The following is the text of the Treatment Abroad response to the Consultation on the European Commission’s proposals for a Directive on the application of patients’ rights in cross-border healthcare.
The full text can be downloaded as a pdf at the bottom of this page. There is also a pdf of the response submitted by the International Medical Travel Association (which we helped to prepare.)
Background on the propsals can be found on the Europa web site.
1) Common principles in all EU health systems
1. What role (if any) should the Commission have in setting standards for crossborder healthcare?
It should be the role of the Commission to ensure that the various pan-European healthcare organisations already in existence work together to agree minimum standards for cross border healthcare. Once these are agreed, then, we believe it is the Commission’s role to ensure that these standards are monitored and maintained.
2) Use of healthcare in another Member State
2. Could there be clinical grounds on which commissioners should be able to refuse to authorise NHS patients going to another EU Member State?
The only clinical grounds for refusal would be related to:
Whether the patient is fit to travel.
Whether the surgery or treatment for which the patient wishes to travel has been recommended by a UK medical professional.
And is available within the UK within the NHS system.
The driver should be patient choice. If the patient elects for treatment in another country and the cost of that treatment is no higher than in the UK, then it should be their absolute right to select that option, as it is already, in terms of patient choice within the UK. If the healthcare commissioner has concerns about the quality of treatment offered by a healthcare provider in another state, then they may raise that concern with the patient, but ultimately, it is the patient’s decision.
3. How can the UK Government ensure that these proposals do not adversely affect the NHS’s ability to plan and manage services (including the ability to retain appropriate ‘Gatekeeping’ arrangements)?
The UK Government can ensure that these proposals do not adversely affect the NHS’s ability to plan and manage services by ensuring that the NHS is competitive within Europe in terms of quality of care, treatment outcomes and access to treatment.
The EU Directive to some extent creates a European market in healthcare. This should be a significant driver for NHS providers to ensure that the care that the patient demands is available locally or within the UK. There is also the incentive for the NHS to outperform European healthcare systems and thus become a preferred destination for patients in other European states.
The number of patients who opt for treatment elsewhere is unlikely to be a significant proportion of NHS patient throughput. Therefore, it is unlikely to have any significant impact on the ability to plan and manage services within the UK in the medium to long term.
If there are specific areas either geographical or within a medical specialism where significant numbers of patients start opting for treatment in another state, then this would be a driver for the NHS to fix the shortcomings in existing provision.
The GP or UK specialist will continue to be the Gatekeeper.
Should prior authorisation schemes be the norm rather than the exception?
There is a requirement for prior authorisation based on the following criteria:
The patient has been assessed by a UK specialist and the treatment/operation is appropriate.
·The patient has a right to that treatment in the UK. It is not a treatment which is available outside of the UK, but not within the UK.
The cost of the treatment or operation abroad is no greater than the NHS tariff price.
The patient is fit for travel.
4. Do you believe the Commission or Member States are best placed to set the list of treatments that are included in the definition of ‘hospital care’?
The Commission should establish a list of treatments that are included in the definition. The list should apply to all states. This will require some negotiation with member States, however there should be a master list of treatments and procedures maintained by the Commission.
5. How can the NHS ensure that patients coming from other Member States are treated in a non-discriminatory fashion that protects clinical prioritisation and does not lead to a detrimental effect on UK patients?
This is no different to the problem presented by the introduction of nationwide patient choice. How does the NHS ensure that patients from a different part of the country are treated in a non-discriminatory fashion?
Patients from other EU states would be treated in the same way.
6. Comments are invited on the likely volume of patients who may wish to access cross-border healthcare and the treatments they may wish to obtain, in a context of prior authorisation for hospital care.
The research undertaken by Treatment Abroad into medical travel estimates that the current annual volume of self pay UK “medical tourists” is around 80,000 to 100,000 pa.
Around 40% of these patients are dental patients, and another 25% are undergoing cosmetic surgery abroad. The remaining 35% consist mainly of patients who would otherwise have undergone elective surgery in the NHS or in the UK private sector. So, the current annual volume of self pay medical travellers is around 30,000.
If we assume that there are around 4.5 million elective waiting list (non-emergency) episodes each year (Source: Hospital Episode Statistics), then the likely numbers travelling for treatment might be as follows:
Uptake of overseas treatment | No of patients pa |
1.0% of patients opt for overseas treatment | 45,000 |
2.5% of patients opt for overseas treatment | 112,500 |
5.0 % of patients opt for overseas treatment | 225,000 |
7.5% of patients opt for overseas treatment | 337,500 |
10.0% of patients opt for overseas treatment | 450,000 |
Our view is that uptake will be low in the first year, perhaps around the 45,000 to 60,000 patients pa level.
