CROSSING THE BORDER FOR HEALTH CARE: ADDING VALUE FOR PATIENTS AND HEALTH SYSTEMS

Page created by Derek Mcdaniel
 
CONTINUE READING
Eurohealth 28(1)                                                                                                                   51

CROSSING THE BORDER FOR
HEALTH CARE: ADDING VALUE FOR
PATIENTS AND HEALTH SYSTEMS
By: Matthias Wismar, Robert Touret, Jonathan Clottes, Gabrielle Dubois, Apolline Damez-Fontaine,
Vincent Rouvet and Ewout van Ginneken

                                         Summary: In the European Union, patients are able to receive health
                                         care in another Member State. This has made life much easier
                                         for people travelling, working, studying, and residing abroad and
                                         provided options for patients facing long waiting times at home or
                                         suffering from rare diseases. These opportunities have been especially
                                         important during the COVID-19 pandemic, which has led to increased
                                         demand for COVID-19 care as well as catch-up care following the
                                         disruption to routine health services. As we are progressing towards
                                         a European Health Union, we suggest where improvements to cross-
                                         border health care could be made.

                                         Keywords: Cross-Border Care, Border Regions, Bilateral Agreements, COVID-19

                                         Introduction                                 Cross-border health care helps European
                                                                                      patients who fall sick abroad, increases
                                         Cross-border health care adds substantial
                                                                                      options to receive planned care in another
                                         value for European patients and citizens.
                                                                                      European Union (EU) country, can help
                                         It has been gradually developed since
                                                                                      patients with rare diseases, and provides
                                         the beginning of the European Economic
  Matthias Wismar is Programme                                                        opportunities to develop cross-border
  Manager, European Observatory          Community to ensure free movement
                                                                                      collaboration between providers and
  on Health Systems and Policies,        in the European labour market. Cross-
  Brussels, Belgium; Robert Touret                                                    payers. It also has the capacity to help
                                         border health care rests on various legal
  is Head of the Office of European,                                                  alleviate health system pressures in times
                                         frameworks. The two most important
  International and Overseas Affairs,                                                 of crisis.
  Jonathan Clottes is Project            legal frameworks are: 1) the regulation
  Manager, Gabrielle Dubois              on the coordination of social security
  is Project Manager and                                                              Learning from experiences during the
                                         systems (European Commission
  Apolline Damez-Fontaine                                                             COVID-19 crisis, Europe is moving
  is Project Manager, General            Regulation 883/2004); and 2) the patients’
                                                                                      towards the creation of a European Health
  Directorate of Healthcare Services,    rights directive (Directive 2011/24/EU)
  French Ministry of Solidarity and                                                   Union, in which EU countries work more
                                         (see Box 1). Cross-border care received an
  Health, Paris, France; Vincent                                                      closely together to protect the health of
  Rouvet is the General Director of      important impetus when Directive 2011/24
                                                                                      Europeans and to collectively respond to
  the Hospital of Cerdanya, Puigcerdà,   on the application of patients’ rights in
  Spain; Ewout van Ginneken is                                                        cross-border health crises (see the article
                                         cross border health care passed in 2011
  Berlin Hub Coordinator, European                                                    by Mauer et al. in this issue on a European
  Observatory on Health Systems          (Table 1 distinguishes between the
                                                                                      Health Union). In this context, cross-
  and Policies, Berlin University of     regulation and the directive), though
                                                                                      border health care must not be forgotten
  Technology, Germany.                   further progress towards implementation
  Email: wismarm@obs.who.int                                                          and warrants further attention.
                                         in practice and user-friendliness
                                         is necessary.

