Cross-border Health Care Directive Research Articles

The role of the 2011 patients' rights in cross-border health care directive in shaping seven national health systems: Looking beyond patient mobility

Reports on the implementation of the Directive on the application of Patients' Rights in Cross-border Healthcare indicate that it had little impact on the numbers of patients seeking care abroad. We set out to explore the effects of this directive on health systems in seven EU Member States. Key informants in Belgium, Estonia, Finland, Germany, Malta, Poland and The Netherlands filled out a structured questionnaire. Findings indicate that the impact of the directive varied between countries and was smaller in countries where a large degree of adaptation had already taken place in response to the European Court of Justice Rulings. The main reforms reported include a heightened emphasis on patient rights and the adoption of explicit benefits packages and tariffs. Countries may be facing increased pressure to treat patients within a medically justifiable time limit. The implementation of professional liability insurance, in countries where this did not previously exist, may also bring benefits for patients. Lowering of reimbursement tariffs to dissuade patients from seeking treatment abroad has been reported in Poland. The issue of discrimination against non-contracted domestic private providers in Estonia, Finland, Malta and The Netherlands remains largely unresolved. We conclude that evidence showing that patients using domestic health systems have actually benefitted from the directive remains scarce and further monitoring over a longer period of time is recommended.

Zawieszenie zwrotu kosztów opieki zdrowotnej a dyrektywa transgraniczna

ADJOURNMENT OF REFUND OF HEALTH CARE COSTS IN THE LIGHT OF THE CROSS-BORDER HEALTH CARE DIRECTIVEThis paper outlines the possibility of adjournment of health care costs refund in the light of the cross-border health care directive. The main purpose of this paper is to determine whether cross-border health care Directive has been correctly implemented in the national law. The Directive permits adjournment of refund of cross-border health care costs. It seems that the Directive is not properly implemented into the polish law. The controversy surrounds the act of tying reimbursements to a strict budget in the National Health Fund.

3.11 - Health Technology Assessment (Hta) In Croatia: National And International View

Formal activities of the Agency for Quality and Accreditation in Health Care and Social Welfare in the field on HTA at the national level began in October 2009 through the Department for Development, Research, and HTA. The aim of the Croatian HTA process and reporting is to produce credible and standardized information that is relevant and useful to decision makers in the Croatian publicly funded health care system and to meet their needs for reliable, consistent, timely, and relevant HTA information. Main barriers that slow the establishment of optimal and sustainable HTA processes, as well as facilitate factors (EU Projects EUnetHTA, EQUIPT, and SELFIE; HTA Network; ISPOR HTA Roundtable Europe, HTA Council, HTA Training Program; HTAi; WHO National Contact Point on HTA) will be discussed in brief. Croatia already recognized the utmost importance of international collaboration and joint HTA work through EUnetHTA (joint production of HTA reports, EUnetHTA tools and processes). For small countries like Croatia, European cooperation on HTA is essential due to limited human and financial resources. In light of alignment with Article 15 on Cooperation on HTA of Cross-Border Health Care Directive, HTA Network Strategy paper, HTA Network Reflection paper, and WHO Resolution - Health intervention and technology assessment in support of universal health coverage, it can be expected that the HTA process will soon become sustainable and mandatorily linked to reimbursement/investment or disinvestment decision in Croatia.

Europe, different approaches to similar problems

Europe is a political reality, 28 countries with health systems with full responsibility of each member state, without a common portfolio of services and structures for planning, management and control. In terms of servicing two major agreements: emergency care through UE and more recently Cross-border Health Care Directive implemented October 2013. However the cover (portfolio of services), the provision, professional contracts, planning, financing are different and always taking into account the limits of national borders that no longer exist. The analysis of indicators of resources and health show relations according to the financing and payment systems, and less relation to the level of spending. The services and emigration policies show the difference between countries and the difficulty to have a common European policy to access health services. The challenges facing individual countries are common, although the solutions adopted are very different. Proposals made of the Future Hospital Commission (Royal College of Physicians UK) analysing their health care situation, is very common throughout the EU, and measures proposed could be largely adopted.

The impact of the EU Directive on patients’ rights and cross border health care in Malta

The patients’ rights and cross-border health care directive was implemented in Malta in 2013. Malta's transposition of the directive used the discretionary elements allowable to retain national control on cross-border care to the fullest extent. This paper seeks to analyse the underlying dynamics of this directive on the Maltese health care system through the lens of key health system stakeholders. Thirty-three interviews were conducted. Qualitative content analysis of the interviews reveals six key themes: fear from the potential impact of increased patient mobility, strategies employed for damage control, opportunities exploited for health system reform, moderate enhancement of patients’ rights, negligible additional patient mobility and unforeseen health system reforms. The findings indicate that local stakeholders expected the directive to have significant negative effects and adopted measures to minimise these effects. In practice the directive has not affected patient mobility in Malta in the first months following its implementation. Government appears to have instrumentalised the implementation of the directive to implement certain reforms including legislation on patients’ rights, a health benefits package and compulsory indemnity insurance. Whilst the Maltese geo-demographic situation precludes automatic generalisation of the conclusions from this case study to other Member States, the findings serve to advance our understanding of the mechanisms through which European legislation on health services is influencing health systems, particularly in small EU Member States.

Ideas from the second UEMS conference on CME/CPD: new EU directives on a patients' rights in cross-border healthcare and professional qualifications.