However, as the practice becomes more widely accepted, then this might rise to around 100,000 to 150,000 patients pa.
7. What information, and presented in what format(s), do you think patients need to make an informed decision on receiving treatment in another EU Member State?
The information will need to incorporate:
Information on how the scheme works, what the patient’s rights are and how they access treatment in another state.
Information on the prior authorisation process.
Access to information on hospitals in other Member States that enables patients to research facilities and make comparisons. We do not envisage that the NHS will provide a comprehensive database of hospital facilities in other member states. However, there may be a role for commercial organisations such as ourselves to provide access to such a system. This might incorporate data on hospitals in other states in terms of:
Information for other states on the process for accreditation of hospitals.
Information for other states on the training and qualification of doctors.
The likely additional costs in terms of travel and accommodation for themselves and their accompanying partner.
Any additional risks which are implied by opting to travel to another state for treatment.
The requirement for additional travel insurance to cover medical travel.
Format of information
The primary resource for provision of this information would be on the web. The web would be the main information/data store for all resources relevant to the system. This resource should of course fulfil the usual accessibility requirements.
Edited extracts of the web based information should be used to provide printed materials for patients. These should be produced in multiple languages and distributed subject to local population profile via the local PCT’s and NHS facilities.
8. Where should NHS national contact points be located, should they only be required to provide information about patient rights/entitlements and the home system, and how might they make use of existing resources?
There will need to be one designated contact point within each Primary Care Trust.
There will need to be an NHS national contact point. Location is irrelevant.
They should be required to provide access to information as described above.
We are not qualified to comment on how this should be integrated with existing NHS resources.
A central national resource could be operated by a sub-contracted commercial partner with relevant experience in the medical travel sector. Obviously, if this is a possibility, we would welcome the opportunity to discuss cooperation.
3) Co-operation on healthcare
9. Is an EU prescription template feasible and what would it look like? What advantages and disadvantages could there be to this?
We are not qualified to comment on how the prescription system might be operated.
10. How do you think the European reference networks and proposed health technology assessment network might best add value to the UK?
We believe the establishment of European Reference Networks is an excellent idea, particularly for rare diseases. Ideally, these Networks should incorporate a primary location for treatment and should be linked to pan European national centres using telemedicine.
As an example, there are particular types of childhood sarcomas which affect only 50 children in each State per year. Establishing a central point of research and expertise, and pooling both resources and skills for these would be extremely beneficial in terms of quality of care and outcomes.
The NHS should see the establishment of European Reference Networks as an opportunity, and should develop a strategy to ensure that the UK becomes the “hub” of a significant number of European Reference Networks.
We are not qualified to comment on how the technology assessment system might be operated.
11. The draft Directive proposes that the EU plays a greater role in setting required standards in data collection and e-health (including health record systems and e-prescriptions). Would this add value and what impact might this have on current UK systems?
We are not qualified to comment on data collection and e-health.
4) Other questions on the impact of the draft Directive
12. What are the implications of the draft Directive for private insurance schemes and private providers?
Given that the Directive will apply to insurance based health systems in other member States, then there is no reason why it should not also impact on UK based private health insurance. Thus, if an insured patient requires an operation, then he or she would have the right to opt for treatment elsewhere in the EU, provided that the cost of treatment is no higher than the tariff that would normally be paid by the insurer to a UK healthcare provider.
There are implications for the private healthcare sector in terms of:
Loss of patient throughput, as waiting list patients seek more rapid treatment overseas.
Loss of patient throughput, as insured patients seek more rapid treatment overseas.
Acquisition of patients funded by insurance schemes in other Member States.
13. What proportionate measures can we take so that all patients, regardless of age, race or ethnicity, disability, religion or belief, gender, sexual orientation or socio-economic status feel a) reassured they will be treated with respect and their specific needs considered b) they are fully informed to make the right choice for them?
Information will need to be published in multi-language versions.
There should be no requirement on hospitals in Member States to cater for the ethnicity of patients from outside of their normal catchment area.
Patients from ethnic backgrounds will need to be advised that hospitals in other Member States may not be able to cater for their specific requirements in terms of language, and diet.
14. To what extent do you think that these proposals will have a positive or an adverse impact on equity? What can be done to manage any adverse impact?
By extending patient choice and access to healthcare, these proposals should have a positive impact on equity. Some people may be more adept at taking advantage of extended choice, but that is the nature of the patient population.
We are not qualified to comment on how the NHS should deal with any negative impact on equity.
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