asbl A Literature Review of Cross-Border Patient Mobility in the European Union Irene A. Glinos and Rita Baeten Septembre 2006 Observatoire social européen – www.ose.be Europe for Patients Project – www.europe4patients.org “A Literature Review of Cross-Border Patient Mobility in the European Union” has been carried out in the “Europe for Patients” project. By its full name, “The Future for Patients in Europe” is a European Research Project, part of the Scientific Support to Policies (SSP) component of the European Union’s 6th Framework Programme. It is a 3- year project financed by DG Research and runs from February 2004 to January 2007. Acknowledgements We would like to thank the following people for their help and collaboration with this literature review: Philippe Harant and Willy Palm for their kind co-operation and valuable feedback as respectively external and internal reviewers of the study; Lien De Peuter and Romain Nivelle for their dedicated work in translating and processing literature in Dutch and German; Pascal Garel at the Standing Committee of the Hospitals of the European Union (HOPE) for continuous and tireless assistance in finding relevant literature and contacting HOPE members; Werner Brouwer at the Erasmus University Rotterdam for his help in suggesting and uncovering useful material from his archives; the Europe for Patient project partners for their support in unearthing local sources and in particular Helena Legido-Quigley for suggesting a new type of patients1, which was previously unexplored and not considered as an aspect of patient mobility; as well as all the numerous persons we have contacted at ministries, organisations, public authorities at local-, regional- and state-levels, hospitals, insurance funds, companies, associations etc across Europe – we are grateful for the time and effort you invested in helping us with providing first-hand information and pertinent material. We do not mention the long list of names at the risk of forgetting someone. Last but not least, from our Observatoire social européen, asbl team we thank for their great help: Valérie Cotulelli with the page lay-out of the report; Dominique Jadot with searching for and discovering documentation; and Benoît Malice and Renaud Smoes with finding, preparing and designing maps. 1 People going abroad for health care for reasons of (bio)ethical legislation. - 2 - TABLE OF CONTENTS Acknowledgements ..................................................................................................................................2 Executive Summary .................................................................................................................................5 Introduction.............................................................................................................................................13 1. Scope and methodology................................................................................................................14 1.1 Descriptive, exploratory and explanatory research questions...............................................14 1.2 What the review intends to cover and what it does not intend to cover.................................14 1.3 Methodology .........................................................................................................................14 1.4 The phases of the study........................................................................................................15 1.5 Technical limitations of the review ........................................................................................15 2. Technical characteristics of the literature.......................................................................................17 3. Conceptual framework: definition and typology of patient mobility.................................................18 3.1 Definitions of patient movements..........................................................................................18 3.2 Typology of patient mobility...................................................................................................18 3.2.1 Types of patients ..............................................................................................................18 3.2.2 The setting of patient mobility – types of borders..............................................................19 3.2.3 The context of patient mobility – types of actors and types of arrangements ...................20 4. Experiences of patient mobility across Europe ..............................................................................22 4.1 Patient mobility in border-regions..........................................................................................24 ■ Sweden – Denmark The Oresund region .........................................................................24 ■ Denmark – Germany Southern Jutland – Schleswig-Holstein ..........................................27 ■ Germany – The Netherlands Rhine - Waal.......................................................................31 ■ Germany – The Netherlands – Belgium Meuse-Rhine .....................................................33 ■ Belgium – The Netherlands ..............................................................................................38 ■ The Netherlands – Belgium / Germany Five Euregios......................................................44 ■ Germany – Austria Bavarian Alps....................................................................................46 ■ Germany – Switzerland Region of Constance.................................................................47 ■ France and its border-regions...........................................................................................47 ■ Belgium – France – Luxembourg Wallonia – Lorraine – Luxembourg ............................49 ■ France – Belgium .............................................................................................................51 ■ French Thiérache – Belgian Thiérache.............................................................................51 ■ France – Italy Provence-Alpes-Côte d’Azur – Imperia.....................................................54 ■ France – Spain French Cerdagne – Spanish Cerdagne..................................................55 ■ Estonia – Latvia Valga – Valka.........................................................................................57 ■ Northern Ireland – Republic of Ireland..............................................................................58 4.2 Patient mobility due to relative weaknesses or shortcomings in national system..................59 4.2.1 Patient mobility due to waiting lists, lack of competence or lack of capacity at home.......59 ■ Denmark...........................................................................................................................59 ■ Norway .............................................................................................................................62 ■ Malta – the UK..................................................................................................................64 - 3 - ■ The UK – Germany/ France/ Belgium...............................................................................66 ■ Republic of Ireland – Northern Ireland/ UK.......................................................................67 ■ Spain – Portugal...............................................................................................................69 4.2.2 Patient mobility due to differences in price and co-payments...........................................69 ■ Germany/ Denmark/ the UK – Poland ..............................................................................69 ■ Hungary............................................................................................................................71 ■ Austria/ Italy – Slovenia ....................................................................................................73 ■ Finland – Estonia..............................................................................................................73 4.2.3 Dissatisfaction with the system and/ or perceived lower quality at home..........................73 ■ Italy...................................................................................................................................74 ■ Greece..............................................................................................................................75 Conclusions............................................................................................................................................78 Annex I - Guide used for analysing the literature....................................................................................87 Annex II - The technical characteristics of the reviewed literature..........................................................90 Annex III - Reference list......................................................................................................................105 - 4 - A LITERATURE REVIEW OF CROSS-BORDER PATIENT MOBILITY IN THE EUROPEAN UNION Executive Summary With the present literature review we set out to examine patient flows across Europe; to identify the types of patients, actors and factors which contribute to patient mobility; and to highlight the similarities and differences between cross-border initiatives as well as the broader implications they might have, bearing in mind that