The European Union still has work to do before it has real interconnected health care. This is the conclusion of the European Court of Auditors in a report published on Tuesday 4 June, entitled 'EU actions for cross-border healthcare: significant ambitions but improved management required'.
Overall, the Court is relatively disappointed with the impact of the Directive and the Regulation on this matter. It concludes that there is a scarcity of knowledge of the possibilities offered by the EU, a limited exchange of health data and too few actions in terms of cooperation on rare diseases.
While the report begins by directly pointing out that health is a national competence and that the EU's mission is limited to complementing the action of the Member States, it highlights two tools that are supposed to enable Europeans to seek treatment abroad: Regulation 883/2004, which covers treatments not scheduled abroad, and Directive 2011/24/EU, which covers scheduled treatments. These two texts allow patients to be reimbursed for medical care received in another Member State.
Two interesting trends
Overall, the Court of Auditors' analysis highlights two trends: on the one hand, the use of cross-border healthcare varies greatly from one Member State to another and, on the other hand, there is a gap between the Commission's announcements in respect to health data exchanges and actions on the ground.
As regards the use of healthcare, the Court shows that this is far from the medical tourism feared by some Member States at the time of the adoption of the Directive: less than 0.05% of European citizens are receiving planned healthcare abroad, or 213,096 people in 2016. However, French patients represent nearly two thirds of this figure (146,054 people). Followed by Danish (25,343 people) and Finnish (11,427 people) patients. The countries of destination are mainly Spain, Portugal and Belgium.
The other interesting trend is the Commission's announcements in respect to health data exchanges. "In December 2017 the Commission announced that in 2018, 12 EU Member States will start exchanging patient data on a regular basis. By the time of our audit (November 2018), exchanges of patients’ health data electronically across borders had only started", notes the report, which concludes that the Commission underestimated the difficulties inherent in deploying the eHealth Digital Service Infrastructure (eHDSI) and was too optimistic about the results. Since then, two countries have enrolled in this service: since the beginning of the year, Finland has been making its electronic prescriptions available abroad, while Estonia recognises prescriptions from other European countries (see EUROPE 12176/30).
Recommendations
The Court of Auditors concludes its report with three recommendations: (1) provide more support for National Contact Points to improve information on patients' rights of access to cross-border care; (2) better prepare for cross-border exchanges of health data; (3) improve support and management of European Reference Networks to facilitate rare disease patients’ access to healthcare.
Report available in 23 languages at: https://bit.ly/2WdrDqg (Original version in French by Sophie Petitjean)