                                                                                                   Eurohealth — Vol.28 | No.1 | 2022
52                                                                                                                           Eurohealth 28(1)

                                                                                               were reported up from 232,054 in 2018.
                                                                                               The growth occurred predominantly in
     Box 1: The legal framework for cross-border health care in the EU:                        cross-border care not requiring prior
     general principles for better access to care                                              authorisation. These numbers are not
                                                                                               directly comparable because of variations
     The regulation on the coordination of social security systems (European
                                                                                               in the number of countries reporting
     Commission Regulation 883/2004) provides the legal framework for unplanned
                                                                                               each year. The total expenditure on all
     care and planned care organised by the competent authority (i.e. those with the
                                                                                               reimbursements reported by the Member
     power to perform the designated function, such as a sickness fund or national
                                                                                               States also rose in 2019 to €92 million
     government). The coordination of social security systems was introduced to
                                                                                               up from €73.3 million in 2018. 3 The
     facilitate cross-border mobility for workers, which is a precondition for a European
                                                                                               impact of the directive on national health
     labour market. Therefore, the predecessor or the regulation on the coordination
                                                                                               budgets appears marginal estimated at
     of social security systems, Regulation of the Council Number 3 on social security
                                                                                               only 0.004% of the EU-wide annual health
     of cross-border workers, came into force almost in parallel with the creation of the
                                                                                               care budget. 4 However, as mentioned
     European Economic Community. The regulation has been reformed several times
                                                                                               above, the data are incomplete.
     and renamed but retained its function in guaranteeing cross-border social security.

     The patients’ rights directive (Directive 2011/24/EU) is more recent and
                                                                                               How does the cross-border European
     establishes the right to seek health care in another Member State. It was passed
                                                                                               care framework benefit EU citizens?
     after a long political process in 2011 with an implementation period of three years. It
     codifies a series of landmark rulings from the European Court of Justice (CJEU) on        It covers European patients who fall
     cross-border health care. The case law focused on demands of European citizens            sick abroad
     that the free movement of services also applies to health services and goods
                                                                                               EU nationals, who are crossing the border
     and therefore they derived from this an entitlement to access cross-border health
                                                                                               to live, work, study or retire can rely on
     care. 1 In a series of rulings, the CJEU followed these demands with the exception
                                                                                               the European Health Insurance Card
     of ‘hospital care’, or what is now called ‘planned care’ allowing pre-authorisation
                                                                                               (EHIC) when falling sick. It allows anyone
     through competent authorities. 1
                                                                                               who has health coverage in their country
     Beyond codifying case law, the patient’s rights directive is of particular importance     of origin to receive medical treatment
     to the development of cross-border health care as it stipulates provisions with           in another Member State for free or at a
     regards to ‘cooperation in health care’. The topics addressed are instrumental            reduced cost if that treatment becomes
     to the improvement and accessibility of cross-border health care for patients,            necessary during their visit abroad. Pre-
     e.g. assistance and cooperation, recognition of a prescription issued in another          existing chronic conditions which require
     Member State, the European Reference Networks (ERNs), action in the area of rare          care, such as kidney dialysis, are also
     diseases, eHealth, and cooperation on Health Technology Assessment (HTA).                 covered. Students who study in another
                                                                                               country can also use the EHIC for health
     There is a host of other hard- and soft-law instruments surrounding the regulation
                                                                                               care. Posted workers, who are sent by their
     and the directive. Their purpose is to specify, implement or explain the legal
                                                                                               employers for up to 24 months to another
     frameworks.
                                                                                               EU Member State can use the EHIC to
                                                                                               obtain health care in the country of work,
                                                                                               though their employer needs to request a
                                                                                               form prior to the posting as a statement
The number of patients using cross-          Switzerland, from Austria to Germany,
                                                                                               of the applicable legislation. The same
border health care is currently small        from Luxembourg to Belgium, and from
                                                                                               is applicable for workers, who work in
                                             Belgium to Luxembourg. 2 The number
Overall, the number of patients using                                                          more than one country. Frontier workers,
                                             of patients using cross-border health care
cross-border health care under both legal                                                      that commute on a daily or weekly basis
                                             under the regulation is difficult to assess
frameworks – the regulation and the                                                            to another Member State may choose
                                             and clear trends cannot be identified.
directive – appear small and the budgetary                                                     between health care in their country of
                                             There are many reasons for inaccuracies.
impacts are very limited.                                                                      residence or country of work. This right is
                                             There are severe data gaps 3 and some
                                                                                               retained at retirement and extended to their
                                             Member States do not make a distinction
It is estimated that unplanned health                                                          families and their survivors.
                                             between planned care under the regulation
care under the regulation amounts to
                                             and the directive. Moreover, some of the
around 2 million patients per year. Figure 1                                                   It increases the option to receive
                                             bilateral agreements for cross-border
provides an overview on the budgetary                                                          planned care abroad
                                             health care do not routinely report
impact of cross-border health care under
                                             their data.                                       EU nationals can also ask for access
the regulation, which amounts to 0.4% of
                                                                                               to cross-border health care for planned
the total health care budget in the EU. For
                                             The numbers of patients using the directive       procedures. This is particularly attractive
planned health care, the most prominent
                                             for cross-border health care and the costs        when long waiting lists exist in the
flows took place from France to Belgium,
                                             reimbursed by the competent authorities           country of residence or if the health care
from Luxembourg to Germany, from
                                             is much smaller. In 2019, 290,890 cases           facility may be closer to the place of
Germany to Austria, from Germany to

