Cross-border healthcare in the EU (movement of services and/ or patients) Reinhard Busse

Transkript

1 Cross-border healthcare in the EU (movement of services and/ or patients) Reinhard Busse

2 Patient mobility HOW MANY? Country A WHY? Country B Benefit Package A using Service Taxonomy A and Fee Schedule A Accessibility A x Quality of service A x Benefit Package B using Service Taxonomy B and Fee Schedule B Accessibility B x Quality of service B x WHICH SERVICES? WHAT COSTS? (SERVICES x REIMBURSEMENT)

3 Europabefragung 2012 Angeschrieben: TK-Versicherte die 2010 geplante und/oder ungeplante Behandlungen im EU-Ausland hatten (abgerechnet durch die TK) EU-Ausland: Länder, für die 1408/71 gilt (EU-Mitgliedsstaaten, Staaten des Europäischen Wirtschaftsraumes (EWR), d.h. Norwegen, Island Liechtenstein sowie Schweiz) Rücklaufquote 41%, davon gültige Fragebögen analysiert Geplante EU-Auslandsbehandlungen: n = 3307 (19%) Special Eurobarometer 425 (Oktober 2014)

4 How many?

5 Größenordnung des Phänomens 4% in 2007 Source: Eurobarometer 425 (2014)

6 Zielländer Deutschland

7 Zielländer Deutschland - Zahnbehandlungen

8 Would you be willing to travel to another EU country to receive medical treatment? 2007 YES NO DK/NA 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% EU15 satisfied with healthcare at 44home Mainly for treatments not available at home, quicker access and better quality NMS concerned about financial impact Estonia & Finland: >60% NO % CY MT Cyprus & Malta: >80% YES IE DK NL LU PT EL SI ES IT SE PL RO UK EU15 EU27 BE NMS12 Source: Eurobarometer 210 (2007) SK BG HU AT CZ DE LT FR LV EE FI

9 and 2014 Malta, Netherlands & Cyprus: >66% YES Source: Eurobarometer 425 (2014) Finland: 70% NO

10 Bereitschaft und Erfahrung Würden Sie sich wieder geplant im EU-Ausland behandeln lassen? (n = 3029) 4% 1% 22% Bestimmt Eher ja Eher nein Definitiv nicht 73%

11 Why? (And why not?)

12 People s readiness to travel for care Push factors (why people go) Pull factors (why people don t go) Availability of treatment Timeliness (waiting lists) Quality and safety Provider s reputation Affordability Responsiveness Information Increased mobility No need felt Language and cultural barriers Financial cost Administrative complexity Legal uncertainty Lack of information Lack of trust

13 Warum ins Ausland? (projiziert)

14 Warum ins Ausland? Europabefragung

15 Maltese patients treated in the UK Source: Azzopardi Muscat, Cacchia and Xuereb in Patient mobility in the EU (OBS, 2006) Limited size (400,000 inh.) and medical capacity, traditional links with UK (language, doctors training) Overseas treatment programme based on bilateral agreement Treatment Abroad Advisory Committee defines types of care (high cost, low volume) Referral to specific NHS reference centres NHS specialists visits to Malta for pre- and post-op consulting

16 Dutch insurers contracting with Belgian hospitals Fluid border (shared language, culture) Motivations Competing Dutch insurers (lower prices, waiting lists, selective contracting) Competing Belgian providers (oversupply, fee for service) In Flanders: 89% of foreign hospital patients are Dutch Middleman: Belgian sickness fund Control of billing Building international networks

17 Veneto region monthly hospital admission of EU citizens 0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec LHA 10 Western Veneto LHA 12 Veniziana LHA 22 Bussolengo Source: Scaramagli, Daron et al 2006

18 Warum NICHT ins Ausland?

19 Which services?

20 Welche Behandlungen?

21 What is the money spent on? Ratios vs. overall expenditure (Germany 2002) Eye diseases 3.2 Ear diseases 3.0 Infections 2.0 Injuries 1.3 Psychiatric diseases 0.4 Pregnancy/ birth 0.4 Cancer x as often as within country 1/3x as often as within country

22 Role of price differentials? The first nine patients sent to France by the English NHS (not shown: the 40 journalists who accompanied them) 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 Cataract Hip Knee NHS UK private France ARE THESE Comparing DATA prices REALISTIC? ARE THEY REPRESENTATIVE? HOW CAN THE DIFFERENCE BY EXPLAINED?

