Brussels, 07 Jun 2006
An EU-funded research project, 'Europe for Patients' (e4p), has published an evidence-based study on patient mobility across Europe, highlighting the lack of common practice. The publication, entitled 'Patient Mobility in the European Union: Learning from Experience', is one of the first sets of results to come from the policy-oriented research strand of the Sixth Framework Programme (FP6) in the area of health.
Launched in 2004, the e4p brings together a multidisciplinary team from Belgium, Estonia, Ireland, Italy, Slovenia, Spain and the UK to examine the current nature of patient mobility across national frontiers within the EU from a number of perspectives, namely legal, health policy, health services research and health management.
The project is one of the first initiatives to be supported under the 'Scientific support to policies' (SSP) activity of FP6.The impetus for such an undertaking, the project consortium says, comes from the need to provide scientific underpinning. EU policymakers also need an evidence base so that they can take concerted and coordinated action to allow Europe's citizens/patients to benefit from enhanced mobility in Europe.
The ensuing publication comprises a number of case studies that describe the extent of patient mobility between the featured countries, the scale and nature of mobility, the reasons why mobility exists, the factors that either facilitate or hinder it, and the potential impact on the health care systems concerned.
It finds that there is a wide range of ways in which cross-border care is organised, managed and funded. For example, in tourist areas, it is common to find patients using E111 and E121 forms and, more recently, the new European Health Insurance Card. However, it is apparent that, in reality, these procedures do not always work as efficiently as they should, both for patients and care providers.
The study highlights cases where providers do not accept the forms and demand the patient should pay out of pocket. The German case study found that this often happens to German tourists in, for example, the Netherlands. Spanish health care providers obtain no tangible benefit from completing the paperwork associated with the E111, as the foreign reimbursements remain at the national level. As a consequence, some ask patients to pay out of pocket and reclaim from their travel insurance policy.
However, some funding organisations, such as German health insurance funds, have begun to agree contracts with providers in tourist areas abroad, for example with German physicians based in Majorca. This is of particular interest, the authors of the study say, because it creates a precedent whereby the insurance companies engage directly with practicing physicians, without the German physicians' association playing an intermediary role. This could potentially have implications for governance mechanisms in place in Germany, and it would not be the first time that arrangements put in place to facilitate cross-border care have stimulated changes in domestic policies.
While such bilateral cooperation agreements are commendable, the study argues that in order to better manage patient mobility across the EU, Member States need to develop a set of shared principles. These include better understanding the market forces, as well fostering patient trust and involving them in the planning health services.
'This account of practical experience comes at an interesting moment in the policy debate over health care and the role of the European Union, particularly in the light of the Lisbon Agenda and the discussion on the social implications of the EU internal market,' writes Octavi Quintana, director of the Health Directorate at the Commission's Research DG, in the foreword to the study.
Looking to the future, the Commission is proposing under the Seventh Framework Programme (FP7) to include more extensive research on optimising the delivery of health care to European citizens. It will focus on practical and implementation aspects, such as translating clinical outcome into clinical practice, quality, efficiency and solidarity of health systems, health promotion and disease prevention, evidence-based medicines and better and appropriate use of new health therapies and technologies.