First Joint European Hospital Conference

The morning section focused on current European health policy with a keynote presentation by Mars Di Bartolomeo, Minister of Health and Social Affairs, Luxembourg.The afternoon was devoted to the EU Directiveon Patients’ Rights and its impacton hospitals. The key presentation was given by Annika Nowak, European Commission and was followed by comments from various European countries (UK, Hungary, France, Belgium, Sweden and Greece).

Current European Health Policy

Mars Di Bartolomeo took the opportunity to reflect on current European health policy and also the effect of directives on healthcare. He believes that equitable access, technology, cross-border, e-health and transparency of services are all important issues, which must be viewed through increasing costs/budget constraints for hospitals.

For Di Bartolomeo, European integration has become self-evident as a development,“we are no longer scared of European health policy.” He did however admit that the European health market had provoked some heroic disputes. He confessed to resisting to health being restricted to market rules. Yes healthcare is a service but it is special, it is not just buying and selling based on contract but the services offered must also comply with high quality standards and there are also provider beneficiary and reimbursement and social security systems to think about too.

EU policy should focus on first-rate medicine for everyone. This will cost more money but proven assets and values are worth being defended. The health minister also spoke of the need for comparable data and indicators for quality and bench marking.

Long-term strategies are essential in overcoming crises and the minister spoke of the Europe 2020 strategy and how it affects healthcare. The Europe 2020 strategy is about intelligent, sustainable growth and social cohesion. It is about investingin good health; each citizen is entitled to health promotion and care. The health sector constitutes a high cost factor but there is very high added-value: Quality of life cannot be expressed in Euros.

Di Bartolomeo continued with the following hypothesis: “Nothing deprives the welfare state of resources than poor health”. He was realistic to the fact that medical progress will not make health cheaper; costs will not go down but you can get more for your money.

After this very informative speech the spotlight moved to the expert panel made up of representatives from each of the three European associations. GeorgeBaum, President of HOPE (European Hospital and Healthcare Federation) was thefirst to comment on current European health policy. Baum reiterated the fact that European integration is essential but that there must be limits on standards.

Baum believes that we, as Europeans, are far too unrestricted in our movement to be denied healthcare in another country when it cannot be treated at home. Heemphasised the need for balance in the movement of health professionals and patients citing the worry that some regions will be under a greater burden than others.

Another key issue for HOPE is qualificationsfor healthcare professionals. They are worried that all care professionals will soon need 12 years of schooling to be qualifiedto do their job.

To speak on behalf of the EAHM Mr. HeinzKölking took the floor. He stressed the value of these conferences in bringing Europe together. Mr. Kölking highlighted personnel issues including increased competition with other sectors and the scarcity of people willing to work in healthcare. This is not helped by the new levels of complexity compared to ten years ago (ICU, IT) and the high pressure on staff. He believes that leading and supporting staff is a task for the management. Kölking explained that the EAHM believes management on different levels is key to facing the current challenges in healthcare. Forthis reason EAHM is focusing on the professionalisation of management. Staff are key to the smooth running of a hospital and bad management can cause a lot of damage.

Last to take the stage before the lunch break was João de Deus, President of AEMH. He stressed that although different countries have different systems all hospital models hospitals across Europe are prime targets for cost-saving measures. For the AEMH the key goal is patient safety and quality. This includes risk management and improved pre and post graduate medical training.

De Deus finished by stressing that hospital management should be based on quality and safety and he strongly believes there should be more doctors in hospital management.

EU Directive on Patients’ Rights and its Impact on Hospitals

Annika Nowak, a representative from the European Commission (DG SANCO D2) was tasked with quite a responsibility: Explaining the directive on patients’ rights in cross-border healthcare. Putting the longevity of this contentious issue into context, she explained how there have been 12 years of European Court of Justice rulings on patient mobility from Kohll and Decker in 1998 to Elchinov in 2010. The Commission proposal was adopted in July 2008 after which there was the first and second reading resulting in the formal adoption of the Council on 28 February 2011. The Directive entered into force on 24 April 2011.

