A new dawn for cross-border healthcare in Europe?

To keep things simple, this blog has moved to the IMTJ web site. You can find the Health Tourism Blog here in future. Here's an extract of the latest blog post on "A new dawn for cross-border healthcare in Europe?"

A new dawn for cross-border healthcare in Europe?
Will European hospitals see a surge in patient numbers following the approval of the EU Directive on Cross-Border Healthcare by the European Parliament recently?

I would like to say...Yes! But the reality may be a little different. So....let’s take a look at how the EU Directive may (or may not) change the way that healthcare works in Europe and more importantly whether it will give a boost to the medical travel sector.

Consolidation of existing patient rights
The EU Directive does not give patients any rights to cross border healthcare that they don’t have already. It doesn’t introduce any new rights. These rights have already been established by the European Court of Justice. What the Directive aims to do is to establish a framework within which cross border healthcare will operate and to set the rules regarding how patients will access care and what kind of treatment they are entitled to. The new rules should be in place by 2013 (in theory....).

The Directive will end the uncertainty about the kind of treatments that patients are entitled to elsewhere within Europe and it will also allow domestic healthcare systems to maintain control of the patient’s entitlement to cross border healthcare. But the Directive does present opportunities for hospitals and healthcare providers to generate revenue from patients from elsewhere in the EU.

But overall, there will not be an overnight change and we are unlikely to see a surge in the number of cross border patients within the EU.

Within the UK, there are already well established procedures for National Health Service patients who wish to exercise their right to cross border care under existing EU law. Every NHS trust has (in theory) a procedure in place to deal with requests and to manage the process. See “NHS Choices - Planned treatment abroad”. Last year, it is believed that around 500 British patients exercised their right to cross border healthcare and underwent treatment abroad that was funded by the NHS.

.........Read the full article at IMTJ: Go to "A new dawn for cross-border healthcare in Europe?"

NHS Patient Choice - Lessons for medical tourism

In the UK, "patient choice" is one of the driving forces in healthcare. Since April 2008, patient choice has been extended in the UK. Patients can choose which hospital they are treated in....anywhere in the country. Patients can choose the time of their hospital appointment. In some cases, patients can choose the individual consultant they see. The NHS Choices website lists information about all NHS hospitals, such as their MRSA rates, facilities and ratings and reviews by patients which means that patients can make an informed choice.
The NHS Choose and Book web site enables people to make their choices.
In reality, the patient choice initiative has been a bit of a disappointment. One problem is that not enough patients are actually aware that they have a choice. The Report of the National Patient Choice Survey, England - December 2008 has analysed uptake of patient choice so far.
The key findings:

• The percentage of patients recalling being offered a choice of hospital for their first outpatient appointment was 46% in December 2008, the same as in September but up from 30% in the first survey (May/June 2006)
• 50% of patients were aware before they visited their GP that they had a choice of hospitals for their first appointment, up from 48% in September and 29% in the May/June 2006 survey.

The factors influencing choice

• Hospital cleanliness and low infection rates were given most often (by 74% of patients) as an important factor when choosing a hospital.
• The other five are quality of care (given by 64% of patients), waiting times (63%), the friendliness of staff (57%), the reputation of the hospital (55%) and location or transport considerations (54%).

So what can medical tourism businesses learn from this?

If UK patients can compare NHS hospitals on MRSA rates, post operative infection rates and outcomes, why can't they do this for overseas hospitals? Or perhaps, why is it difficult if not impossible to find a hospital treating medical tourists that publishs such data or makes it freely available on their web site?

Many people in the UK have the right under EU law to travel abroad for treatment. The EU Directive sets up a framework around this. but the basic right of free movement already exists. So, why aren't people taking advantage of this?

• They don't know they have the right.
• They don't "trust" overseas hospitals.
• They would rather wait for treatment on the NHS in their local area.

Awareness of overseas treatment options can be generated by the providers themselves. One of the best tools to consider is the use of patient stories to create local press coverage and thus raise awareness. See this story in the Scotsman. Let's see more of them!

The challenge facing the medical tourism industry

The recent European Congress on Health Tourism in Budapest reflected some of the current issues and challenges facing the medical tourism industry, particularly those presented by a world recession. Budapest is Europe's dental tourism hub, attracting patients from countries such as the UK, Ireland, Germany, Austria, Switzerland and Scandinavia. If the recession is hitting medical tourism, then Budapest is going to feel it more than most.