Eurohealth — Vol.28 | No.1 | 2022
Eurohealth 28(1)                                                                                                                                                                                                      53

Table 1: Cross-border health care legal frameworks in comparison

                                                                          Regulation on the coordination of social security                      Directive on patients’ rights in cross-border health care

           Countries included                                             EEA and Switzerland                                                    EU Member States, Iceland, Norway and Liechtenstein

           Patients covered                                               EU nationals, stateless people and refugees who reside in the          Insured persons
                                                                          territory of a Member State
           Sectors covered                                                Public health care                                                     Private and public health care

           Services covered                                               Unplanned necessary care and planned care organised                    Planned and unplanned/necessary care initiated through
                                                                          through the competent authority                                        the patient
           Expenditure covered                                            Competent authority covers the expenditure incurred;                   Reimbursement of health care costs according to national
                                                                          travel expenses are not covered                                        tariffs in country of affiliation; travel expenses are not covered

Note: After the United Kingdom’s withdrawal from the EU, British citizens can continue to use their EHIC card until expiry date or they can apply for the Global Health Insurance Card which covers
unplanned but not planned care in the countries covered by the regulation; Norway, Iceland and Liechtenstein joined the legal framework in 2015.

Figure 1: Budgetary impact of cross-border health care under the regulation,                                                                                    rare diseases, which affect 30 million
by type, 2019                                                                                                                                                   European Union citizens. 5 While a
                                                                                                                                                                number of countries have strategies or
                                                      0.45
                                                             %                                                                                                  plans to address rare disease, the scarcity
                                                                                                                                                                of cases and knowledge in this area
                                                                                                                                          0.4%
                                                      0.40                                                                                                      makes a European approach necessary
healthcare spending related to benefits in kind

                                                                                                                                                                and cross-border cooperation is needed
 Cross-border healthcare as a share of total

