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Patient Mobility in Europe


Patients crossing border to receive care /buy health goods ... Ecole Nationale de la Sante Publique. Erasmus University. Jagellonian University, Cracow ... – PowerPoint PPT presentation

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Title: Patient Mobility in Europe

Patient Mobility in Europe
  • Report from the Europe for Patients Project
  • Facilitating Mobility within and between
  • Meeting the Challenges of Increased Mobility
  • Magdalene Rosenmöller
  • IESE Business School
  • Scientific Coordination, Project Europe for

Patient Mobility - eHealth
  • Who is the European Patient?
  • Patient Mobility Opportunity
  • Europe 4 Patients Project
  • The Challenges of Patient Mobility
  • eHealth to support Patient Mobility
  • And now?

Who is the European Patient?
  • Patients crossing border to receive care /buy
    health goods (Border Regions Euregios)
  • Patients crossing border - framework of
    co-operative agreements (Germany Holland,
  • Patients sent abroad to overcome capacity
    restrictions at home (purchased care in Belgium
    for UK residents - WL)
  • Citizens on holiday need to use health care
    services(Mass Tourism Veneto Region)
  • Citizens retiring to a different country usual
    access to health care(Long term residents Spain)

Patient Mobility an Opportunity
  • Increasingly integrated Europe
  • ? BENEFITS from enhanced patient mobility?
  • Benefits for Patients
  • better access to health care
  • better quality - centres of reference
  • Benefits for health policy makers / professionals
    / providers
  • sharing of capacities across borders, better use
    of existing ones
  • Concentration of Excellence in Europe
  • Mutual learning Exchange of Best Practices

(No Transcript)
e4p Project
  • SSP Scientific Support to Policies
  • European Commission FP6 SP1
  • The Future for Patients in Europe
  • Europe for Patients, e4p
  • Duration 3 years, Feb. 2004 Jan 2007
  • Benefits and challenges of enhanced patient
    mobility in Europe
  • how the benefits can be increased
  • how challenges can be addressed

Project Objective
  • to contribute scientific evidence
  • that will enable policy makers at EU, national
    regional level
  • to take concerted and coordinated action
  • to allow Europes citizens / patients
  • to benefit from enhanced mobility in Europe

e4p Project Partners
  • IESE Business School (Spain) (Coordinator)
  • LSHTM London School of Hygiene and Tropical
    Medicine (UK)
  • LSE London School of Economics (UK)
  • OSE Observatoire Social Européen
  • Faculty of Law Ghent University (Belgium)
  • CCBS - Centre for Cross Border Studies, Queens
    University Belfast
  • Slovenia IVZ - Slovenian Institute of Public
  • Estonia Praxis
  • Veneto Region
  • AIM Association International de Mutualité
  • European Observatory on Health Care Systems

Project Activities
  • Research Activities - across Europe and in-depth
    case studies
  • Legal Framework
  • at EU and national level,
  • recent EU jurisprudence (patient and provider
  • Situational Analysis
  • patterns of patient mobility,
  • contracting arrangements,
  • quality, patient orientation and information,
    communication between professionals, etc.
  • Case Studies
  • on cross border arrangements, purchased care,
    mass tourism, long term residents (Ireland,
    Belgium/UK, Spain, Slovenia/Austria,
    Estonia/Finland Veneto Region)
  • Identification of options for change
  • primary legislation practical and monitoring

Issues of Patient Mobility
  • Legal Issues
  • Patients rights a Right to Care? EU
  • Providers mutual recognition, professional
  • Policy - planning of resources, rationing, ..
  • Contracting Arrangements
  • Inclusion / exclusion of treatment, monitoring?
  • Quality
  • Accreditation - Health Technology Assessment
    Effectiveness of Care
  • Information to patients on health systems
    access / Q /
  • Readily accessible / easily understandable?
  • Patient Participation
  • Communication between professionals
  • eHealth exchange medical records, privacy data,
    share clinical guidelines..

