Intra-European medical travel remains minor: a commentary in response to ‘Hermesse J, Lewalle H, Palm W. Patient mobility within the European Union. Eur J of Public Health. 1997’ Free

Given the rapid integration of EU Member States and current debate on patient mobility in the EU, one would expect a significant amount of intra-European medical travel. The available data, however, reveals relatively low cross-border healthcare throughout EU history. In 2006, the Observatoire Social Européen in Brussels found that the overall numbers of medical travel in Europe remained ‘minor’. Medical travel seemed the result of specific circumstances such as waiting times or national bioethical legislations, and were endemic to certain areas and contexts such as tourist areas and border regions.¹ Later, in 2008, the European Commission stated that cross-border healthcare was responsible for (only) 1% of public expenditure on healthcare² involving an expenditure of US$13.5 billion (Forbes, 2009).³

In Germany, a survey by one of the largest health insurances, ‘Techniker Krankenkasse’, with over 7 million insured, found that its members were actually quite mobile but only 2–5% of those needed healthcare, and whose costs represented <0.5% of their overall expenditure.⁴ According to ‘Zorgverzekeraars Nederland’, the sector organization representing the Dutch providers of healthcare, 1% of medical care for the Dutch takes place abroad ‘consciously’. Medical travel out off the Netherlands increased between 2001 and 2005 but has stagnated ever since.⁵

Mr Westerwoudt, spokesperson of Centraal Ziekenfonds (‘CZ’), third largest Dutch health insurance with over 3 million insured, was also quoted recently as saying ‘Medical travel is dead’ and ‘Financial crisis or not, we never really believed in it’. In addition, whatever medical travel still happens, happens in border areas. ‘CZ’ states that 90% of Dutch medical travellers go to border areas in Belgium (8000 people per year) and Germany (2000 people per year). According to ‘CZ’, these numbers have been steady for the past years and will remain so.⁶ Belgium’s national healthcare institution confirms with 16 500 medical travellers in 2006 coming to Belgium of which 10 000 Dutch, 3000 Luxemburgish and 1600 Italians.⁷ In the UK, an estimated 50 000 people per year were travelling from the UK to other European countries for health reasons.⁸

European researchers were able to describe these patient flows in Europe in relation to their predominant motivations.

Patient mobility due to availability shortcomings (waiting lists, lack of competence or lack of capacity):

• Denmark–EU

• Norway–EU

• Europe–Sweden

• Malta–the UK

• UK NHS patients–Germany/France/Belgium

• Republic of Ireland–Northern Ireland/UK

• Spain–Portugal

Patient mobility due to differences in prices or co-payments:

• Germany/Denmark/the UK–Poland

• Austria (etc.)–Hungary (etc.)

• Austria/Italy–Slovenia

• Finland/Sweden–Estonia

Patient mobility due to perceived lower quality and dissatisfaction with the system:

• Italy

• Greece

• Bulgaria/Romania (etc.)

Despite the overall low number of medical travel, European healthcare providers and policy makers are increasingly cooperating in cross-border healthcare. German health insurances have agreed on contracts with providers in tourist areas such as Mallorca in Spain and the largest Dutch healthcare insurance group UVIT recently signed agreements with over 30 German hospitals and clinics.⁹

EU citizens themselves also brought a series of cases to the European Court of Justice (ECJ) seeking to assert rights to reimbursement. (In the ‘Decker’ case for example, Mr Decker was refused reimbursement for spectacles bought across the border in Belgium using a prescription issued in Luxembourg.) The ECJ, however, has consistently ruled in favour of reimbursement for similar healthcare received abroad. The European Commission later on adopted a proposal end of 2008 for a directive on patients’ rights in cross-border healthcare (CEC, 2008a). Given the current imbalance between supply and demand of healthcare in between EU Member States, this directive may further increase patient mobility, benefiting both patients and providers alike.

Acknowledgements

I am grateful to Rita Baeten (Observatoire Social Européen) and Regina Herzlinger (Harvard Business School) for their feedback on the commentary above.

Conflicts of interest: None declared.

References