                                                      0.35
                                                                                                                                                                to promote better, faster and more
                                                                                            0.3%
                                                      0.30                                                                                                      accurate diagnosis. According to a survey
                                                                                                                                                                conducted by Eurordis, which covered 8
                                                      0.25
                                                                                                                                                                rare diseases, 25% of patients waited from
                                                      0.20                                                                                                      five to 30 years for a correct diagnosis,
                                                                                                                                                                and during that time 41% received a
                                                      0.15
                                                                                                                                                                misdiagnosis. 6 To help patients with
                                                      0.10
                                                                   0.1%                                                                                         rate diseases, the directive of 2011 led to
                                                                                                                                                                the creation of 24 European Reference
                                                      0.05                                                                                                      Networks (ERNs), including 900 highly
                                                                                                                  0.02%
                                                                                                                                                                specialized units from over 300 hospitals
                                                      0.00
                                                                                                                                                                in 26 EU countries. 7 Through the pooling
                                                                 Unplanned           Health care provided to      Planned         Total cross-border
                                                                 health care         persons living in a MS      health care         health care                of medical expert knowledge, the ERNs
                                                                                  other than the competent MS                                                   provide common expertise thus offering
                                                                                                                                                                patients potential benefits in terms of
                                                  2
Source:
                                                                                                                                                                early diagnosis and improved treatment.
Note: No data is available on prior authorised care from countries with prior-authorisation procedures from Germany. No data                                    Meanwhile, The Rare 2030 (Eurordis)
is available on health care not requiring prior authorisation from Germany, Hungary, Luxembourg, the Netherlands.                                               foresight study, initiated by the European
                                                                                                                                                                Parliament and supported by the European
residence. There is, however, always a                                                                  procedure. Some Member States,                          Commission, emphasises the importance
requirement to seek prior approval under                                                                however, require pre-authorisation for                  of European cross-border cooperation
the regulation. But once authorisation has                                                              the obtained care subject to specific                   and innovation in this area and will help
been granted, all financial aspects are                                                                 conditions. In contrast to the previously               guide a reflection on rare disease policy
taken care of by the competent authority,                                                               mentioned process, the patient needs                    in Europe over the next decade. 8
be it a sickness fund or a health authority.                                                            to pay in advance and can only claim
In case of undue delay, e.g. if care cannot                                                             reimbursement upon completion of
                                                                                                                                                                Bilateral agreements have been
be provided within a medical justifiable                                                                the procedure.
                                                                                                                                                                developed to allow for cross-border
time, the pre-authorisation requirement is
                                                                                                                                                                collaboration across Member States
not applicable.                                                                                         It can help patients with rare diseases
                                                                                                                                                                and regions
                                                                                                        who cannot access treatment at home
EU nationals can seek cross-border                                                                                                                              A mapping exercise commissioned by
                                                                                                        Cross-border health care under the
health care on their own initiative under                                                                                                                       the European Commission in 2016/2017              9

                                                                                                        directive also provides substantial benefits
the directive. They are free to choose a                                                                                                                        identified 1,167 projects of which 423
                                                                                                        for patients living with rare diseases at the
provider across the border for a planned                                                                                                                        projects were listed, showcasing a great
                                                                                                        European level. There are more than 6000

                                                                                                                                                                                  Eurohealth — Vol.28 | No.1 | 2022
54                                                                                                                           Eurohealth 28(1)

                                                                                                a tri-national competence centre for
                                                                                                cross-border collaboration between
     Box 2: The bi-national Hospital de Cerdanya /Hôpital de Cerdagne                           Germany, France and Switzerland in the
                                                                                                Upper Rhine Region. TRISAN conducts
     The AECT-HC/GECT-HC is a cross border hospital, situated in the Est Pyrenees.
                                                                                                studies, provides information, connects
     Its very name (AECT/GECT stands for European Grouping of Territorial
                                                                                                stakeholders for best-practice exchanges,
     Cooperation) speaks of its vocation as a bi-national instrument, devised
                                                                                                and supports the cross-border cooperation
     to facilitate access to specialised medical care for a local population of
                                                                                                project. 10
     around 33,000 (although this greatly increases during peak tourist seasons)
     inhabiting 50 municipalities on a 1340 km2 territory.
                                                                                                Several Member States have bilateral
     The founding partners of the AECT-HC/GECT-HC are the public health care                    cross-border agreements for planned
     systems of France and Catalonia, Spain. The EU contributed 60% of the building             health care in place. They help to
     costs through FEDER funds; CatSalut and ARS-Occitanie shared the rest, and                 overcome temporary capacity shortages
     funded 100% of the equipment. The facility is managed jointly by both health care          and the long waiting lists resulting
     systems with a yearly operating budget of €20 million.                                     from it. According to a study on the
                                                                                                Franco-Belgian ZOAST-initiative
     The project for a bi-national, shared hospital that is pivotal to a future cross-border
                                                                                                (Zones Organisées d’Accès aux Soins
     health care network, was long in the making. It originated in 2005 with a declaration
                                                                                                Transfrontaliers), the largest share
     of intent signed by the French and Catalan authorities, and in 2007 the EGCT
                                                                                                of inpatient interventions provided
     was registered. The need for a new hospital was particularly important for the
                                                                                                were gastroplasty for the treatment
     local French population whose main reference hospital was in Perpignan, which
                                                                                                of obesity, stent placement, treatment
     was difficult to access through mountain roads or by the helicopter emergency
                                                                                                of diaphragmatic hernia or hiatal
     medical service.
                                                                                                hernia, therapeutic ureteroscopy, hip
     Since its opening in September 2014, the centre offers access to 11 medical and            replacement, pacemaker, knee prosthesis,
     surgical specialties to the local population and tourists in a small but modern local      polysomnography, treatment of bilateral
     hospital that is well equipped. Through strategic alliances with sister organisations,     inguinal, femoral or obturator hernia
     in Catalonia and Occitanie, a further 15 specialities, comprising facilities for           and cholecystectomy. For outpatient
     haemodialysis and (soon to be available) for chemotherapy treatments have                  and ambulatory care, the most common
     also been made available.                                                                  interventions involved ophthalmological
                                                                                                operations, mainly for cataract.

