Dr Constantine Constantinides talks on the EU directive on Cross Border Healthcare


Like most who will be reading this, I am a promoter and champion of the European Union Cross-border Healthcare Scheme (“Scheme” in this article should be taken to mean the EU Directive on Cross Border Healthcare.)  I participated in and contributed to the EU Commission Consultation in 2006 – and continue to be actively involved in the efforts to see the scheme fully implemented.

Nevertheless, I have also been and continue to be a constructive critic. Reality needs to prevail above politics and the narrow interests of Eurocrats. I have written and spoken on the subject.

Developing events compelled me to write again.

Putting something “on ice” means to postpone or delay this something. Similarly, putting something “on hold” means stopping all activity – to stop the progress of something.

Sadly, today (2012), as a result of the economic and political turmoil in EU-member countries, both terms seem to apply to the European Cross-border Healthcare Scheme.

Plans for the breakup of the Euro... and its effect on the Scheme

Policy Exchange (a UK-based think tank -) in March 2012 shortlisted five contestants for the best plan for the breakup of the Euro. We all now realize that breakup of the Euro - or radical changes to the system - are real possibilities.

If the Euro System breaks up – or changes radically - the Scheme is not likely to survive – as originally designed and planned.

Cross-border activity... and the effects of Euro breakup

With a breakup of the Euro – or even just “internal devaluation” in some countries, practically all forms of cross-border activity will be impacted. Internal devaluation has already started with a reduction in salaries and pensions and the prices paid by the government for services and products.

So, even without a Euro breakup, what effect will internal devaluation have on the Scheme and reimbursement, and reimbursement rates?

I leave you to ponder this.

An imperfect Scheme

Like the Euro, the Scheme was incompletely thought out and to a certain degree, is flawed. Although “providing certainty” was a central theme, all along, certainty on several issues still needs to be provided. Implementing an incompletely thought-out Scheme is an invitation to certain trouble.

Readiness and compliance

With practically all European countries battling with political and economic challenges, implementing the Scheme and becoming “ready and compliant” will be the last thing on the agenda of politicians and bureaucrats. The Scheme very prominently involves new rules, systems, regulations and reimbursement, and a Scheme-specific reimbursement system – a logistical maze and headache (if not a nightmare).

No EU country wants to add this headache to its other headaches – for now, at least.

Rule out 2013...what we are already seeing on the ground

2013 was slated as the year for the Scheme to start being fully implemented. I think we need to shift expectations and the date. What afflicts Greece, Spain, and Portugal afflicts, to a certain degree, practically all EU countries – including Germany (I think).

Recession is driving citizens to abandon private health insurance and patients are flocking to public healthcare facilities – inundating some of them to breaking point. With public sector hospitals now having no “spare capacity”, they are unlikely to welcome foreign patients with open arms.

The effect of Europe-wide Recession…on public and private sector healthcare provision

As part of austerity policy, public sector hospitals are being closed down and others “merged”. National Health System benefits are being curtailed and some are in fact scrapped. Salaries of health sector professionals and other workers are being slashed. Governments (on the Right, Left and Centre) are keen to unload the responsibility and burden of providing healthcare services to its citizens.

We are already seeing governments working towards this “in stealth mode”. No government is saying this openly and in public – but the private sector knows this very well – and is rubbing its hands.

On the other hand, in some of the EU countries, private healthcare providers, mainly hospitals, are currently operating in crisis mode. They are having to borrow to meet obligations, including “payroll”. And some are even “retrenching” and putting staff on “part time” or “obligatory unpaid leave”.

The “Libyan Patient” provided only a short-lived and temporary financial relief for some. Some are now placing hopes on the Syrian Patient.

Only a year ago (2011) Greek private sector hospitals were informing me that they had no spare capacity and therefore, did not want medical tourists. Now they see medical tourism, including the EU Scheme as a saviour (judging by the calls I get and the meetings I am invited to attend with groups of top executives). But it is a bit late in the day.

Looking on the bright side of life... a chance to think again and think through

Looking on the bright side of life, this hiatus may be a blessing for the Scheme, offering us the opportunity to think again and think things through. We may just be able to avoid the sort of mistakes which led to the flawed Euro concept, which, because of “time pressure” led to its hurried implementation.

Of course, like the Euro, the fate of the Scheme will be determined by politics as much as economics!


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