. While maintaining prior authorization of cross-border health care, the new Regulations contain provisions that limit its use such that a refusal will most likely involve no harm to the health of the patient. …