                                                                                                Can cross-border health care help
variety in European collaboration in             for France. In France, those agreements
                                                                                                COVID-19 patients and alleviate
health care, social care and public health.      are intended to provide a legal framework
                                                                                                pressure on health systems?
These collaborations can provide concrete        for the establishment of local cross-border
advantages for EU citizens. The projects         health or medico-social cooperation            The COVID-19 pandemic has put great
not only address patient mobility but            agreements. The aim is to promote the          stress on EU Member States’ health
also target workforce mobility, sharing          development of cooperation in health or        systems, in some cases leading to
of knowledge and infrastructure,                 medico-social care between France and          situations in which acute beds, intensive
emergencies, and joint investment in             bordering countries and to ensure better       care unit (ICU) beds and workforce
medical infrastructure.                          access to quality care in border regions by:   were not sufficient to meet the surge
                                                                                                in demand for COVID-19-related care.
                                           – guaranteeing continuity of care and
The findings show that most activity                                                            During the first wave of the pandemic in
                                             faster recourse to emergency assistance
takes place in central and western Europe                                                       the spring of 2020, within a two month
between countries, particularly those      – optimising the organisation of the                 period, almost 300 European COVID-19
with similar welfare traditions (e.g.        health care offer and by encouraging               patients were treated in another Member
Scandinavian countries), or a shared         the sharing of capacities (material and            State. Most transfers took place from the
history (e.g. Italy and Slovenia or Italy    human resources)                                   French Region of Grand Est, Northern
and Austria). Furthermore, cross border                                                         Italy and the Netherlands to Austria,
                                           – encouraging the sharing of knowledge,
collaborations can be aimed at overcoming                                                       Germany, Luxembourg and Switzerland
                                             practices, and human and material
gaps in regional provision, which occurs,                                                       (see the article by Winkelmann et al. in
                                             resources (see Box 3).
for example, in the cross-border bi-                                                            this issue). These transfers were a measure
national hospital of Cerdanya in the                                                            of last resort aimed to help countries
                                           These cross-border framework
Pyrenees (see Box 2).                                                                           and regions on the brink of collapse due
                                           agreements are intended to complement
                                                                                                to capacity shortages. 11 Even though
                                           the measures already provided for by
This type of bilateral cooperation can                                                          some of these initiatives were organised
                                           Regulations 883/2004 and 987/2009,
take the form of cross-border framework                                                         outside the European frameworks, they
                                           and by Directive 2011/24 EU on cross-
agreements and conventions, as is the case                                                      nevertheless serve as a reminder of the
                                           border care. An example is TRISAN,

Eurohealth — Vol.28 | No.1 | 2022
Eurohealth 28(1)                                                                                                                                                                     55

