Cross-border #healthcare needs to be better implemented

This week saw a European Parliament debate in Strasbourg on the implementation of the cross-border healthcare directive, an area that the European Alliance for Personalise Medicine (EAPM) is following closely - writes Denis Horgan, EAPM Executive Director.
The EPP’s Ivo Belet acted as rapporteur on an own-initiative report on the implementation of the directive, which everyone has acknowledged has been sub-optimal, despite having been in place for the best part of nine years.

The report was widely welcomed by Parliament and was adopted with 512 votes in favour, 32 against, and 62 abstentions.

Belgian MEP Mr Belet told Parliamentary colleagues, and Vytenis Andriukaitis, European Commissioner for Health and Food Safety, that if there was one area in which Europe has proved its value, then that is healthcare.

Specifically on cross-border healthcare, he pointed out that, for patients in living border regions, it is often cheaper to get medical care in the closest hospital, which can actually be across a border.

This is even more the case for those with chronic or rare diseases since they need specific care.

The problem is, there are still to many barriers, with patients coming up against too much red tape, not being sure when they can be reimbursement, and not knowing thecosts.

Here in 2019 these barriers need to disappear - especially given that the Directive dates back to 2011. There are still many shortcomings, he said.

Belen put a great deal of emphasis on information for patients, saying that this would be a key step. He told colleagues that many patients do not know about their rights or even where to go to find information.

With this in mind, he said, this is why Parliament is calling for one-stop-shops in all Member States in order to provide the necessary relevant information. The Commission, meanwhile, must continue to monitor implementation on an annual basis.

Meanwhile, there is a need for the EU to consolidate the European Reference Networks and set up specialised centres.

Belen then drew digitalisation into the cross-border healthcare context saying that it is a fantastic tool to improve quality.

Contributions came from other MEPs who made various points, among them that 40% of the EU population lives in what can be defined as cross-border areas, but less than 27% are even aware of the right to healthcare across borders.

It was reiterated that national information offices are important for citizens, and there certainly needs to be an improvement in implementation in all Member States.

For his part, Commissioner Andriukaitis described the topic as being close to his heart. Millions of Europeans travel to other European countries to get correct treatment, and it is safe to say that cross-border healthcare is an issue of high importance for EU citizens.

The commissioner welcomed Parliament's report and fully agreed with the views expressed. It is certainly necessary to improve the implementation of the Directive and Parliament's report was in line with the Commission's own report from September 2018, he said, adding that the Commission has examined the transposition of the Directive into national law, and launched 26 infringement procedures.

The first phase is completed, with the EU Executive moving to in-depth analysis of compliance. This approach is delivering results, Andriukaitis told the MEPs, with many Member States having now changed their legislation.

The Directive allows Member States room for manoeuvre when it comes to transposition, but the Commissioner acknowledged that there is evidence of discrimination against EU citizens, as well as too-complex administrative procedures.

The Commission has launched two cases on reimbursement and is now taking discussions with EU countries to find ways to simplify procedures. In the meantime, Andriukaitis and his institution agree that Member States should provide sufficient funding for the national contact and information points already mentioned.

Commissioner Andriukaitis made much of the fact that the Directive encourages healthcare cooperation in the border regions and that the Commission provides support for regional networks.

Also, electronic health records (EHR) are a key element going forward, and the Commission has just adopted a set of recommendations on an EHR format. The recommendation aims to make help people access records across borders and, as EAPM has previously reported, Finland and Estonia have already started to exchange this information.

Several MEPs who have played important roles working with the Alliance had their own say during the debate.

Romania’s Cristian-Silviu Buşoi told colleagues that the framework helps citizens benefit from reimbursements in any Member State.

However, before he became an MEP, as a doctor he was able to implement the Directive in his home country, yet now administrative measures are in place that tend to block access.

Slovenia’s Alojz Peterle pointed out that, often, patients have problems with their insurance bodies. They do not need a new Directive, but they need correct implementation of the current Directive, he said.

And Malta’s Miriam Dalli said she believed that one of the main benefits of a united Europe is the right to access healthcare in any Member State and for this right to be reimbursed. This is especially important in these times of rapid developments.

It is the responsibility of the EU to ensure equal access to all healthcare systems for all citizens, and that means having the right framework in place, she added.

Finland’s Sirpa Pietikäinen, meanwhile, said that cross-border healthcare services will become more and more important given ever-diminishing resources. The best care must be ensured for patients who need it and Sirpa described it as shameful that so many Member States have failed to properly transpose the Directive, have failed to inform citizens of their rights, and failed with reimbursement.

And Spain’s Soledad Cabez ón Ruiz pointed out that, when it comes to healthcare, powers are shared. For the Directive to be successful, she said,all Member States must be committed to strengthening their healthcare systems. Nothing can be done without this commitment, she insisted.

One of the next objectives of the Commission should be access to eHealth, the Spanish MEP added. Public health systems are the only way to guarantee protected data and access to healthcare, while public health systems must be actively involved from the outset.

This is another aspect that EAPM is following closely, especially with the ongoing MEGA initiative it helped to launch on the sharing of genomic information and other healthcare data.

Another MEP who has worker with the Alliance on many occasions, Germany’s Peter Liese, said that health should be more central to politics, especially for EU policy.

One aim of his party is that, in 20 years, no one should die from cancer in Europe.

Commissioner Andriukaitis noted that now is a good time to raise an awareness campaign on cross-border healthcare as the European elections are coming up, and suggested that it is an ideal campaigning issue.

He also urged Member States to implement measures to avoid discrimination in respect of patients,.

Rapporteur Ivo Belet added that it is the role of the MEPs to keep this topic high on the agenda. The point is not to actively stimulate people to go abroad or treatment, he said, but it is important for patients in cross-border regions and with rare diseases to be able to do so.

If cross-border healthcare were to work optimally, it could be used to illustrate the added-value of European cooperation, the Belgian concluded.

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