Patient Mobility in Europe

1. Patient Mobility in Europe Report from the Europe for Patients Project Facilitating Mobility within and between Countries Meeting the Challenges of Increased Mobility Magdalene Rosenmöller IESE Business School Scientific Coordination, Project Europe for Patients

2. Patient Mobility - eHealth • Who is the EuropeanPatient? • Patient Mobility = Opportunity • Europe 4 Patients Project • The Challenges of Patient Mobility • eHealth to support Patient Mobility • And now?

3. Who is the European Patient? • Patients crossing border to receive care /buy health goods – (Border Regions – Euregios) • Patients crossing border - framework of co-operative agreements (Germany – Holland, Belgium) • Patients sent abroad to overcome capacity restrictions at home – (purchased care in Belgium for UK residents - WL) • Citizens on holiday need to use health care services(Mass Tourism Veneto Region) • Citizens retiring to a different country usual access to health care(Long term residents Spain) NEED – PREFERENCE – COST/CAPACITY

4. Patient Mobility = an Opportunity Increasingly integrated Europe  BENEFITSfrom enhanced patient mobility? • Benefits for Patients • better access to health care • better quality - centres of reference • Benefits for health policy makers / professionals / providers • sharing of capacities across borders, better use of existing ones • Concentration of Excellence in Europe • Mutual learning – Exchange of Best Practices

6. e4p Project • SSP – Scientific Support to Policies European Commission FP6 SP1 • The Future for Patients in Europe • Europe for Patients, e4p • Duration: 3 years, Feb. 2004 – Jan 2007 • Benefits and challenges of enhanced patient mobility in Europe • how the benefits can be increased • how challenges can be addressed

7. Project Objective to contribute scientific evidence that will enable policy makers at EU, national & regional level to take concerted and coordinated action to allow Europe’s citizens / patients to benefit from enhanced mobility in Europe

8. e4p Project Partners • IESE Business School (Spain) (Coordinator) • LSHTM London School of Hygiene and Tropical Medicine (UK) • LSE – London School of Economics (UK) • OSE – Observatoire Social Européen • Faculty of Law Ghent University (Belgium) • CCBS - Centre for Cross Border Studies, Queens University Belfast • Slovenia IVZ - Slovenian Institute of Public Health • Estonia Praxis • Veneto Region • AIM – Association International de Mutualité • European Observatory on Health Care Systems

9. Project Activities Research Activities - across Europe and in-depth case studies • Legal Framework • at EU and national level, • recent EU jurisprudence (patient and provider mobility) • Situational Analysis • patterns of patient mobility, • contracting arrangements, • quality, patient orientation and information, communication between professionals, etc. • Case Studies • on cross border arrangements, purchased care, mass tourism, long term residents (Ireland, Belgium/UK, Spain, Slovenia/Austria, Estonia/Finland Veneto Region) • Identification of options for change • primary legislation & practical and monitoring arrangements

10. Issues of Patient Mobility • Legal Issues • Patients rights – a Right to Care? – EU Constitution • Providers – mutual recognition, professional liability, … • Policy - planning of resources, rationing, .. • Contracting Arrangements • Inclusion / exclusion of treatment, monitoring? • Quality • Accreditation - Health Technology Assessment – Effectiveness of Care • Information to patients – on health systems – access / Q / $ • Readily accessible / easily understandable? • Patient Participation • Communication between professionals • eHealth– exchange medical records, privacy data, share clinical guidelines..

11. eHealth to support Patient Mobility • Information to Patients • Identification, proof of rights • Administration / Financing Processes • Patient Records Communication betw. professionals • Communication physicians - patients • Surveillance Systems • Data and Evidence for Policy Making • Cooperation between Countries / Systems

12. Information to Patients • National • NHS – information to travellers • German AOK Mallorca • Web based information • On different countries • On illnesses (NGOs and Patient Groups) • Scattered - Need to be more personalised and interactive • Future - European Public Health Portal • One stop shop – for information on EU & institutions • Gateway • national and regional websites • civil society groups

13. Identification - Proof of Entitlement • European Health Insurance Card • = E111 • Clear identification, easy administration but 4 different ways NOW! • Different experiences in different countries • Challenges / Issues • What should it contain – what not • Minimum data on chip – or as access to a networked database • Ownership of data? • Data security • Incompatibility between systems • Different experiences - Sesam Vitale / Netcards, Slovenia, Catalonia • Language • Signature – professional liability Future (One system) or Interoperability & Secure IAS services

14. Citizen-centred Patient Record • Communication professionals to patients • Language? Different concepts of care? • Patients need access to information • Often the transfer of info between professionals • Transparency / data security / acceptance • Different rules in different countries • Examples / Future • email to patients (Poland / Germany) • Web based: Personalized internet pages • Dialogues / Follow up on Chronic Illnesses • “Follow Me” (online medical records)

15. Communication between Professionals • Problem - often NOT done • Communication difficult BUT important • Pre – chronic, rare diseases - dangerous conditions, … • Post - Feedback to the GP on treatment, post-op follow up • Issues: language, concepts of care, liability, etc. • New: Move the data not the patients ! • Radiology / Histo Pathology • Telemedicine Clinic Barcelona • Second Opinion • Cooperation: Strasbourg – Luxembourg - Liege • ……………..

