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•Interoperability is a complex challenge within the healthcare ecosystem.•Transparent policies and appropriate initiatives can accelerate interoperability.•The new EIF offers ...principles and recommendations to guide interoperability in healthcare.•Governance establishes the foundations for sustainability of interoperability initiatives.
Healthcare is a highly regulated domain. Seamless, online access to integrated electronic health records for citizens is still far from becoming a reality. The implementation of personally managed health data systems still needs to overcome several interoperability, usability, ethics, security, and regulatory issues to deliver the envisioned benefits. This paper offers a policy viewpoint on how the new European Interoperability Framework (EIF) may benefit the implementation of eHealth systems for the management of personal health information for citizens. Interoperability facilitates sharing of health and illness experiences, coordinated care and research for citizen empowerment and improved health outcomes. The adoption of principles relevant to core interoperability and generic user needs and expectations, as described in the new EIF, in line with European and national regulations are quite essential for the development of safe and secure patient access services to support mobility. An interoperability framework facilitates the creation of the appropriate context in which personal health record applications can be designed and implemented in support of disease specific solutions, such as chronic non-malignant pain, diabetes and cancer. It is evident that no solution will fit all circumstances. However, the new EIF, when adapted for personally managed health data, provides a useful and relevant framework to facilitate implementation and adoption of personal health record systems within a coordinated care environment. Practical implications of this work relate to the need of multi-disciplinary cooperation and European level compatibility and sustainability of the underlying infrastructures required to support reliable and secure access to and sharing of medical data, as well as the readiness to address continuously evolving functional and non-functional requirements for regional, national, and cross-border settings.
EU citizens' access to social rights has become a contentious issue in the EU in the past decade. This article aims to reverse the North–South perspective on intra‐EU mobility and welfare by shifting ...the research emphasis from the labour‐oriented mobility of young Southern Europeans in Northern Europe to the non‐labour‐motivated mobility of Northern EU citizens in Southern Europe. To do so, this analysis addresses the provision of healthcare assistance regulated by European legislation for European retirees and patients in Spain. The analysis shows that retirement migration has been perceived as a state burden, yet patients' mobility has tended to be seen by the Spanish government as a market opportunity. However, the study also indicates that efforts to deal with these two different types of mobility are embedded in structural constraints that go beyond governments' intentions, which adds a new complexity to the limits of freedom of movement and EU citizenship.
•CBHC collaborations are concentrated on fulfilling local and regional demands for accessible health care.•Diverse picture of collaborations across Europe with no “one size fits it all” ...solutions.•Results confirm the importance of so-called fluid borders for CBHC.•Cultural, historical and geographical ties remain important.•Difficulty to reach sustainability of collaboration beyond EU funding.
Cross-border health care (CBHC) collaborations, using EU funding, may represent a lever for local and regional policymakers by which to balance questions of access and quality of health care against economic concerns in health. An analysis of existing collaborations analyses CHBC against the three core dimensions of European Union health policy: fiscal policy, economic policy, or social cohesion policy. We carried out a literature review and a systematic analysis of online data bases on EU-funded CBHC collaborations for the period 2007–2017. Identified projects were classified as referring to CBHC as an element of either of the three dimensions. Out of 1167 identified projects, 423 EU-funded projects were selected. Projects not primarily concerned with economic concerns (internal market) and fiscal aspects predominate. Results indicate the importance of shared historical ties and geographical proximity for CBHC collaborations. Yet, they also show the need for further mixed methods research to investigate whether EU policies in health are more likely to be in line with the needs of policymakers in member states, if they focus on local and regional demands for high-quality, accessible health care rather than on internal market concerns or fiscal aspects.
To improve our understanding of patients’ needs in cross-border healthcare, with a specific focus on handover.
In this qualitative study, we conducted narrative interviews with 8 patients who had ...experienced cross-border healthcare, including handover. Based on an inductive analysis, we crafted stories representing participants’ perspectives. Crafted stories attend to the personal character of patients’ experiences.
We crafted 3 stories relating patients’ cross-border healthcare pathways. We identified 3 recurring issues in these stories: (1) Patient involvement in the decision-making process regarding their healthcare; (2) Communication with their healthcare providers; and (3) Information throughout the healthcare process.
The said issues, albeit no novelty in healthcare, seem to be amplified by cross-border barriers, such as system, language, and cultural differences. To empower patients to be involved in their own healthcare process, these issues should become a topic of conversation between patients and healthcare professionals.
The patient stories in this article could help raise awareness among professionals and patients about the issues patients face in cross-border healthcare. Awareness is a first step in overcoming these issues.
•Patients in cross-border healthcare experience issues concerning involvement, communication, and information.•Patients and healthcare professionals seem to be unaware of these issues and their possible implications for healthcare.•Deliberate communication efforts and adequate information provision are needed to empower patients in cross-border healthcare.•Patient stories can be used to foster awareness of these issues.
