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Cover_WHO_nr22:Mise en page 1 3/9/11 4:35 PM Page 1 22 Cross-border health care has become a much more prominent phenomenon in the AND POLICIES PRACTICES MAPPING AND ANALYSING THE EUROPEAN UNION IN CARE CROSS-BORDER HEALTH European Union. When in need of medical treatment, patients increasingly act as Cross-border 22 informed consumers who claim the right to choose their own providers, including those beyond borders. Patients are supported and encouraged by several factors, including the Internet and more internationally-trained health professionals. Even if the willingness to travel for care varies widely among Member States as well as within social groups, patient Health Care in mobility is often motivated by dissatisfaction with health care provision in the home state and experienced deficiencies in the local health system. Some competent authorities and Observatory health insurers are contracting with health care providers abroad for specific procedures Studies Series to ensure the timely treatment of their patients or they inform them about options and the European Union procedures. Cross-border health care is not only restricted to patients. Medical doctors and nurses go Mapping and analysing abroad for training, to temporarily provide services or to establish themselves in another Member State. Increasingly, individual doctors and hospitals in different Member States practices and policies cooperate with each other. In some cases, rather than patients or providers, even health services move across borders – through telemedicine. Cross-border health care can also Edited by include the collaboration between providers and competent financing institutions. Matthias Wismar This book explores such trends and also looks at the legal framework for this activity as Willy Palm well as examining some of the legal uncertainties surrounding rights, access, Josep Figueras reimbursement, quality and safety. It examines different approaches to these concerns and takes a look at methodologies which can be used to ease or resolve some of these Kelly Ernst issues. It marks an important step in the continuing debate on a legal framework for Ewout van Ginneken cross-border health care. The information and analysis presented in the study will be of considerable use to policy-makers and those with an interest in key aspects of cross- border health care. The editors Matthias Wismar is Senior Health Policy Analyst, European Observatory on Health van Ginneken Ewout Ernst, Kelly Josep Figueras, Willy Palm, Matthias Wismar, by Edited Systems and Policies. Willy Palm is Dissemination Development Officer, European Observatory on Health Systems and Policies. Josep Figueras is Director, European Observatory on Health Systems and Policies and Head of the WHO European Centre for Health Policy. Kelly Ernst is Research Officer, European Observatory on Health Systems and Policies. Ewout van Ginneken is Researcher, Berlin University of Technology, Berlin, Germany. Observatory Studies Series No. 22 Cross-border health care in the European Union The European Observatory on Health Systems and Policies supports and promotes evidence- based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy issues. The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Ireland, the Netherlands, Norway, Slovenia, Spain, Sweden and the Veneto Region of Italy, the European Commission, the European Investment Bank, the World Bank, UNCAM (French National Union of Health Insurance Funds), the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Cross-border health care in the European Union Mapping and analysing practices and policies Edited by Matthias Wismar, Willy Palm, Josep Figueras, Kelly Ernst, Ewout van Ginneken This report has been produced with the financial assistance of the European Community (Health & Consumer Protection Directorate-General; grant agreement 2006WHO05). The views expressed herein are those of the authors and can therefore in no way be taken to reflect the official opinion of the European Community. Keywords: DELIVERY OF HEALTH CARE – organization and administration EMIGRATION AND IMMIGRATION QUALITY OF HEALTH CARE HEALTH SERVICES ACCESSIBILITY HEALTH POLICY INTERNATIONAL COOPERATION EUROPEAN UNION © World Health Organization 2011, on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Address requests about publications to: Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark. Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the European Observatory on Health Systems and Policies to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the European Observatory on Health Systems and Policies be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the European Observatory on Health Systems and Policies. ISBN 978 92 890 0221 9 Printed in the United Kingdom Cover design by M2M Contents Foreword by the editors vii Foreword ix Acknowledgements xi List of tables, figures and boxes xiii List of abbreviations xvii List of contributors xix Chapter 1 The Health Service Initiative: supporting the construction of 1 a framework for cross-border health care Matthias Wismar, Willy Palm, Ewout van Ginneken, Reinhard Busse, Kelly Ernst and Josep Figueras Chapter 2 Towards a renewed Community framework for safe, high-quality 23 and efficient cross-border health care within the European Union Willy Palm, Matthias Wismar, Ewout van Ginneken, Reinhard Busse, Kelly Ernst and Josep Figueras Chapter 3 Access to health care services within and between countries 47 of the European Union Reinhard Busse, Ewout van Ginneken and Markus Wörz Chapter 4 Benefit baskets and tariffs 91 Reinhard Busse, Ewout van Ginneken, Jonas Schreyögg and Marcial Velasco Garrido vi Cross-border health care in the European Union Chapter 5 Quality and safety 121 Helena Legido-Quigley, Irene A. Glinos, Kieran Walshe, Benno van Beek, Cule Cucic and Martin McKee Chapter 6 Mapping national practices and strategies relating to patients’ rights 159 Herman Nys and Tom Goffin Chapter 7 Cross-border collaboration 217 Irene A. Glinos Chapter 8 Past impacts of cross-border health care 255 Rita Baeten Chapter 9 Cross-border health care data 289 Ewout van Ginneken and Reinhard Busse Chapter 10 Annexes to Chapter 5 and Chapter 6 341 Foreword by the editors This book presents an analysis of the broader context related to cross-border health care in the European Union (EU). It was written to support the European Commission in developing a directive on patient rights in cross-border health care. The original manuscript of this book was submitted in July 2007. We have decided to publish this study now, with only minor modifications, as it is still unique in its approach. It covers analytically policy-relevant aspects of cross-border health care that emerged out of a long dialogue between stakeholders, policy-makers and researchers in Europe, starting in the late 1990s as a reaction to the Kohll and Decker rulings. The book presents a rich and detailed cross-European analysis of different dimensions that determine the scope and policy of cross-border care: access to health care, benefits and tariffs, quality and safety, patients’ rights, cross-border collaboration and cross- border health care data. The analysis of the book is still timely and correct, although for some of the chapters more recent data would now be available. We hope that the book can further inform the political debate on the future of cross-border health care in the EU, a debate that will continue even after the final adoption of a proposed directive in early 2011. Uncertainties surrounding cross-border health care will
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