The European Court of Auditors (ECA) has published a special report on EU cross-border healthcare. The verdict: "significant ambitions but improved management required". Ian Youngman looks at why the EU cross-border healthcare offer is still not encouraging more patients to travel for treatment.
The ECA’s report (Special report no 07/2019: EU actions for cross-border healthcare: significant ambitions but improved management required) examined how the European Commission has monitored the implementation of the EU cross-border healthcare directive and supported Member States in informing patients of their rights. They assessed the results achieved on exchanges of health data across borders and checked key actions on rare diseases.
The report concluded that although EU actions in cross-border healthcare enhance Member States’ collaboration, the benefits for patients are limited.
It found that despite the progress made on providing EU citizens with information on cross-border healthcare, in some areas this information remains difficult to access.
The report also identified weaknesses in the Commission’s strategic planning and project management.
The auditors also found problems and delays in exchanging patient health data electronically between national authorities.
In addition, the report stated that despite the fact that a total of between 27 and 36 million people suffer from rare diseases in the EU, the European Reference Networks for Rare Diseases face significant challenges to ensure they are financially sustainable and able to operate effectively across national healthcare systems.
A small number of European countries have done what they can to promote the EU cross-border rules, while many offer only limited information and some actively discourage patients from using the rules. Several countries seem to seek to dissuade potential patients from going to them for treatment, fearing an influx into already over-stretched facilities.
While the report asks countries to do more, in the current political and economic climate, this is unlikely.
What the report and 2016 numbers (see Data Source below) miss is that Ireland is innovating in the way it is supporting cross-border travel for healthcare. The country has a new type of medical tourism agency emerging that only operates for non-paying EU cross-border patients, helping them through the administrative complexities in the outbound and inbound countries. These agencies seem to make money by referring patients only to selected clinics and hospitals. Countries reluctant to pay for cross-border treatment may however make it difficult for such agencies to do business.
The numbers suggest that the UK's probable, but still not certain, exit from the EU is not going to greatly upset the inbound or outbound flow of UK medical tourism.
The report findings support IMTJ’s ongoing assessment that the boom in medical tourism from the cross-border directive predicted by some industry players, has not happened, and for at least the next five years is unlikely to happen.
The auditors recommend the European Commission should:
The directive is aimed at ensuring safe and high-quality medical care across borders in the EU, as well as providing for reimbursement abroad under the same conditions as at home.
EU patients who seek healthcare in another Member State by undergoing planned hospital treatment or purchasing medicines are therefore entitled to relevant information on standards of treatment, reimbursement rules and the best legal route.
EU funding for cross-border healthcare comes primarily from the EU’s Health Programmes, which provide around €64 million a year for health-related issues.
There are two different legal routes for patients to obtain cross-border healthcare treatment: via the EU directive or the EU regulation on the coordination of social security systems.
The report was unable to offer new figures, as it relied on earlier research. The latest figures are for 2016 and since then the political and economic climate has changed in the EU, with Brexit dominating the landscape.
Using 2016 figures, under the directive, around 200,000 patients a year, or less than 0.05% of EU citizens, take advantage of treatment in another Member State.
The majority of patient mobility has been between neighbouring Member States: France having the highest number of outgoing patients at 146,000. The majority of cross-border patients from France sought healthcare in Spain, Portugal, Germany and Belgium.
EU official figures for 2016 include patient mobility for treatments not requiring Prior Authorisation (209,534 patients) and those requiring Prior Authorisation (3,562 patients), giving a total of 213,096.
|
Country |
OUT |
IN |
|
Austria |
9 |
2,437 |
|
Belgium |
30 |
27,457 |
|
Bulgaria |
5 |
686 |
|
Croatia |
200 |
1,680 |
|
Cyprus |
13 |
254 |
|
Czech Republic |
401 |
12,300 |
|
Denmark |
25,343 |
198 |
|
Estonia |
80 |
10,044 |
|
Finland |
11,427 |
403 |
|
France |
146,054 |
371 |
|
Germany |
NO DATA |
27,034 |
|
Greece |
10 |
5,639 |
|
Hungary |
NO DATA |
4,169 |
|
Iceland |
53 |
141 |
|
Ireland |
791 |
674 |
|
Italy |
201 |
9,335 |
|
Latvia |
27 |
167 |
|
Lithuania |
19 |
369 |
|
Luxembourg |
277 |
12,530 |
|
Malta |
4 |
463 |
|
Netherlands |
NO DATA |
1,653 |
|
Norway |
10,301 |
327 |
|
Poland |
8,647 |
6,545 |
|
Portugal |
5 |
32,895 |
|
Romania |
130 |
1,003 |
|
Slovakia |
6,110 |
259 |
|
Slovenia |
1,835 |
117 |
|
Spain |
11 |
46,138 |
|
Sweden |
NO DATA |
6162 |
|
UK |
1,113 |
1,643 |
|
TOTAL |
213,096 |
213,096 |
Source- European Commission 2018
The inbound and outbound EU cross-border patient numbers bear no relation to known inbound and outbound medical tourism flows, except that Spain, Portugal, Belgium and Germany are popular medical tourism destinations for paying medical tourism customers.
The missing outbound numbers in Germany and Netherlands are explained in that, in both countries, healthcare and health insurance are not state provided and it is compulsory for all residents to buy health insurance from insurance companies. The competing insurers in these two countries are reluctant to offer statistical information on cross-border medical travel as they fear that it suggests they are unable to provide adequate treatment at home for their customers.
Sweden is an EEC country but not an EU one, so sees no need to provide figures. Hungary is a EU country but has a problematic relationship with the EU and the European Commission.
At the IMTJ Medical Travel Summit in Berlin, 1 - 3 December 2019 we’re dedicating a session "The EU Directive in Practice" – to explore progress to date. The session, chaired by Balasz Lengyel from the European Commission, will feature expert contributions from:
• Bernd Christl from EU-Patienten.de will provide a "View from a National Contact Point"
• Harald Platou from Oslo University Hospital will talk about "Commissioning care for Norwegian patients"
• Martin O'Rourke from Trasna will cover "Facilitating the EU Directive for Irish patients"
• Denis Horgan from the European Alliance for Personalised Medicine will give his view on "Increasing patient awareness of the Directive".
Don’t miss the opportunity to learn from these experts on the EU Directive. Book now.
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