@EU_Health @EU_eHealth UEMS CESMA Workshop Brussels 3 Dec 2016 @UEMSEurope @Tapani_Piha Cross-Border Mobility in Healthcare? Tapani Piha Head of Unit Cross-Border Healthcare and ehealth Health Systems, Medical Products and Innovation
The Four Freedoms of the Single Market Free movement of goods Free movement of persons Free movement of capital Free movement of services & freedom of establishment
Cross-Border Mobility Patients Patients Rights in Cross-border Healthcare Health Professionals Directive on professional qualifications Telemedicine European Reference Networks E-Prescription and Patient Summary
Mobility of Patients
The Regulations and the Directive Regulations on coordination of social security schemes Emergency treatment Prior authorisation for planned care Reimbursement between institutions Public providers only Directive on patients rights in cross-border healthcare Main rule: no prior authorisation Pay directly to the provider Reimbursement based on national tariffs Public and private providers and medicines tp 19.4.16
Patients rights in Cross-border Healthcare Directive 2011/24/EU National implementation since 2013
Free Movement of Services - Healthcare Directive on patients rights in cross-border healthcare was adopted in 2011. Enter into force 1.1.2014 Kohll and Decker (1998); Ferlini (2000); Geraets-Smits and Peerbooms (2001); Vanbraekel (2001); Inizan (2003); Müller Fauré and Van Riet (2003); Leichtle (2004); Watts (2006); Stamatelaki (2007); Elchinov (2010).
described as. the most significant and wide-ranging European health legislation in a generation. DH Leading the nation s health and care
Three aims 1. Help patients to exercise their rights to reimbursement for treatment in any EU country 2. Provide assurance about safety and quality of cross-border care 3. Establish formal cooperation between health systems 9
Directive makes receiving treatment in another country possible Main rule: no prior authorisation Pay directly to the provider Reimbursement based on national tariffs Public and private providers, medicines Implementation since 2013 tp 19.4.16
Information to patients Rules of reimbursement Procedural guarantees Help Patients Exercising their Rigths in Another Country
National Contact Points Outgoing patients: rights; entitlements; reimbursement; appeal processes Incoming patients: quality and safety standards & systems; complaints and redress procedure; Consult with patient organisations, healthcare providers, healthcare insurers http://ec.europa.eu/health/cross_border_care/docs/cbhc_ncp_en.pdf
Patient mobility - Prior Authorisation Prior Authorisation (PA) must be necessary and proportionate, and may not constitute an unjustified obstacle; Article 8(7) of the Directive requires MS to make publicly available which healthcare is subject to prior authorisation Assessment of the MS transposition (2015) Majority of MS legislation doesn't specify clearly: overnight stay; and or highly specialised care Some MS overuse PA In at least 14 MS, it is unclear exactly which treatments are subject to PA
Conclusions on Patient Mobility (2015) Patients mobility for planned healthcare remains low; Late implementation by MS Low awareness of patients' rights on cross-border healthcare Obstacles in MS legislation: - Extensive use of PA or lack of clarity which treatments require PA; - Unreasonably low reimbursement tariffs; - Burdensome administrative requirements Created a Framework for Patients' Rights More transparency on healthcare services in EU; NCPs to improve information to patients; Liability, complaints procedures
The Second Freedom Mobility of Health Professionals
Growth of foreign phycisians in Germany, selected nationalities, 2000-14 European Source: Bundesarztekammer Observatory on Health 2015 Systems and Policies
Key findings Efficiency > Equity More workforce More skills Savings Fill gaps Losses, no ROI > Destination Source Gaps, shortages country country winner takes all Access, organisation Underserved areas Well-resourced systems Higher income > Lower income countries countries difficult to reform European Observatory on Health Systems and Policies Crisis-hit Less political clout Less capacity to reform, rebuild Greater need
Free Movement of Health Professionals The mobility of health professionals is a fundamental right under Article 45 of the Treaty on the Functioning of the EU and facilitated by the Directive on the mutual recognition of professional qualifications
Bottom Line Conclusion by the Observatory EU = free mobility + increasing flows + great diversity Destination Source EU
Mobility on the research agenda? Domestic measures To pre-empt mobility Workforce intelligence and planning To manage (with) mobility Diaspora networking Cross-country collaboration Better data Better sharing Compensation fund Training, present, future R&R Regional distribution Foreign trained foreign-nationals Integration Foreign trained nationals Returners Facilitated EU scholarships Structural funding European Observatory on Health Systems and Policies Ethical recruitment Coordinating training capacity Platform for knowledge, skills transfers
Mobility of health professionals in the EU Action 1: European cooperation to improve data on mobility patterns and trends Action 2: Share best practice on innovative retention strategies Action 3: Maximise use of EU Cohesion Funds in healthcare World Health Assembly, May 2010
Does Europe need a 5th freedom - free movement of data? Read the latest speech by @Ansip_EU on #EUdataFF http://bit.ly/2djiniq #digirev DigitalSingleMarket @DSMeu
The Fifth Freedom Mobility of Data
Citizens and cross-border possibilities European Reference Networks & Telemedicine E-prescription and patient summary
European Reference Networks Imagine if the best specialists from across Europe could join their efforts to tackle complex or rare medical conditions that require highly specialised healthcare and a concentration of knowledge and resources.