16. Surveillance Systems - Communicable Diseases • CHALLENGE: • Different standards, Different systems •  No exchange, no common / comparable data sets •  Reliability of data? (consistency? aggregation?) •  Uncoordinated / slow response to outbreaks • Local - Border Regions • Same / similar reporting & operating systems • Linked alert systems – linked communication systems, etc • Common learning processes • Central: New ECDC (??) • Central data base – consistency • Support interoperability of systems • Coordination / standards of reactions INTEROPERABILITY - CENTRAL LEADERSHIP - LOCAL ACTION

17. Data and Evidence for Policy Making Challenges in getting a better insight • Data not recorded / incomparable • # EU residents / # E111 / country of origin / type/volume of care • Administrative set upsduality of financial and data flow • Stakeholders unwilling to share data (private providers) • Patient surveys? - data protection, etc.  NEED for better DATA!! – regular recording systems

18. Cooperation between Countries / Systems • Exchange of Best Practice • Excellence Networks: Strasbourg / Luxembourg / Liege • Cross Border Set ups • Netcards, etc.. , eCard in Euregios • Cross Border Health Card Germany - France • Exchange of patient records Lithuania - Austria • Telemedicine Clinic Barcelona • Centres of Excellence Bottom Up ideas – Top Down support!! PH Programme 2007-13 • Support Centres of excellence & sharing expertise between Member States on key health system issues • Synergies with other policies

19. … and NOW…? Modern eHealth structures to support Patient Mobility • European Health Card / European Health Portal • EU ePatient Record, certified signature, ePrescribing, electronic referral and discharge letters, EU wide interoperable Health Information System Bottom Up • Interesting exciting projects, initiatives / private sector Top Down • EU level- Framework • Common Objectives & Common Legal basis - Frameworks • standards (data security, quality); guidelines (minimum sets, contracting) • Support of initiatives & Research • Link to international undertakings • National / Regional • National Strategies - Leadership • Investments, Commitment • Implementation – training, job description, administration

20. THANKS ! magda@iese.edu www.europe4patients.org

21. EU Health 5 – 10 years from now…?? • EU Patient Charter / Rights • Health = part of the fundamental rights of EU citizens • The Rights (and duties) of Patients in Europe • EU supporting Function • QUALITY- EU Provider Accreditation - • EU Network for Technology Assessment • EU established Network of Centres of Reference • EU Human Resource Planning & certification • eHealth • EU wide interoperable Health Information System, EU Health Card, EU ePatient Record, certified signature, ..etc • Contracting • Framework Conditions for Contracting • EU Basket of Services • Competitive pricing? (a healthy market??) • A European Visa Card ?? • EU Health INFO Point • EU Health Webpage / Phone EU HEALTH DIRECT Enabling Good Health for All – A Reflection Process for a new EU health strategy Brussels, 2004 - Commissioner David Byrne

22. Related FP6 SSP projects:Health Basket Health Benefits and Services Costs in Europe Methodology for comparison of the costs of health services between MS • Definition of services provided (structures, contents benefits) • European taxonomy of benefits • Assess costs & prices of services across MS • Identify best practices in costs at micro level – international comparability • Assess cost variations between MS Partners European Health Management Association University of Technology, Berlin CeRGAS, Bocconi University Centre for Health Economics, Univ. of York Danish Institute for Health Services Research Ecole Nationale de la Sante Publique Erasmus University Jagellonian University, Cracow Semmelweiss University, Budapest Universitat Pompeu I Fabra

23. MARQuiS Quality Improvement Strategies • asses quality strategies at a national level (clinical guidelines, performance indicators, patients surveys, etc) and their use • assess quality requirements for cross-border patients (EU regulation, jurisprudence, insurance contracts, patients’ needs) • Pilot studies: how hospitals have applied national quality strategies, meet the defined requirements of cross-border patients, organisational and methodological variables • Drawing conclusions: building on national quality strategies; how to comply with requirements; formal EU procedures? Partners Foundation Avedis Donabedian, Barcelona Academic Medical Centre University of Amsterdam Dutch Institute for Health Care improvement Centre for Research and Advanced Training, Italy European Society for Quality in Health Care HOPE – Standing Committee of Hospitals Manchester Centre for Health Care Management, UK

24. different patients – different eNeeds • Border regions • full access, full inter-operability of systems • Tourists • identification of rights, • evt. Access to patient record / to home physicians • evt. financial coverage (visa?) • Long term residents • Chronic care!) – full connection • + electronic prescriptions • Purchased care • Administrative • Facilitation of one-off communication between professionals