eHealth to support Patient Mobility
  • Information to Patients
  • Identification, proof of rights
  • Administration / Financing Processes
  • Patient Records Communication betw. professionals
  • Communication physicians - patients
  • Surveillance Systems
  • Data and Evidence for Policy Making
  • Cooperation between Countries / Systems

Information to Patients
  • National
  • NHS information to travellers
  • German AOK Mallorca
  • Web based information
  • On different countries
  • On illnesses (NGOs and Patient Groups)
  • Scattered - Need to be more personalised and
  • Future - European Public Health Portal
  • One stop shop for information on EU
  • Gateway
  • national and regional websites
  • civil society groups

Identification - Proof of Entitlement
  • European Health Insurance Card
  • E111
  • Clear identification, easy administration but 4
    different ways NOW!
  • Different experiences in different countries
  • Challenges / Issues
  • What should it contain what not
  • Minimum data on chip or as access to a
    networked database
  • Ownership of data?
  • Data security
  • Incompatibility between systems
  • Different experiences - Sesam Vitale / Netcards,
    Slovenia, Catalonia
  • Language
  • Signature professional liability
  • Future (One system) or
  • Interoperability Secure IAS services

Citizen-centred Patient Record
  • Communication professionals to patients
  • Language? Different concepts of care?
  • Patients need access to information
  • Often the transfer of info between professionals
  • Transparency / data security / acceptance
  • Different rules in different countries
  • Examples / Future
  • email to patients (Poland / Germany)
  • Web based Personalized internet pages
  • Dialogues / Follow up on Chronic Illnesses
  • Follow Me (online medical records)

Communication between Professionals
  • Problem - often NOT done
  • Communication difficult BUT important
  • Pre chronic, rare diseases - dangerous
  • Post - Feedback to the GP on treatment, post-op
    follow up
  • Issues language, concepts of care, liability,
  • New Move the data not the patients !
  • Radiology / Histo Pathology
  • Telemedicine Clinic Barcelona
  • Second Opinion
  • Cooperation Strasbourg Luxembourg - Liege
  • ..

Surveillance Systems - Communicable Diseases
  • Different standards, Different systems
  • ? No exchange, no common / comparable data sets
  • ? Reliability of data? (consistency?
  • ? Uncoordinated / slow response to outbreaks
  • Local - Border Regions
  • Same / similar reporting operating systems
  • Linked alert systems linked communication
    systems, etc
  • Common learning processes
  • Central New ECDC (??)
  • Central data base consistency
  • Support interoperability of systems
  • Coordination / standards of reactions

Data and Evidence for Policy Making
  • Challenges in getting a better insight
  • Data not recorded / incomparable
  • EU residents / E111 / country of origin /
    type/volume of care
  • Administrative set ups duality of financial and
    data flow
  • Stakeholders unwilling to share data (private
  • Patient surveys? - data protection, etc.
  • ? NEED for better DATA!! regular recording

Cooperation between Countries / Systems
  • Exchange of Best Practice
  • Excellence Networks Strasbourg / Luxembourg /
  • Cross Border Set ups
  • Netcards, etc.. , eCard in Euregios
  • Cross Border Health Card Germany - France
  • Exchange of patient records Lithuania - Austria
  • Telemedicine Clinic Barcelona
  • Centres of Excellence
  • Bottom Up ideas Top Down support!!
  • PH Programme 2007-13
  • Support Centres of excellence sharing expertise
    between Member States on key health system issues
  • Synergies with other policies

and NOW?
  • Modern eHealth structures to support Patient
  • European Health Card / European Health Portal
  • EU ePatient Record, certified signature,
    ePrescribing, electronic referral and discharge
    letters, EU wide interoperable Health Information
  • Bottom Up
  • Interesting exciting projects, initiatives /
    private sector
  • Top Down
  • EU level- Framework
  • Common Objectives Common Legal basis -
  • standards (data security, quality) guidelines
    (minimum sets, contracting)
  • Support of initiatives Research
  • Link to international undertakings
  • National / Regional
  • National Strategies - Leadership
  • Investments, Commitment
  • Implementation training, job description,