There were workshops and presentations from various providers and industry players at the Budapest Congress. One of the more down to earth of these presentations was made by Dr Bela Batorfi of The Batorfi Dental Implant Clinic in Budapest. This impressive clinic usually carries out around 1,800 dental implants per year. But with the onset of the global financial crisis they have seen some worrying trends:

• The number of patients from abroad has fallen by around 30%. Medical tourists are harder to find!
• The average spend per patient has decreased from around £5,000 to £2,600. Medical tourists are spending less per visit.
• The average age of patients has increased. Medical tourists are delaying treatment.

The experience of the The Batorfi Dental Implant Clinic is reflected among many of the other dental treatment providers in Budapest. It's not the case that Budapest is losing patients and market share to other destinations. Understandably, many clinics are concerned about the fall off in business and how long it will continue.

Against the backdrop of the financial crisis, Hungary is one of the many countries planning a "medical city" aiming to attract patients from across the world to a centre of medical excellence. According to Balázs Stumpf-Biró, Executive Director of the European Medical Tourism Alliance (EuMTA), Hungary is planning to establish 100 hectares of land near Budapest’s international airport as a health complex, similar to Dubai Healthcare City.

Whether this development suffers the same fate as Dubai Healthcare City remains to be seen. The initial building boom in Dubai has come to a grinding halt. Building anything in the current financial environment is a risky business, and with the medical travel market to Hungary down around 20% to 30%, it's going to be a brave investor who lays the first brick.

Various estimates of medical travel numbers for Hungary put the number of incoming medical tourists at around 300,000 to 350,000 per annum. The vast majority of these are for dental treatment, and many may be "short trip/low cost" cross border visitors from Germany and Austria. But that's still a valuable market.

So what's the long term outlook for medical tourism destinations such as Hungary? Better than most, I would suggest. The medical travel market is here to stay and is here for the long term. Hungary has been at the forefront of medical travel in Europe for the last decade and it can retain that position.

But like most countries being encouraged down the medical tourism route it needs to tread carefully. We hear the usual overblown claims by industry proponents such as the Medical Tourism Association that "the biggest potential market for Hungary is the USA". I can just see hundreds of thousands of Americans getting out their maps of Europe, locating Budapest and booking their long distance flight via New York/London/Amsterdam for their dental implants. It isn't going to happen.

So where should Hungary be focusing its efforts?

Well... :

• There's a population of 550 million in the "United States of Europe" who may begin to exploit the opportunities within the EU Directive on patient mobility.
• Not so far away from Hungary, there are 140 million Russians who are beginning to spend their money on holidays all over Europe. Medical travel will follow this trend.
• And the UK dental problem is here to stay. See this recent article in the Independent: This may hurt a little: Rise in hospital admissions for last-ditch tooth extractions

My advice to Hungary... The same as you would get from business guru, Tom Peters (In Search of Excellence).

Stick to the knitting - stay with the business that you know!

EU votes on medical tourism directive

Members of the European Union's various committees vote this week on whether to make changes to the EU Directive on cross border healthcare. The Directive aims to provide a framework for patient mobility, whereby patients in one member state will have the right to treatment in another state.

The UK's General Medical Council (GMC), which regulates the country's 230,000 doctors, is running a lobbying campaign to protect Britons seeking healthcare in Europe from what it describes as "dangerous" doctors. the GMC wants the new EU laws to give patients access to the disciplinary history of incompetent clinicians.

Quoted in the Guardian, Paul Philip, the GMC's deputy chief executive says:"The vast majority of doctors do a very good job under very difficult circumstances. However, when UK patients travel to mainland Europe, there is a risk they could be treated by a doctor who is not fit to practise or not fully qualified to give the required treatment."

UK patients have full access to GMC records and are able to check whether a doctor has been disciplined, or is the subject of a disciplinary hearing. The GMC wants doctor organisations in other countries to provide similar patient access to information about their doctors.

In the first 9 months of 2008, the UK NHS paid for over 500 British patients to have treatment elsewhere in Europe. Some patients were also funded by their primary care trusts. It is estimated that another 80,000 Britons funded their own treatment overseas.

EU Directive on cross border healthcare boosts health tourism

After a six month delay, the EU Proposal for a Directive on patient’s rights in cross border healthcare has finally been released. It provides an added stimulus to the already growing number of medical tourists who seek hospital treatment elsewhere in the European Union. Its aim is to create a formal framework for cross border healthcare and remove the obstacles that patients face if they wish to travel for treatment in other EU countries.


I'll attempt to answer some of the questions that people are asking about this new Directive and its impact.

Why do we need a Directive on cross border healthcare?
The Directive has come about from a desire to create a European market in healthcare, and to some extent as a result of European Court judgements which have upheld the rights of patients to gain reimbursement for treatment in other countries where they have been subject to "undue delay" in their own country.