The Directive has three aims:

• To help patients exercise their rights to reimbursement for healthcare received in another EU country;
• To provide assurance about safety and quality of cross-border healthcare;
• To establish formal cooperation between health systems.

The Directive is said to help patients access information through the national contact points, clarify the rules regarding reimbursementand provide procedural guarantees. The healthcare provider role includes provision of information to the patient, professional liability insurance, calculation of prices and medical records. The safeguards put in place for health systems include conditions for reimbursement, the maintaining of national rules and the prior authorisation system.

Quality and safety are promoted through transparency and account ability, Member State responsibilities and cooperation of Member States.

The transposition period for the Directive is 30 months (until 25 October 2013).This period will include bilateral discussions. The Commission questionnaire has been completed by all Member States in detailon patient rights and the Commission will also visit all 27 Member States to check on progress. The Committee on cross-border healthcare has also been set up.

Nowak concluded by praising all Member States for taking this process so seriously and reiterating that the European Commission is closely following all developments. After Ms. Nowak’s informative presentation on the Directive itself it was time to hear from representativesof Member States and the effects of the Directive in their countries.

Elisabetta Zanon spoke on behalf of the UK NHS. The UK does not expect to see alarge increase in demand for healthcare from foreign patients but is concerned that longer waiting times in the UK could motivate patients to travel abroad for their care. The main challenge for the UK concerns tariffs and prices. In the NHS, 60 percent of care is not covered by tariffs and prices are often set at a local level. This is hard to define so the UK would like to see definitions of entitlements and worries about maintaining the ability to plan and prioritise.

Moving to France, Prof. Robert Nicodeme from the French Medical Chamber believes that healthcare personnel are missing from the Directive. This is an important issue as they are very active in healthcare mobility. Competence is another big issue here; everyone wants a competent doctor and each country must measure performance and ability with the same set of competences. This is not defined in the Directive.

The Hungarian perspective, given by Dr. Gyorgy Harmat, President of the Hungarian Hospital Federation, focused on the legal dimension of the Directive stating that there is a need for more legal provisions, especially regarding the use of e-health. Another key issue highlighted was the linguistic challenges of cross-border care. Patient mobility in Hungary is quite low but waitinglists are moderate and there is low level domestic cost meaning there is a fear that this could cause a flow into the country.

The Belgian representative, Dr. Miek Peeters explained that at the time of the conference, national planning and debate on the Directive had not yet started due to the government situation. Quality and safety are key concerns. Member States must impose certain standards and the Directive does push for Member States to improve this. It will be interesting to see how this will influence standards of quality of care. Non-discrimination on basis of nationality was highlighted, as were the high numbers of foreign patients in Belgian hospitals. Special mention was given to equal access with refusal as the exception not the rule and an end of higher tariffs for foreigners.

Dr. Thomas Zilling, Vice-President of AEMH spoke for Sweden, one of the more liberal countries in Europe. He explained that Swedenis strongly in favour of the Directive and indeed already demand no prior-authorisation for Swedish nationals to receive care in another country and be reimbursed at home.This does, however, depend on their abilityto pay for the care before reimbursement and the government are working to change this process. Swedish medical doctors demand that the government establish an authority that protects the patients’ rights regarding crossborder healthcare.

The final country to voice its opinion was Greece. Dr. D. Kremalis emphasised the difficult economic situation in Greece and that healthcare is not excluded from the cuts. Kremalis believes there is a need for further clarification on the Directive and the healthcare provided but is confident this is a stepforward to the Europeanisation of healthcare. There are questions to be answered on a practical level (regulations, coordinationof social security system) and dialogue must continue. He believes that the scopeof the reimbursement system is significantly narrow and that although a step in theright direction, the Directive does not createa real European right to healthcare.

A lively discussion took place after the national perspectives with Ms. Novak taking questions from the floor. The conference, andthe session on this Directive in particular, hasshown that the issue of cross-border healthcare is far from resolved but that it is clear a level playing field needs to be established between all involved and all Member States must be involved to make it work. A sense of freedom for patients has been established as aright; political progress has been made.