#EAPM – Lack of information having an impact on cross-border health care

| January 3, 2019

The Cross-Border Healthcare Directive, although certainly well-meaning, has never really been implemented to its intended full capacity and has certainly not come anywhere near reaching its potential.  For its part, the European Commission itself has, through a study, identified four areas which have the greatest potential to act as barriers to patients if left unaddressed, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan.

These are systems of reimbursement, use of prior authorisation, administrative requirements and charging of incoming patients.  Now, as we enter 2019, EAPM would like to see ‘new year’s resolutions’ from all stakeholders to improve the situation to aid better health care for EU citizens, when it is needed, and wherever in the Union they may be.

To briefly recap on the Directive:

•    EU citizens have the right to access healthcare in any member state and to be reimbursed for care abroad by their home country.
•    The Directive on patients’ rights in cross-border healthcare sets out the conditions under which a patient may travel to another EU country to receive medical care and reimbursement. It covers health-care costs, as well as the prescription and delivery of medications and medical devices.
•    The goal, with health policies and systems increasingly interconnected, is to make it easier to access information on available healthcare in other European countries, as well as alternative health-care options, and/or specialized treatment abroad.

Under the Treaty on the Functioning of the European Union, in the definition and implementation of all Union policies and activities, a high level of human health protection is to be ensured whilst the organization, management, financing and delivery of healthcare remains the responsibility of the EU member states.

Case law over the years has acknowledged that patients have, under specific conditions, the right to access health care in other member states than their own. However, all stakeholders are well aware that the implementation of the Directive has not exactly gone to plan and a European Commission monitoring report – entitled Study on cross-border health services: enhancing information provision to patients, and written by the consortium of Ecorys, KU Leuven and GfK Belgium – makes recommendations to improve the situation.

It has even given a nod to Brexit, more of which later…  The 2018 review comes to the conclusion that limited numbers of patients make use of their right to seek treatment in another member state, although the EU Executive states that many Europeans are willing to consider treatment abroad. The main reasons in the latter case include the opportunity to receive treatment that is not yet available in their home country, or to receive better quality treatment.

It is noted that there are some socio-demographic factors determining the willingness of patients to go abroad, specifically age, employment and education.

But the blame is squarely put on a general lack of awareness of the existence of the Directive, although this has improved in the last three years. Bottom-line, though, more than five years after the Directive’s transposition deadline (October 2013), patients’ awareness of their rights and possibilities to access health services abroad are still relatively low.  The blame seems to fall on National Contact Points, known as NCPs.

Each member state has at least one NCP tasked with providing patients – and, crucially – health professionals with information concerning rights regarding a cross-border healthcare service or product.  It has come to light that information on patients’ rights is generally lacking on the NCPs’ websites. Insight into what to do in case of undue delay, information on complaint procedures and settlement of any dispute, as well as information on how long it takes to process reimbursement or prior authorization requests is also scarce.

This hardly gets us us any nearer to the Holy Grail of optimum patient access.  Of course, as well as a lack of information, cross-border patient mobility is an important issue. Current levels of such mobility are still relatively low, but for certain groups of patients, due to having rare diseases perhaps, cross-border health care is the most appropriate and accessible care. On the downside, this encounters issues such as the continuity of care and the exchange of information between the health professionals on different sides of a border.

On top of this, there are also logistical and administrative barriers, which can unintentionally have a negative effect for patients. EAPM has always been aware of the issues, and they are not only about patient or healthcare professional knowledge.

The Alliance would argue that the implementation, or lack thereof, of the Directive has provided a graphic demonstration of just how far Europe remains from any real coherence on health policy and on innovation. The directive’s effectiveness has always depended upon collaboration by member states at EU level. But such collaboration is in short supply when the EU tackles many aspects of health (just take the ongoing debate regarding joint action on HTA as a pertinent example). And, as a result, the opportunities for patients to take advantage of the cross-border measures are limited.

As the Alliance has stated before, the legislation should have enabled a shift away from national isolationism in health. The rules were partially intended to make the EU’s internal market work for health for the first time, by strengthening the freedoms relating to movement of goods, people, and services.

Proper implementation of the Directive’s measures could be crucial to progress in personalised medicine. Freer movement of patients and data around Europe, closer collaboration on reference networks and data banks, wider access to information, institutionalised cross fertilisation between providers, payers, and regulators, and enhanced common understanding on health technology assessment are all preconditions for the successful evolution of personalised medicine.

To realize its full potential, a new level of coherence on EU policy is necessary. The Directive was held up as a test case for Europe’s ability to seize opportunity, as well as a crucial determinant of how far and how fast Europe can develop valuable new therapeutic approaches.  It hasn’t really happened as it should have done. As for the UK, post-Brexit cooperation in this field remains to be seen but it’s hard to see an improvement. As it stands, a yearly 1,000 (estimated) UK citizens are reimbursed for treatment in accordance with the Directive.

France, Poland and Latvia are up there as the most popular destinations chosen by Brits for treatment. In reverse, the UK treats around 1,500 EU patients with some 40 National Health Service Hospitals involved.  Brexit could very well deliver a major blow to long-term implementation of a Directive that is already a long-way-away from where it should be. But the onus remains with the 27 other Member States, and the Commission, to get implementation of the Directive right.

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Category: A Frontpage, EU, European Alliance for Personalised Medicine, Health, Personalised medicine