With a growing trend for treating people outside their own country, ‘patient choice’ is being touted by the EU as a solution to national problems…
Healthcare tourism is not the answer
WORKERS, FEBRUARY 2009 ISSUE
Is health-care tourism to replace adequate healthcare provision? There has been much in the news recently about what is becoming known as cross-border health care – the growing trend for people to be treated in a country other than their own.
Not only has the tabloid press spotted the issue, but the European Commission is proposing a directive on “the application of patients’ rights in cross-border health care”. At present the House of Lords Select Committee on the European Union is looking at this directive and Britain’s largest health care trade union, Unison, has sent in its own response.
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One of the first things this response does is to put the issue into context. At present the number of people actually receiving care abroad is at very low levels; the EU’s own figures confirm that only 4 per cent of Europeans received medical treatment in another member state of the EU in the year before June 2007. But the directive is explicit in its desire to go beyond what it describes as patients’ rights. Article One of the directive states that it “establishes a general framework for the provisions of cross border health care” and there are repeated references to the “international market for cross border health care”.
Within the directive the patient has the right to reimbursement of costs and treatment abroad regardless of the types of provider of that treatment, public or private. This brings up what Unison describes as “the ugly prospect of the UK’s publicly funded NHS having to reimburse private providers in foreign countries”. It has even been suggested that this could lead to private European health providers being given a place on the NHS “choose and book” system (“choose and book” is the NHS method of booking appointments in primary and secondary health care).
Encouraging private providers
Unison notes in its submission that this market, should it develop, will have the hallmark of those markets already established in health care. These encourage private healthcare providers to choose to treat the most profitable patients and conditions, rather as is the case in America, but to ignore other more problematic and unprofitable ones.
As is usually the case, the coverage this matter has received has not been especially profound in the British media. The fact that people will have to pay up front, and then claim back health care costs, will mean that only those rich enough to stump up the cash in the first place will be able to participate.
Also, the directive makes provision only for the reclaiming of the cost in the patient’s own country, making it unlikely that patients in poorer countries will be able to gain much in coming to countries such as France and Britain whose health care systems, while excellent, are more expensive than say Bulgaria’s or Latvia’s.
There are myriad additional administrative problems associated with the cost of travel, the length of overnight stays, the acceptability or otherwise of prescriptions, and the culpability of individual health care professionals.
The bottom line is that this directive is not to do with enhancing or improving the health care that is available to workers in Europe’s various countries.
As Unison concludes in its submission to the House of Lords Committee looking at this matter, “Unison believes that far from its stated desire of reducing inequality, the directive would do precisely the opposite as it seeks to further the expansion of European health care markets under the guise of boosting patient choice. Furthermore, the directive is unrealistic and if implemented would have a detrimental impact on the NHS. The directive is also a missed opportunity to assert the fundamental right of patients to receive health care within Europe.”
Quelle surprise!