Key features of European Reference Networks Provide diagnosis and treatment in rare diseases Patient centered and clinically lead 10 members - hospitals, clinics - in at least 8 countries Call for proposals open until 21 June 2016 Based on Article 12 of the Directive on Patients Rights
ERNs - Telemedicine and Networking Remote training Memeber Remote guidance and Diagnosis Member Secure exchange of patient information, databases, registries Member Virtual clinical patient consultation (tumour boards) Member Remote monitoring and follow-up Local Healthcare Provider Local Healthcare Provider
ehealth Digital Service Infrastructure DSI Hospitals NCP Core services NCP GPs Horizontal Building Blocks eid, ( ) ehealth Building Blocks terminology server, tp 19/11/2015 NCP NCP: National Contact Points is Member State's connection to the EU network
Connecting Europe Facility (CEF) supports building of the real exchange of e-prescriptions and patient summaries 2015 The CEF Work Plan allocates 15 mill. March 2016 20 Member States sent proposals 2018 First countries go live tp 14/04/2015 2020 Last countries go live
Digital Single Market
72% of EU individuals uses INTERNET regularly 150 Million subscriptions fixed Broadband 130 mobile subscriptions per 100 people DIGITAL BUSINESS HALF of EU enterprises provide mobile devices for business use 276.5 million EUR turnover of EU B2C ecommerce (2012) 14% of EU SMEs selling online 28% EU enterprises use Social media 29% of EU enterprises use e-invoices DIGITAL ECONOMY ICT drives 1/3 rd EU GDP growth 1995-2007 38% EU venture capital 900 000 estimated demand/supply gap by 2020 55% work outside ICT sector ICT in Other Sectors ICT sector 4.4% 17% EU patents ICT professionals 7% of GDP Size of the 6% of Gov't R&D 2.4% of workforce digital economy 17% of business R&D by ICT sector Digital Single Market Strategy + 4.1% yearly employment growth
Digitisation Access to your health data Data privacy and security eprescription Electronic Health Record/ PHR/EMR Quantified self Dr Google and digital health literacy Digital skills Prevention/ diagnose/ treatment/ monitoring/ rehabilitation Telemedicine Informal carer From Terje Peetso DG CNECT Oct 2016 Secondary use of health data Access to healthcare
Digital Single Market Strategy Five Actions under DSM Strategy Five actions 1. Exchange of health data 2. Promotion of telemedicine 3. Access to own health data 4. mhealth 5. Standardisation in medicinal products tp 26.10.16 DSM Instruments Digitising European Industry European Cloud Initiative Priorities for ICT Standardisation E-Government Action Plan
@V_Andriukaitis @EU_HEALTH @EU_Commission @EU_eHEALTH DG Health and Food Safety site http://ec.europa.eu/health/ehealth/policy/index_en.htm DG Connect site http://ec.europa.eu/digital-agenda/en/eu-policy-ehealth