100 million potential patients ‘not well-informed’ on cross-border health options

By European Alliance for Personalised Medicine Executive Director Denis Horgan

A major survey undertaken on behalf of the European Commission has shown that the experience of cross-border health care in the EU has changed little since 2007.

This is despite the implementation of a Directive on patients’ rights in cross-border health care more than a year prior to the poll.

Back in 2011, a directive proposed by the Commission on the application of patients’ rights in cross-border health-care was adopted by the European Parliament and the European Council. The directive entered into force at the end of 2013 across all member states.  Its objectives were to provide clear rules and reliable information to patients regarding access and reimbursement for healthcare received in another EU country, “to meet patients' expectations of the highest-quality health care when travelling abroad and to ensure EU countries work closer together in the interest of patients”.

For the report, nearly 28,000 people, coming from different social and demographic groups, were interviewed across all 28 member states at the end of October 2014, on behalf of the Commission’s Directorate-General for Health and Consumers (SANCO).  It found that one-in-twenty patients said they had experienced medical treatment in another EU country in the last year, which equates to an increase of just 1% on 2007.

Yet around half would be willing to travel to another EU country for medical treatment with the most common reasons for patients doing so being to receive treatment unavailable in their own member state and/or to receive better quality treatment.  Indeed, in 26 of the 28 member states, the key reason given by people was to receive treatment that is not available in their own country although, in two countries, this came after the desire to receive better quality treatment.

Countries where people were the most open to cross-border health care tended to be those living in smaller countries, such as Malta, the Netherlands, Cyprus, Denmark and Luxembourg. Patients were least prepared to seek treatment abroad in Germany, Finland, France and Austria, as well as in Belgium and Lithuania.  Around 55% of those asked said that the main reason for not wanting to get treatment in another country was that they were satisfied with the medical treatment they received in their own, while possible language difficulties were an issue for more than one quarter of those asked. And, not surprisingly, just under half of Europeans felt that “it was more convenient to be treated near home”.

In a strange choice of words, the report states that “lack of knowledge and awareness is not listed among the main reasons for not receiving treatment abroad today. Indeed, only 21% of the respondents who did not seek treatment abroad said that they ‘do not have enough information about the availability and quality of medical treatments abroad’.”

Please note and consider that phrase, “only 21%”.

In a 28-member state EU that figure “only” equates to more than 100 million potential patients who did not seek treatment abroad because they have a ‘lack of knowledge or awareness’ of cross-border treatment.

A little further into the report we learn that around the same number "do not have enough information about the availability and quality of medical treatments abroad".  The Brussels-based European Alliance for Personalised Medicine (EAPM) would very much like to highlight here the fact that 100 million is a great many people.

Later, the report concedes that patients only seem to have partial knowledge of their rights to cross-border health care, with less than 30% knowing that they can get a prescription from their doctor to use in another EU country. On top of this, only a ‘small minority’ knew when prior authorization was needed before seeking treatment in another EU country, with the legislation being complicated and differing from member state to member state.

The bottom-line is that most Europeans who were asked did not feel well-informed about the types of health care they have the right to be reimbursed for in another EU country – a massive 78%. Clearly, there are some large gaps in public knowledge and, doubtless, among GPs too.

Crucially, while 50% of those asked said they feel informed about their right to be reimbursed for healthcare in their own country, a staggering 80+% feel less-than-well informed about their rights when being treated in another EU country, with only one-in-ten having heard of the National Contact Point that provides information about EU cross-border health care.

For certain, there is no doubt that the provision of cross-border health services, reimbursement policies and coverage by national health-care systems is a highly complex affair, but nearly four-fifths of people not feeling well-informed is surely excessively high.  Meanwhile, the survey once again uses the word ‘only’ to describe the 15% of respondents who encountered problems getting reimbursed for cross-border treatments with the vast majority – 69% – saying they had had no problems getting reimbursed back home. Presumably, the missing 16% had at least some difficulties.

For example, Maria, a 28-year-old cancer sufferer from Valetta, told EAPM: “Not only did I have to dig out the information on where to go outside my own country, I also had considerable issues being reimbursed. It’s not easy in the first place to leave home for treatment, and this only makes it harder.”

And Finn, a 63-year-old from Copenhagen, revealed that he wasted more than a year hunting down treatment for his rare disease and lost time and quality of life “because I simply was not made aware of my options”.

EAPM strongly believes that the provision of cross-border health care is vital to giving the best treatment possible to all patients in the EU who need and want it, and that for its part the European Union should go much further down the line of encouraging member states to inform patients, and those who treat them, of their rights.

The Alliance believes that support to member states on streamlining their reimbursement procedures and making them more efficient, and with less red tape, is also an urgent requirement.  The facts about what works and what doesn’t in cross-border health care are in the report – it is time to act.

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