European Observatory on Health Systems and Policies

Quality and cross-border collaboration: Priority areas for action

Dr Matthias Wismar

Senior Health Policy Analyst

European Observatory on Health Systems and Policies

available on www.healthobservatory.eu

European Observatory on Health Systems and Policies

Eurohealth on cross-border collaboration

• Regulatory procedures of doctors

• Disease management across borders

• The role of discharge summaries

• Cross-border recognition of medecines prescriptions

• Patient information for hospital choice?

• Intro-European retiremement migrants

• Risk communication for cross-border health threats

• Cross-border hospital collaboration

• Telemedicine solutions

• Cross-border dental care

www.healthobservatory.eu

European Observatory on Health Systems and Policies

Overview

• The expert panel

• The problem

• cross-border cooperation and collaboration – Areas of existing and potential benefits

– areas where there is the potential for successful cooperation

– Areas that could benefit from more cooperation and collaboration

– Obstacles

– Priority areas for EU

• Conclusions

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Expert Panel on Effective Ways of Investing in Health

• Expert Panel’s mission is to provide the Commission with sound and independent advice in the form of opinions in response to questions (mandates) submitted by the Commission on matters related to health care modernisation, responsiveness, and sustainability. The advice does not bind the Commission.

• Mandate cross-border collaboration • Dec 2014-April 2015, appoved on 29 July 2015 • The members of the Working Group are:

– Expert Panel members: Prof Helmut Brand, Prof Lasse Lehtonen (Chair/Rapporteur) Dr Dorjan Marušič, Prof Martin McKee

– External experts: Dr Luigi Bertinato, Mr Willy Palm, Dr Matthias Wismar

European Observatory on Health Systems and Policies

The Expert Panel: Mandate

• 3. Cross-border cooperation

• Can the Expert Panel identify areas which would benefit from greater formal cross-border co-operation and collaboration in healthcare provision, or can they propose a methodology for such identification to be carried out? This should have a particular focus on service configuration in border regions, but could also consider issues outside border regions.

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Problem: Major health and safety risks in cross-border care

• complications requiring follow-up care

• discontinuity of medical documentation

• uninformed decision-making

There is a clear need to undertake targeted research to assess how best to achieve the potential benefits of increased cross-border care and minimize any problems

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Problem: Large variations across Europe

• Terminology

• Revalidation

• Fitness to practice

• Issue of transparency of data concerning pharmaceuticals and medical devices

• consistency of information contained in discharge summaries

• birth registration and citizenship that arose in the event of a mother giving birth in another MS

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• Three analytical levels – System – Organizations – Clinical practice

• Limists – Snapshot in a very dynamic field – Effects of configurations – Weighing

• Results: – Vast differences in

• The use of different mechanims • The start of the policies • The implementation

Problem: Differences in policies of healthcare quality

European Observatory on Health Systems and Policies

Extend and nature of existing and potential benefits in cross-border cooperation and collaboration

• Poor documentation – on the scale of the phenomenon, – the types of patients involved, – the services and goods that they receive, and – the monetary implications of their movement

• At present there are no financial incentives for Member States to implement the directive

• Potential benefits – greater choice for patients – improved professional and vocational education and training for the

personnel, – better mobility for health professionals, and – quicker response to medical emergencies in geographical proximity.

Potentials seem promising, data and evidence is scant

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areas where there is the potential for successful cooperation

• To ensure that effective policies exist to ensure the quality of care within each country

• Specific measures are needed to strengthen cross-border care. Patients coming with sufficient information.

• The third step involves measures related to aftercare, Patients leaving with sufficient information

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Areas which could potentially benefit from greater formal cross-border cooperation and collaboration, especially concerning service configuration in border regions

• bilateral agreements between Member States or their health insurance companies

• where there are large tourist inflows, both during the summer and winter seasons.

European Observatory on Health Systems and Policies

Obstacles to successful cross-border cooperation in health care

• Lack of information is a major barrier. • differences in interpretation of the Directive. This is a particular concern

in relation to prior authorisation • Payment mechanisms are another obstacle • Better communication to all citizens within the EU on their rights to

health care when they have to access health care facilities in another Member State has to be guaranteed.

• Medical tourism is marketed primarily at those who can afford to pay for it, thereby creating health inequalities in Europe, where universal health care coverage is the key to the development of a social framework that benefits all European Citizens.

• The EHIC, introduced to facilitate access to care when needed, is not always working as intended.

• These include measures to increase consistency of discharge summaries, including agreement on core content.

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Priorties of actions at EU level

• systems to provide data on the number of patients moving, the types of treatment they are receiving, any problems they are experiencing, and examples of how these can be overcome.

• a need to understand better the implications of variations in access to certain key diagnostics, therapies and costly medications among Member States. Research on this topic is still limited.

• questions about the role of equity and solidarity in health care in Europe. To what extent is it acceptable that access to life-saving and sustaining treatments vary between countries?

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raise awareness and understanding of entitlements t

• creating an explicit European policy to maximise the benefits of cross-border collaboration;

• implement more effective and targeted communication strategies on the benefits of cross border collaboration with patient and professional organisations;

• create mechanisms to support sharing of best practice among National Contact Points;

• explore the scope to create a mandate for the commission to fund European Reference Networks;

• create mechanisms to share best practice in areas such as medical records, prescriptions and e-Health, to improve collaboration between those working in different health systems;

• encourage national and regional authorities to establish mechanisms to strengthen continuity of care across borders; Cross-border Cooperation

• establish mechanisms to understand better the variations that exist in clinical practice and, where they are not supported by evidence, how these can be overcome;

• establish a focal point for discussions on cross-border health care.

European Observatory on Health Systems and Policies 16

We have come a long way, talking now about quality in cross-border health care

Kohll and Decker (1998)

Think about the positive repercussions of cross-border healthcare on health systems in Member States