Travel abroad for healthcare has increased rapidly; interventions include organ transplant; cardiac surgery; reproductive care; and joint, cosmetic, and dental procedures. Individuals who receive ...medical care abroad are a vulnerable, sentinel population, who sample the local environment and can carry home unusual and resistant infections, documented in many reports. Medical tourists are at risk for hospital-associated and procedure-related infections as well as for locally endemic infections. Patients may not volunteer details about care abroad, so clinicians must inquire about medical procedures abroad as well as recent travel. Special infection control measures may be warranted. Healthcare abroad is associated with diverse financial, legal, ethical, and health-related issues. We focus on problems the infectious disease clinician may encounter and provide a frame-work for evaluating returned medical tourists with suspected infections. A better system is needed to ensure broad access to high-quality health services, continuity of care, and surveillance for complications.
•Cross-border healthcare has ensured care for citizens throughout the European Union.•European cross-border healthcare has continued during the COVID-19 pandemic.•North American cross-border ...healthcare is rare but need is ever present.•Acting in isolation during COVID-19 Canada and the United States closed the border.•Cross-border healthcare would be beneficial for North America.
Cross-border healthcare is an international agreement for the provision of out of country healthcare for citizens of partnered countries. The European Union (EU) has established itself as a world leader in cross-border healthcare. During the Coronavirus disease of 2019 (COVID-19) pandemic, the EU used this system to maximize utilization of resources. Countries with capacity accepted critically ill patients from overwhelmed nations, borders remained open to healthcare workers and those seeking medical care in an effort to share the burden of this pandemic. Significant research into the challenges and successes of cross-border healthcare was completed prior to COVID-19, which demonstrated significant benefit for patients.
In North America, the response to the COVID-19 crisis has been more isolationist. The Canada-United States border has been closed and bans placed on healthcare workers crossing the border for work. Prior to COVID-19, cross-border healthcare was rare in North America despite its need. We reviewed the literature surrounding cross-border healthcare in the EU, as well as the need for a similar system in North America. We found the EU cross-border healthcare agreements are generally mutually beneficial for participating countries. The North American literature suggested a cross-border healthcare system is feasible. A number of challenges could be identified based on the EU experience. A prior agreement may have been beneficial during the COVID-19 crisis as many Canadian healthcare institutions-maintained capacity to accept critically ill patients.
•Decentralized healthcare systems structure territorial borders within countries, fostering internal cross-border healthcare.•Historical, financial and political factors shape policy-makers’ ...engagement in cross-border healthcare.•Cross-border healthcare arrangements may become an arena for partisan competition.•Political and financial tensions hamper articulating effective responses to patient mobility in Spain.
Cross-border patient mobility has become a topic of increasing interest for policy-makers and academic scholars. However, the focus on international dynamics hinders the fact that healthcare mobility takes place within national boundaries as well, particularly in countries characterized by decentralized health systems. This paper shifts the focus from the drivers of international patient mobility to the ones of policy-making on patient mobility within national borders, analyzing more than fifty policy arrangements adopted between Spanish Regions in the period 2000-2020. As the findings indicate, geographical/historical, economic and political factors are key to understanding the development of cross-border healthcare agreements, as well as the conflicts that may arise therefrom. Accordingly, these arrangements may become a controversial issue and a key arena for partisan competition, affecting the articulation of effective responses to patient mobility in Spain and, ultimately, patients’ rights.
•ATMPs can face challenges with patient access.•Payers and regulators were interviewed to evaluate new access pathways for ATMPs.•EU cross-border access opportunities could streamline patient access ...to ATMPs.
To investigate the viability of several cross-border access opportunities to streamline patient access to advanced therapy medicinal products (ATMPs) in the context of the new Regulation on Health Technology assessment (HTA). The regulation, proposed by the European Commission and adopted in December 2021strongly advocates joint European collaboration to make innovative, life-changing therapies, such as ATMPs, more widely available to patients in Europe. ATMPsoffer ground-breaking new opportunities for the treatment of various diseases. However, healthcare systems are often required to undergo significant adaptation in terms of infrastructure development, adoption of new legislation or implementation of alternative reimbursement solutions before access to patients can be granted. This calls for new cross-border access pathways to streamline access, especially in non-EU4+UK countries.
Desk research and 60-minute interviews with regulatory and payer experts were conducted to evaluate new access pathways for ATMPs.
Some pathways, such as cross country collaborations (e.g. joint treatment centers) have the potential to provide long-term access to ATMPs. However, several important challenges were identified that currently prevent cross-border access from being viable options for routine access to ATMPs, especially for SMEs.
Through open communication and collaboration between manufacturers, payers and policy makers to overcome challenges associated with currently available access pathways for ATMPs, cross-border solutions could represent real opportunities for manufacturers, including SMEs, to expedite reimbursed patient access to ATMPs.
In December 2021, a new regulation was adopted on a European level to promote cross-European collaboration to make innovative treatments more widely available to patients. Making sure patients have access to innovative, potentially life-changing, treatments is associated with many challenges. As a result, patients, especially those who live outside of the four biggest countries in the European Union (EU), also known as the EU4: (France, Germany, Italy and Spain) and the UK where the necessary infrastructure is often lacking, can experience difficulty accessing the innovative treatments they need. We conducted interviews with experts (payers and regulators) to evaluate new pathways to make sure (non-EU4 + UK) patients get better access to innovative therapies. Collaboration and open communication between countries, manufacturers, payers and regulators presents a viable way of achieving this.
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