Irene A. Glinos

Patient mobility in the European Union

Getting healthcare in another European country should be straightforward, but it often creates problems for both patients and healthcare systems

Purchasing health services abroad: practices of cross-border contracting and patient mobility in six European countries.

OBJECTIVES Contracting health services outside the public, statutory health system entails purchasing capacity from domestic non-public providers or from providers abroad. Over the last decade, these practices have made their way into European health systems, brought about by performance-oriented reforms and EU principles of free movement. The aim of the article is to explain the development, functioning, purposes and possible implications of cross-border contracting. METHODS Primary and secondary sources on purchasing from providers abroad have been collected in a systematic way and analysed in a structured frame. RESULTS We found practices in six European countries. The findings suggest that purchasers from benefit-in-kind systems contract capacity abroad when this responds to unmet demand; pressures domestic providers; and/or offers financial advantages, especially where statutory purchasers compete. Providers which receive patients tend to be located in countries where treatment costs are lower and/or where providers compete. The modalities of purchasing and delivering care abroad vary considerably depending on contracts being centralised or direct, the involvement of middlemen, funding and pricing mechanisms, cross-border pathways and volumes of patient flows. CONCLUSIONS The arrangements and concepts which cross-border contracting relies on suggest that statutory health purchasers, under pressure to deliver value for money and striving for cost-efficiency, experiment with new ways of organising health services for their populations.

Worrying about the wrong thing: Patient mobility versus mobility of health care professionals:

Patients and health care professionals in the European Union (EU) benefit from legislation on the freedom of movement between Member States. In relative terms, many more doctors and nurses move within the EU than patients. Despite this, patient mobility has attracted more attention from policy-makers and the public while workforce mobility remains largely ignored. This is paradoxical and imprudent. On the one hand, the scope of patient mobility is narrow and self-limited. On the other hand, current and forecasted health care workforce shortages across the EU, global competition for health care professionals, and current economic pressures are all good reasons to start worrying about the mobility of health care professionals and its implications for health systems.