Factors favouring Patient Mobility Opportunities
  • Patient Choice
  • Cross Border Settings - proximity Language,
    cultural issues
  • Familiarity with health systems
  • Geographical and economical situation (Spain)
  • Cost/quality ratio for patients (out of pocket,
    private) (Estonia)
  • Providers Interest
  • Development of services to attract patients
    (Slovenia, Estonia)
  • Belgian hospitals exporter of care (NHS)
  • System Elements
  • Universality of care, Access, services provided
  • Sharing Capacity
  • Scarcity of supply of care (waiting lists) (NL,
  • Sharing capacity across borders
  • Centres of Excellence

Factors hindering Patient MobilityChallenges
  • Lack of Information
  • Of patients / the player of the systems
  • Perceived legal uncertainty
  • Purchasing, contracting,
  • Culture/Language
  • Cultural differences, Different understanding of
    care - home care
  • Language differences
  • Health system design, structural aspects
  • Health systems not designed / adapted to take EU
    into account
  • No strategy for patient mobility (Slovenia)
  • Reluctant providers, no incentives efforts
    outweigh benefits (B)
  • No offer - nursing homes for elderly UK people in
  • Lack transparency, private systems step in (hotel
    clerks, taxi drivers deviate flow towards private
    clinics in Malaga)

EU Health 5 10 years from now??
  • EU Patient Charter / Rights
  • Health part of the fundamental rights of EU
  • The Rights (and duties) of Patients in Europe
  • EU supporting Function
  • QUALITY- EU Provider Accreditation -
  • EU Network for Technology Assessment
  • EU established Network of Centres of Reference
  • EU Human Resource Planning certification
  • eHealth
  • EU wide interoperable Health Information System,
    EU Health Card, EU ePatient Record, certified
    signature, ..etc
  • Contracting
  • Framework Conditions for Contracting
  • EU Basket of Services
  • Competitive pricing? (a healthy market??)
  • A European Visa Card ??
  • EU Health INFO Point
  • EU Health Webpage / Phone EU HEALTH DIRECT

Enabling Good Health for All A Reflection
Process for a new EU health strategy Brussels,
2004 - Commissioner David Byrne
Related FP6 SSP projects Health Basket
  • Health Benefits and Services Costs in Europe
  • Methodology for comparison of the costs of health
    services between MS
  • Definition of services provided (structures,
    contents benefits)
  • European taxonomy of benefits
  • Assess costs prices of services across MS
  • Identify best practices in costs at micro level
    international comparability
  • Assess cost variations between MS

Partners European Health Management
Association University of Technology,
Berlin CeRGAS, Bocconi University Centre for
Health Economics, Univ. of York Danish Institute
for Health Services Research Ecole Nationale de
la Sante Publique Erasmus University Jagellonian
University, Cracow Semmelweiss University,
Budapest Universitat Pompeu I Fabra
  • Quality Improvement Strategies
  • asses quality strategies at a national level
    (clinical guidelines, performance indicators,
    patients surveys, etc) and their use
  • assess quality requirements for cross-border
    patients (EU regulation, jurisprudence, insurance
    contracts, patients needs)
  • Pilot studies how hospitals have applied
    national quality strategies, meet the defined
    requirements of cross-border patients,
    organisational and methodological variables
  • Drawing conclusions building on national quality
    strategies how to comply with requirements
    formal EU procedures?

Partners Foundation Avedis Donabedian,
Barcelona Academic Medical Centre University of
Amsterdam Dutch Institute for Health Care
improvement Centre for Research and Advanced
Training, Italy European Society for Quality in
Health Care HOPE Standing Committee of
Hospitals Manchester Centre for Health Care
Management, UK
different patients different eNeeds
  • Border regions
  • full access, full inter-operability of systems
  • Tourists
  • identification of rights,
  • evt. Access to patient record / to home
  • evt. financial coverage (visa?)
  • Long term residents
  • Chronic care!) full connection
  • electronic prescriptions
  • Purchased care
  • Administrative
  • Facilitation of one-off communication between