EU kicks off debate on health consumer 'choice'

Patients should be able to shop around for medical provision from across the EU, the European commission has urged while beginning a debate on the future of healthcare.

European health commissioner Markos Kyprianou has published proposals aimed at firming up “patient rights” based on consumer case law from the EU courts.

His proposals will launch a fierce debate on market liberalisation and public state provision after Brussels initially dropped healthcare from the controversial EU services directive.

“The healthcare that patients need is sometimes best provided in another EU country,” he said on Tuesday.

“A clear, practical framework is needed to enable patients to and those who pay for, provide and regulate health services to take advantage of cross-border healthcare where that is the best solution.”

“This will also help to unlock huge potential for European cooperation to help improve efficiency and effectiveness of all EU health systems.”

Key issues to resolve will be the conditions under which an EU citizen can seek medical care abroad with the bill picked up by national health services or insurance schemes.

How healthcare will be authorised and paid for will raise vexed issues of waiting list targets and huge possible profits for private health providers.

Many EU member states, political parties and trade unions have argued that medical services should fall outside the scope of Europe’s single market in the public interest.

But EU judges have decided that, public or private, all health provision should be judged under internal market rules, with a series of rulings allowing “patient mobility” since 1998.

A May 2006 ruling allowed a UK woman, Yvonne Watts, to jump a one year queue in the state run British National Health Service to get a hip operation in France.

Along the lines of court judgments, Kyprianou is proposing patients will only be able to travel for treatment at the same price as the same procedure carried out in their home country.

The Luxembourg court ruled that “undue delay” from national healthcare providers should entitle consumers to go to other EU countries – with their home country health schemes picking up the bill.

While open markets in health services may bring consumer choice and boost economic growth there are concerns on the impact on public budgets for medical care.

Countries with the longest waiting lists – and stretched resources – could find themselves facing substantial reimbursement costs as patients travel abroad for quicker treatment.

EU health spending is a lucrative plum from the private sector, worth 7.7 per cent of GDP in 2003 the market grew 10 per cent in the three years after 2000.

The commissioner also envisages internet technology allowing “e-health” consultations with doctors – without the patient or provider leaving their home territory.

The commission initially proposed including health within the scope of the services directive, but the European parliament squashed the proposal back in February, forcing the latest rethink.

The greatest legal certainty for the EU would probably come from a new European directive on health services, since this would be binding on each member state.

But with standards of care differing widely, in an EU soon to include Romania and Bulgaria, alarm bells will ring over “health tourists” straining healthcare provision in Europe’s medical care leaders.

Member states also have a wide range of views on issues such as professional qualifications, patient rights and hospital safety, all of which could spark a repeat of the protests that dogged the wider services proposal.

The commission is set make policy proposals following a consultation throughout September, Europe's health ministers are expected to discuss the issue "before the end of the year".

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