     Box 3: The case of Franco-German cross-border cooperation When the COVID-19 crisis began, cross-border cooperation
     before and during the COVID-19 crisis                     led the ARS Grand-Est and the Prefecture to reinforce their
                                                                                          cooperation and to innovate actions on areas including
     France has several cross-border framework agreements that                            contact tracing and the exchange of practices. Indeed,
     allow, at the regional level, the directors of the Regional Health                   the Grand-Est region was very strongly affected at the
     Agencies (Agences Régionales de santé, ARS) to sign local                            beginning of the crisis in March 2020. Thanks to the solidarity
     health cooperation agreements in order to promote patient care                       provided by neighbouring countries, including Germany,
     and the mobility of health professionals in border regions.                          transfers of patients in intensive care units were organised.
                                                                                          Thus, between 22 March and 5 April 2020, 160 patients
     ARS Grand-Est has four framework agreements for health
                                                                                          were transferred from France to neighbouring countries of
     cooperation between France and Belgium, Luxembourg,
                                                                                          the Grand-Est Region (Belgium, Luxembourg, Germany,
     Switzerland and Germany.
                                                                                          Switzerland) or other EU countries (Austria), of which 74% of
     The Franco-German cross-border health cooperation                                    which were transferred to Germany.‡
     framework agreement,* covers the border area of the former
                                                                                          In the same spirit, France has offered to receive patients in
     regions Alsace and Lorraine regions of the Grand-Est on
                                                                                          intensive care if the health situation so requires.
     the one hand, and the German Länders (States) of Baden-
     Württemberg, Rhineland-Palatinate and Saarland on the other.                         Furthermore, in order to consolidate cross-border cooperation
     It aims to ensure better access to care for the populations of                       in light of the lessons learned from the COVID-19 crisis, ARS
     the border region, to guarantee continuity of care and faster                        Grand-Est has proposed to develop a joint cross-border
     access to emergency assistance, to optimise the supply of                            observatory on health data for the border areas § in order to
     care and promote the sharing of professional knowledge and                           facilitate a harmonised exchange between the parties.
     practices, and to facilitate crisis management.
                                                                                          On the Franco-German border, with regard to the prospects
     Further conventions have also been added in specific areas.                          offered by the Treaty of Aix,¶ this common desire to work on
     For example, the field of cross-border emergency medical                             strengthening health cooperation would apply particularly to
     assistance, is the subject of several conventions between                            the cross-border living areas that are institutionally embodied
     the ARS Grand-Est, the health structures concerned, the                              by the Eurodistricts.
     SAMU (Service d’Aide Médicale Urgente; Emergency medical
     service) and fire departments and the neighbouring Länder.†
     These specific conventions allow the emergency call centre
     responsible for the region to call on the emergency resources
     of the neighbouring region to shorten the response time or to
     compensate for the temporary unavailability of means. 13
                                                                                          ‡   Data from the ARS Grand-Est.
                                                                                          §   Bassins de vie frontaliers.
     *   Signed in 2005 and entered into force in April 2007.                             ¶ Treaty between the French Republic and the Federal Republic of Germany on Franco-
     † Between Alsace and Rhineland-Palatinate as well as between Alsace and                 German cooperation and integration, signed on 22 January 2019 and entered into force
         Baden-Württemberg both on 10 February 2009.                                          on 22 January 2020.

potential of cross- border care in crisis                          Cerdanya Hospital between France and                     there are pending issues that need to be
situations. Countries could explore the                            Spain cooperates with French hospitals                   addressed for cross-border health care to
European frameworks better to facilitate                           to share intensive care capacity and                     be realised in its full potential:
the continued demand for COVID-19-                                 personnel, working with the border police
related services as well as new demand                             to ensure access for patients and health                 ●E
                                                                                                                              HIC needs improvement: In 2019,
for backlog care (see the article by van                           professionals. 12                                         there were close to 250 million EHIC
Ginneken et al.).                                                                                                            cards issues amounting only to 53.1%
                                                                                                                             of insured persons in the EU. The
                                                                   What needs to be done to reap the full
Furthermore, several countries have been                                                                                     EHIC has also faced some acceptance
                                                                   potential of cross-border care?
working together, with assistance from                                                                                       problems with health care providers. 2
the EU and its frameworks, in providing                            Cross-border health care adds value
                                                                                                                            ●	Better information for patients and
emergency care for COVID-19 patients                               for patients in many circumstances. At
                                                                                                                               health professionals: Patients and
in the Interreg regions. For example,                              present, there is limited utilisation of
                                                                                                                               health professionals are not always
the Euregio Meuse-Rhine confronted                                 cross-border care and the budgetary
                                                                                                                               informed on the options for cross-
with the pandemic set up a trilateral                              impact is negligible. The European
                                                                                                                               border health care, even in border
crisis management centre (Task Force                               Commission is carrying out an evaluation
                                                                                                                               regions. 14 The expansion of cross-border
Corona)*. Furthermore, the cross- border                           of the cross-border health care directive
                                                                                                                               digital services for both patients and
                                                                   to assess its effects (see Box 4). However,
*   The Euregio fosters regional cross-border collaboration                                                                    professionals will be important.
on all economic, social, and cultural aspects. It was created in
1976, with judicial status achieved in 1991.
                                                                                                                                              Eurohealth — Vol.28 | No.1 | 2022
56                                                                                                                                              Eurohealth 28(1)