23 10.000, , , , , , , , , ,00 0,00 Hip Appendectomy Stroke AMI Denmark England France Germany Hungary Italy Netherlands Poland Source: HealthBASKET country reports (2007); *Data for stroke vignette in Hungary, Italy and Poland not available at the time of writing. Figure 4.1: Differences in reimbursement level (price) for selected case vignettes

24 Vorabgenehmigung/Kostenvoranschlag Hatten Sie vor der letzten EU- Auslandsbehandlung einen Kostenvoranschlag bei der TK eingereicht? (n= 2867) Ja 26% Nein 74%

25 Erstattung? Sind weitere Kosten von einer Versicherung übernommen worden? (n = 15098) Ungeplant Ja Nein Geplant 0,0 20,0 40,0 60,0 80,0 100,0

26 Erstattung? Wie viel hat die Versicherung jeweils gezahlt? 0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0 80,0 TK (über nachträgliche Kostenerstattung) TK (direkt über Versichertenkarte Private Zusatzversicherung Andere Nichts Weniger als ich Mehr als ich Alles

27 Kosten für die Patienten - Europabefragung Wieviel haben Sie für Behandlung und Zuzahlungen am Ende der Abrechnung tatsächlich bezahlt? Welche Zuzahlungen haben Sie für Behandlung und Zuzahlungen am Ende der Abrechnung tatsächlich bezahlt? Minimum 0 0 Maximum Median Modalwert Perzentile Perzentile Perzentile Perzentile Perzentile Gültig Fehlend

28 Knowledge and information

29 Berechtigungswahrnehmung - Eurobarometer Source: Eurobarometer 425 (2014)

30 Berechtigungswahrnehmung - Europabefragung Ist Ihnen bekannt, dass Sie einen Anspruch auf EU-Auslandsbehandlungen haben? 0% 10% 20% 30% 40% 50% 60% Nein Ja, bei ungeplanten Not- und Akutbehandlungen Geplant Ungeplant Ja, bei allen ambulanten Behandlungen Ja, bei allen Behandlungen

31 Information über Leistungskatalog und Nationale Kontaktstellen

32 Information Wo? (projiziert)

33 Information Wo? Europabefragung 0% 10% 20% 30% 40% 50% 60% 70% 80% TK customer service Friends or Family TK hotline GP or specialist at home Travel agency Hotel at destination Other websites Overall Inpatient hospital care (3 highest, 4 lowest) Balneotherapy, inpatient (3 highest, 3 lowest) Dental care (2 highest, 1 lowest) GP services (1 highest,1 lowest) Specialist care (1 highest, 1 lowest) Outpatient hospital care (0 highest, 1 lowest) Balneotherapy, outpatient (0 highest, 0 lowest) TK website Newspaper/Journal TK travel hotline

34 Information Was? (projiziert)

35 Information Was? (Europabefragung) 0% 10% 20% 30% 40% 50% 60% 70% 80% Share of costs carried by insurance Entitlement to services abroad Reimbursement modalities Saving opportunities Combining treatment with vacation Equipment in facility of treatment Medical quality of services in the EU Services available abroad Experience of other patients Staff language skills Qualifications of treating physician Overall GP services (2 highest, 6 lowest) Dental care (6 highest, 1 lowest) Inpatient hospital care (3 highest, 3 lowest) Balneotherapy, inpatient (2 highest, 2 lowest) Balneotherapy, outpatient (1 highest, 1 lowest) Specialist care (1 highest, 1 lowest) Outpatient hospital care (0 highest, 1 lowest) Waiting times in country of treatment Payment modalities abroad Risk of treatment abroad Other elements

36 36

37 Suchbegriff Osteoarthritis 37