Cross-Border Healthcare Purchasing

1
Cross-Border HealthcarePurchasing Provision

• Dr. John M. CACHIA MD MSc FFPH
• Department of Institutional Health
• MALTA

2
The Agenda of the Working Group

• Financial impact and sustainability of
  cross-border care
• A framework for cross-border healthcare
  purchasing
• The reasons for patient mobility
• Information to patients on quality, safety, and
  continuity of care
• Rights and responsibilities
• Liability issues

3
Work plan deliverables for 2005

• Framework providing guidelines for purchasing
• Mechanisms for patient information
• Legal certainty on liability issues
• The financial impact of mobility
• The motivation for patient movement across
  borders
• The need for treatment purchase by institutions

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Guidelines for Purchasing

• Non-legally binding guidelines for health care
  authorities, providers and purchasers
• Target is health care purchasing that is not
  covered by social security coordination
• Contiguous not overlapping
• General guiding principles setting out common
  elements in national and EU law
• Indicative list of elements that can be included
  in a purchasing contract

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Legal issues requiring clarification(1)

• Which legal framework to be applied?...of the
  sending state or of the receiving state?
• Liability rules which apply? What if care starts
  in one state and continues in another? How does
  this change in NHS and tax-based systems?
• Legal rules to apply concerning transfer of
  information?
• Administrative data vs. clinical data?

6
Legal issues requiring clarification(2)

• Can MS prioritise in favour of their citizens?
  Valid criteria for prioritisation?
• Price setting can there be higher fees for
  patients from other MS? Is unequal price
  justifiable?
• Are there any principles that could cause
  confusion with application of 1408/71?
• Can guidelines be applied to care based on
  internal market rules?

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Specific contracting guidelines(1)

• Types of medical treatment covered
• Patients to be covered
• Duration of contract and renewal
• Information exchange between contractor and
  purchaser admission, treatment, follow-up,
  complications, malpractice
• Information exchange between contractor and
  patient admission, treatment, travel, language,
  financing, relatives

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Specific contracting guidelines(2)

• Care pathways and responsible persons
• Contact points and information flow
• Financial arrangements payment terms, payment
  calculation, charges to be paid by patient
• Administrative arrangements medical records,
  process of care, authorisations
• Review and updating

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Patients rights and responsibilities

• Information to patients on quality, safety and
  continuity of care in their own state and in
  other MS
• Identify good information systems
• Identify information gaps
• Bring together experts from Commission-supported
  programmes
• Develop a procedure on how patients can obtain
  information

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Finance and motivation of mobility

• Impact for sending and receiving states
• Financial sustainability of health care systems
  involved
• Collaboration with relevant stakeholders
• Reasons for mobility
• Present and future needs for purchase of
  treatment
• Mechanism to gather and disseminate information
  and data on mobility

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Conference of experts

• Main Foci
• Legal issues
• Financial aspects
• Main Objectives
• To present current projects
• To assess examples of best practice
• To exchange knowledge
• To determine further research requirements
• To enhance network of experts working on
  cross-border healthcare issues

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Conclusion
WORK IN PROGRESS