What does Europe do for its ill?

, by Mathilde Marmier, Translated by Kirsty Chetcuti

All the versions of this article: [English] [français]

What does Europe do for its ill?

From Sweden to Poland, passing through Portugal and Italy, illnesses in Europe are more or less the same. At the same time though, national healthcare provisions differ in major ways and for good reason, their organisation and financing remains an exclusive competence of the member states under the subsidiary principle.

Be it a matter of sterility, of diabetes or cancer - every State provides different reimbursement for medical expenses, in terms of the therapeutical protocol, to use the correct financial terms. Despite this, due to the principle of free movement of people at the heart of the European Union, it is conceivable to imagine taking medicine for an illness in the North of Europe, in a country like Spain or having cheaper dental care in Eastern Europe. This practice, called “border care” gives rise to suspicion in national governments.

Medical Tourism in Europe

Initially, the competences of the European Union in health matters limited itself to big adjustments in public health matters. Today, the European legislation influences in an increasing manner, the organisation of national health systems. It is from now on possible to be taken care of by one’s native country in case of an emergency arising in a country of the European Union. It becomes equally possible to travel Europe to benefit from care programs – such as a surgical operation – which could be less expensive or of better quality.

In this case, the present legislation permits the patient to be under the responsibility of the native country to manage to provide proof that the taking care of is superior in terms of advantages of one’s health in another country of the European Union. The procedure of the prior agreement of health insurance of social countries assured, as well as the grading of the taking care of, are therefore determined by the national systems, on the base of the effected reimbursements in the country. The Court of Justice of the European Community has always arbitrated in favour of patients who have been seen reimbursing their care abroad in numerous cases, with there buying in the absence of the prior agreement.

Patients’ Mobility: not at any price!

It’s in this context that the need arises for practical training in border care. In fact, the responsibility of this care isn’t without emerging problems. Firstly, one asks the question about the quality of given care in the States. The quality norms of the European scale are inexistant and these norms vary in an important way from one State to another. By way of example, the procedures of the health institution’s certification differs and doesn’t lean on the same indicators according to the State. The fact that one State permits the taking care of patients in another State is therefore problematic since it will eventually assume the consequences of “bad” responsibility, so much on the plan of the quality of life of the patient more than the financial plan. It is advisable to envisage the complexity which would generate the taking care of complication cases in the consequence of an operation effected abroad. Should the health insurance take in charge the repair, though cannot be insured the minimum level of quality in the country where care has been given?

At the scale of all the countries, the explosion of border care could equally generate important economical imbalance for social protection systems.

At the scale of all the countries, the explosion of border care could equally generate important economical imbalance for social protection systems.

Then, one asks the question of the access of these border cares, and unevenness that their expansion could generate. One can easily imagine that certain illnesses from the States where the system is less effective will come out to benefit from more advanced technologies. What will these illnesses be? This phenomenon will probably be at the origin of an increase to unequal access to care. What will be the effect on the national systems of countries where the health systems are less effective? Will they be encouraged to improve? All in all, wouldn’t the border carers want to contribute to make health inequality worse between the States, these inequalities being golden and already major?

A Project of Directive and Negotiation

The Ministers of European health are very reluctant to the development of border care and work hard to anticipate their consequences of national systems on various levels: expenditure generated by health abroad, lengthening waiting lists in hospitals and at the doctor’s, the setting up of new quality norms. A directive project has been rejected by the Council at the end of 2009.

During the previous Council of the Ministers of health in Madrid last April, the Spanish Minister of Health presented an “alleged document”, his objective consisting of approving this directive on border care before the end of the Spanish presidency, the upcoming 30th June. The text foresees that a “quality certificate” is granted to the health institutions by the national health systems. On top of the prior authorisation dispensed by the health insurance of the native country, the reimbursements of patients wouldn’t be carried out but for quality-acknowledged care by the same country. The dispenses involved would be in charge of the native countries, if however, the prices don’t exceed those of the native country, in which case the excess would be at the patient’s expense.

Come and discuss!

Access to quality care anywhere in Europe is one of the major issues in future years.

The progress of medicine being permanent, access to quality care anywhere in Europe is one of the major issues in future years. While the directive project on border care has been rejected by the Council at the end of 2009, how can one adapt the European legislation to new waiting patients? Should one adjust himself towards European quality norms? How can one manage the patients’ mobility and organising border care? Where does the role of the member states in the responsibility of care dispenses stop in other European States?

Image: Musgrove Park Hospital, Taunton, by boliston on Flickr.

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