                                                  ●	Strengthening the evidence base and                 5
                                                                                                            Nguengang Wakap S, Lambert DM, Olry A, et al.
                                                     monitoring of bilateral agreements:                 Estimating cumulative point prevalence of rare 255
     Box 4: Evaluation of the patients’              information on the prevalence and                   diseases: analysis of the Orphanet database. Eur J
     right directive                                 analysis on the effectiveness of
                                                                                                         Hum Genet 2020;28(2):165 – 73.

                                                     bilateral agreements and a continuous
                                                                                                         6
                                                                                                             EURORDIS. Survey of the delay in diagnosis for
     The European Commission is                                                                          8 rare diseases in Europe (‘eurordiscare 2’), 2007.
                                                     monitoring would help to provide a
     carrying out an evaluation of the                                                                   Available at: https://www.eurordis.org/sites/default/
                                                     stronger evidence base.                             files/publications/Fact_Sheet_Eurordiscare2.pdf
     cross-border health care directive
     to assess how the rules are working          ●B
                                                    etter integrate and support the                     7
                                                                                                            European Commission. European Reference
     (or not working) in the interests of          possibility of having bilateral                       Networks, 2017. Available at: https://ec.europa.eu/
     patients. 16 It will focus, in particular,    agreements within the European                        health/ern_fr