The 2nd UEMS Conference on Continuing Medical Education (CME) and Continuing Professional Development (CPD) held in Brussels on February 28th2014 was a great opportunity to gather all stakeholders involved in the field of CME/ CPD accreditation in Europe and to discuss common grounds on the basic principles that make accreditation necessary for medical staff and for the benefit of patients. In particular it was an opportunity for representatives of the European Commission (EC) to introduce two new European directives that came into force at the end of 2013: (1) the Patients’ Rights in Cross-Border Healthcare Directive, and, (2) the Professional Qualification Directive 2013/55 [2]. The event was also an opportunity to discuss the enormous impact these directives will have on patients care, healthcare quality and daily practice for doctors and all healthcare professionals. According to the new European Union (EU) rules healthcare professionals are expected to update their knowledge, skills and capabilities acquired during undergraduate and postgraduate professional education via efficient knowledge management practices (CME evidence-informed practice) and CPD lifelong learning programs, incorporating inter-professional education, psychosocial and humanitarian aspects of patient care, communication skills, and cultural awareness. European directive 2011/24/EU on a Patients’ rights in cross-border healthcare

Transposition and National-Level Resources: Introducing the Cross-Border Healthcare Directive in Eastern Europe

The Cross-Border Patients’ Rights Directive represents an attempt to resolve the unclear situation that had developed due to ‘negative integration’ within the field of healthcare. While the adoption of the directive ends the EU-level decision process, it represents the start of the implementation process, where national institutional structures and interests play a key role. This article investigates the role of resources as a key factor shaping transposition within the member states, with a focus on Poland and Bulgaria. The article shows that a multidimensional perspective of resources is important for understanding transposition of EU directives in member states. While previous research has tended to consider resources at the aggregate, national level, the present study shows that specific concerns about the ‘adjustment costs’ at the sector system level are of key importance.

200th ENMC International Workshop “European Reference Networks: Recommendations and Criteria in the Neuromuscular field”, 18–20 October 2013, Naarden, the Netherlands

200th ENMC International Workshop “European Reference Networks: Recommendations and Criteria in the Neuromuscular field”, 18–20 October 2013, Naarden, the Netherlands

Implementation of the Patients’ Rights in Cross-border Healthcare Directive in Latvia

Latvia, being one of the EU Member States, has an obligation to implement the rules stated by the Directive 2011/24/EU on Patients' Rights in Cross-border Healthcare (hereinafter--the Directive) before 25 October 2013 in existing national legislation and practice. Implementation was carried out under pressured circumstances. A National Contact Point has been established, information is provided for patients in Latvian and to some extent in English, the Medical Treatment Risk Fund will start operations to provide compensation for harm, and the restrictions and procedure for prior authorisation have been stated. The need to secure quality of care and patient safety and well as privacy protection are the most challenging tasks for Latvia. It can be concluded that some progress in patients' rights can be achieved, but it is doubtful if patients' mobility will be stimulated.

Cross-border Healthcare in Spain and the Implementation of the Directive 2011/24/eu on the Application of Patient’s Rights in Cross-border Healthcare

This work describes and assesses the implementation of the Cross-border Healthcare Directive in Spain. Although implementation has not yet taken place, the Government has already adopted a draft implementing regulation, on which this article is based. In addition, this article deals with a number of other rules that have been adopted in Spain, which are not strictly aimed at the implementation of the Directive but which are expected to facilitate its implementation and to help cement its effectiveness.

European Reference Networks: developing a EUCERD opinion

The establishment of European Reference Networks as laid out under the Cross Border Health Care Directive (CBHCD) is a major opportunity for the rare disease community. There have been many successful networks for rare disease groups, but their establishment has been ad hoc and funding streams variable. Sustainability has been a major challenge. Although the assessment of the quality of these networks has not been systematic, nonetheless networks have succeeded in establishing important infrastructure including disease specific registries, shared tools such as tele-expertise and the production of disease specific guidelines and training pathways. Within the CBHCD it is envisaged that European Reference networks will be established, and these will not only relate to rare diseases. These networks will primarily link nationally designated centres of expertise. Within the EUCERD a process is being followed to inform the CBHCD committee on the specific issues relating to ERNs for rare diseases. These recommendations relate to areas of designation and governance, capacity building and resources to support ERNs and quality assurance. The recommendations will be discussed in a series of meetings in 2012, with the aim of producing a EUCERD recommendation on ERNs for rare diseases by the end of the year in line with the timeline of the cross border health care directive.

The Cross-Border Health Care Directive: More Free Movement for Citizens and More Coherent EU Law?

In 2011 the Patients' Rights in Cross-border Health Care Directive was adopted. This Directive is meant, inter alia, to implement the case law of the Court of Justice on patient mobility. This article investigates the ways in which the position of patients has been reinforced. The question of whether the dual system of reimbursement of costs – on the basis of Regulation 883/2004 and on the basis of the Treaty – has been simplified, or whether it has become even more complicated, is also investigated.

Changes in European Cross-Border Cancer Research and Treatment

1% ( € 10 billion) of overall public health spending ( € 1,000 billion) in the 27 EU states. That may change with the Cross-Border Health Care Directive, which passed in January 2011 and goes into effect in 2013. As with the E112 form, the patient’s home country health service will require prior authorization for treatment, but only if a hospital stay is involved or the treatment is very expensive. According to the parliament report on the directive, “the aim is absolutely not to encourage cross-border health care as such but to ensure its availability, safety, and quality.” Under the directive, a patient’s request can be refused only if the treatment could quickly be obtained in the patient’s home country or for doubts about the qualifi cations of the physician in the other member state. Each member state must establish at least one national patient contact point for information on health providers, reimbursement procedures, and when prior authorization is necessary. Patients may choose between public or private facilities. However, the directive’s stipulation that patients bear any costs incurred beyond the level reimbursed by their home country might deter some patients. Long-term care and organ transplants are exempt. And the directive doesn’t cover travel and accommodation costs. The European Commission estimates that under the new rules, overall EU 27-state public health spending will go up by just € 30 million a year.