Quality and cross-border collaboration: Priority areas for action

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European Observatory on Health Systems and Policies

Quality and cross-border collaboration:

Priority areas for action

Dr Matthias Wismar

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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

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Overview

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The expert panel

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The problem

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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

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Obstacles

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Priority areas for EU

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Expert Panel on Effective Ways of

Investing in Health

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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.

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Mandate cross-border collaboration

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Dec 2014-April 2015, appoved on 29 July 2015

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The members of the Working Group are:

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Expert Panel members:

Prof Helmut Brand, Prof Lasse Lehtonen

(Chair/Rapporteur) Dr Dorjan Marušič, Prof Martin McKee

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External experts:

Dr Luigi Bertinato, Mr Willy Palm, Dr Matthias

Wismar

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The Expert Panel: Mandate

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3. Cross-border cooperation

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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

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Problem: Major health and safety risks

in cross-border care

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complications requiring follow-up care

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discontinuity of medical documentation

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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

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Terminology

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Revalidation

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Fitness to practice

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Issue of transparency of data concerning

pharmaceuticals and medical devices

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consistency of information contained in discharge

summaries

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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

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Results:

– Vast differences in

• The use of different mechanims

• The start of the policies

• The implementation

Problem: Differences in

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Extend and nature of existing and potential benefits

in cross-border cooperation and collaboration

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Poor documentation

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on the scale of the phenomenon,

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the types of patients involved,

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the services and goods that they receive, and

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the monetary implications of their movement

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At present there are no financial incentives for Member States

to implement the directive

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Potential benefits

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greater choice for patients

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improved professional and vocational education and training for the

personnel,

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better mobility for health professionals, and

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quicker response to medical emergencies in geographical proximity.

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areas where there is the potential for successful

cooperation

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To ensure that effective policies exist to ensure

the quality of care within each country

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Specific measures are needed to strengthen

cross-border care. Patients coming with sufficient

information.

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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

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bilateral agreements between

Member States or their health

insurance companies

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where there are large tourist

inflows, both during the summer

and winter seasons.

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Obstacles to successful cross-border

cooperation in health care

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Lack of information is a major barrier.

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differences in interpretation of the Directive. This is a particular concern

in relation to prior authorisation

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Payment mechanisms are another obstacle

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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.

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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.

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The EHIC, introduced to facilitate access to care when needed, is not

always working as intended.

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These include measures to increase consistency of discharge summaries,

including agreement on core content.

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Priorties of actions at EU level

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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.

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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.

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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;

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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

servatory on Health Systems