     on patients access to safe and                framework: Similar to the agreements                  8
                                                                                                            Rare 2030. Foresight in Rare Disease Policy.
     high-quality health care in another           between France and some of its border                 Recommendations from the Rare 2030 Foresight
     country and how it encourages                 countries, the measures provided are                  Study. The future of rare diseases starts today.
                                                                                                         2021. Available at: http://download2.eurordis.org/
     cooperation between national health           already complimented by the regulation
                                                                                                         rare2030/Rare2030_recommendations.pdf
     care providers, also on rare diseases         and the directive mentioned above,
                                                   while addressing local issues.
                                                                                                         9
                                                                                                             Bobek J, Schmidt AE, Bachner F, Röhrling I,
     and ERNs. Following an extensive
                                                                                                         Seethaler J. Cross-border. Care – Study on
     consultation of stakeholders
                                                                                                         cross-border cooperation: capitalising on existing
     across the EU including national             Conclusion                                             initiatives for cooperation in cross-border regions.
     and regional authorities, health                                                                    Main Results, 2018.
                                                  Cross-border health care adds value
     professionals, health insurers, patient
                                                  for patients and helps to provide timely               10
                                                                                                            TRISAN web site. Available at: https://www.trisan.
     organisations and citizens, its report
                                                  access to high quality health care. This               org/
     is expected to be published in the
                                                  may be especially important during the                 11
                                                                                                            Winkelmann J, Scarpetti G, Hernadez-Quevedo C,
     Spring of 2022.
                                                  COVID-19 pandemic which has led to                     van Ginneken E. How do the worst-hit regions
                                                  increased demand for COVID-19 care                     manage COVID-19 patients when they have no spare
                                                                                                         capacity left? 23 April 2020. Available at: https://
                                                  as well as catch-up care following the
                                                                                                         eurohealthobservatory.who.int/monitors/hsrm/
 ●	End financial risk for patients:              disruption to routine health services. If we           analyses/hsrm/how-do-the-worst-hit-regions-
    In many countries, the directive is           are to strive towards a European Health                manage-covid-19-patients-when-they-have-no-
    implemented in a way that discourages         Union, we should continue to invest in                 spare-capacity-left
    patients to use it; in particular, it does    cross-border health care by improving                   12
                                                                                                             European Commission. Communication from the
    not contain information on tariffs            the user-friendliness, providing help for              Commission: Guidelines on EU Emergency Assistance
    and levels of reimbursement. Patients         cross-border collaboration, strengthening              on Cross-Border Cooperation in Healthcare related
    therefore often prefer to use cross-          the ERNs, and further expanding the                    to the COVID-19 crisis. Available at: https://eur-lex.
                                                                                                         europa.eu/legal-content/EN/ TXT/?uri=celex%3A520
    border health care under the regulation.      cooperation of cross-border regions,
                                                                                                         20XC0403%2802%29
                                                  Member States, and at European level.
 ●	Improve continuity of care: Cross-                                                                   13
                                                                                                            France-Germany cooperation agreements
    border hand-over and continuity of care                                                              (Conventions de coopération France-Allemagne).
    remains a difficult task. In general,         References                                             Available at: https://www.cleiss.fr/docs/cooperation/
    electronic patient records or paper           1
                                                      Wismar M, Palm W, Figueras J, Ernst K, Van
                                                                                                         cc-france-allemagne.html
    records do not travel with the patient        Ginneken E. Cross-border health care in the European   14
                                                                                                            Beuken JA, Bouwmans ME, Verstegen DM,
    or is inadequately acknowledged. 15           Union: mapping and analysing practices and policies.   Dolmans DH. Out of sight, out of mind? A qualitative
    The EU eHealth network has created            Copenhagen: World Health Organization, on behalf       study of patients’ perspectives on cross-border
                                                  of the European Observatory on Health Systems and      healthcare in a European border region. Patient Educ
    the MyHealth@EU infrastructure to
                                                  Policies, 2011.                                        Couns 2021;104(10):2559 – 64.
    facilitate the transfer of medical records
    and by 2025 all EU countries are
                                                  2
                                                     De Wispelaere F, De Smedt L, Pacolet J.              15
                                                                                                             Beuken JA, Verstegen DM, Dolmans DH, et al.
                                                  Coordination of social security systems at a glance    Going the extra mile – cross-border patient handover
    expected to be connected.
                                                  2020 Statistical Report. European Commission           in a European border region: qualitative study of
 ●	Improve user-friendliness: The legal          Directorate-General for Employment, Social Affairs     healthcare professionals’ perspectives. BMJ quality
                                                  and Inclusion, 2021.                                   & safety 2020 ;29(12):980 – 7.
    provisions are complicated and deter
    potential patients from using cross-          3
                                                     Wilson P, Andoulsi I, Wilson C. Member State         16
                                                                                                             Cross-border healthcare – evaluation of patients’
    border health care.                           Data on cross-border healthcare following Directive    rights web site. Available at: https://ec.europa.
                                                  2011/24/EU. European Commission, 2019.                 eu/info/law/better-regulation/have-your-say/
 ●	Strengthening the ERNs: The                   4
                                                                                                         initiatives/12844-Cross-border-healthcare-
                                                     European Commission. Report from the
    ERNs had a promising start. With              Commission to the European Parliament and the
                                                                                                         evaluation-of-patients%E2%80%99-rights_en
    the expansion of the networks and             Council on the operation of Directive 2011/24/
    the uptake of more patients with              EU on the application of patients’ rights in
    rare disease in the virtual panel             cross-border healthcare. COM(2018) 651 final.
                                                  Available at: https://eur-lex.europa.eu/resource.
    consultations the question of additional
                                                  html?uri=cellar:bc5ac6d2-bd7c-11e8-99ee-
    investment in infrastructure and              01aa75ed71a1.0019.02/DOC_1&format=PDF
    expertise needs to be answered.

 Eurohealth — Vol.28 | No.1 | 2022
You can also read