What does it cover?
The Directive proposes a number of developments in cross border healthcare, including reimbursement of medical tourists, patient safety and quality issues, European cooperation on healthcare, assessment of new medical technology and standards for e-health and transfer of patient information between member states.

How will it affect UK NHS patients?
In April this year, NHS patient choice in the UK was extended, giving patients the right to opt for treatment anywhere in the UK. The Directive, in effect, extends this patient choice to anywhere in the EU, provided that the treatment is available at a cost which is the same or lower than the NHS cost.

Under the Directive, the NHS will be requested to establish a direct payment or reimbursement system. This means that patients will not have to fund the treatment and then claim the cost back from the NHS. They will have to fund their travel and accommodation costs. No prior approval is required from the NHS or the patient's primary care trust.

It doesn't mean that patients in the UK or elsewhere in the EU can opt for treatments overseas that are not covered by the NHS. So, if a new drug or a new procedure is available in another country, the patient cannot obtain payment for this.

How many patients will opt for treatment abroad?
Who knows? Patients may decide to travel abroad because:

• Surgeons and hospitals with better results for their treatment may be available elsewhere in Europe.
• Hospital infection rates may be lower in other European countries.
• Faster treatment may be available elsewhere.

It is worth noting that:

• There is no requirement for the patient to be suffering "undue delay" in treatment.
• The patient will need a referal from a GP.
• Patients cannot jump the waiting list in other countries..... which is one reason why why we will not see large numbers of patients travelling to the UK for treatment. They will join the end of the queue of existing UK patients.
• And since the UK is one of the most expensive healthcare providers in Europe, this will also discourage an inflow of patients from lower cost countries.

How will it affect the NHS?
It depends on how many UK patients opt for treatment abroad. If the NHS can prove that the number could be so large that it would affect the planning and funding of healthcare facilities in the UK, then it can make an application to set up a "Prior Approval" system which means that a patient would have to apply for treatment abroad. This is unlikely, I believe. It would be an admission of failure by the Government that the NHS cannot compete in a competitive European marketplace.

Overall the Directive has to be a good thing for both the NHS and UK patients. It could reduce the burden on NHS waiting lists, and offer cost savings where cheaper treatment is available elsewhere in the EU. It would also mean that NHS hospitals would face increased competition and would have to improve their performance relative to other European healthcare providers.

What else is covered by the Directive?
In addition to clarifying the position regarding medical tourism within the EU, the Directive also embraces:

• The establishment of common principles in terms of guaranteeing patient safety and ensuring quality and continuity of care.
• Stimulating greater European cooperation on healthcare including the establishment of “European Reference Networks” which would create a concentration of expertise, training and resources for specific diseases and health issues.
• Establishment of a European network for the assessment of new medical technology.
• Establishment of standards for e-health, in particular the transfer of patient information and treatment records between member states.

When will it take effect?
It's a draft directive, so it has to go through the EU mechanisms to be officially adopted as policy. But it's a part of a consultation process that's been going on for three years, so it's likely to become reality.

Good news or bad news for the medical tourism industry?
Undoubtedly, good news! It will add to the credibility of medical tourism, and will mean that people become more familiar with and confident about travelling for treatment. It will also reinforce the need for an improvement in standards and business practices in the industry. (See the Treatment Abroad Code of Practice for Medical Tourism).

Ultimately, it will result in greater patient choice and more people will choose to travel for treatment abroad.

For patients seeking treatment now who can't wait until the Directive comes into force, they can download Treatment Abroad's Guide to Medical Tourism or visit Treatment Abroad.

EU Cross-border Healthcare Directive boosts health tourism

The new EU Cross-border Healthcare Directive which is to be announced today intends to lift restrictions on patients travelling for treatment in other EU countries. Patients wishing to travel to other EU countries for medical treatment will be able to reclaim the cost of treatment from the NHS and will only have to pay their travel and accommodation costs, plus any top-up fees if charges in the foreign hospitals are higher than the NHS cost.

The directive could revolutionise the way we experience healthcare in the UK and throughout the rest of Europe. The directive will take the concept of patient choice to a new level. Competition from European hospitals could prompt much needed changes within the NHS. Successive UK governments have made token gestures to introduce market forces within the NHS; ranked 17th out of 29 European countries in the recent Euro Health Consumer Index, the NHS now faces real competition in the European marketplace.

The Directive will provide a framework for cross border healthcare and will deal with issues such as quality of care, patient safety, method of funding and transfer of patient information. There are also plans to introduce "European reference networks" which would bring together medical expertise across Europe and encourage greater collaboaration between centres of excellence.