Rare diseases, are defined by the European Union as life-threatening or chronically debilitating diseases with low prevalence (less than 5 per 10,000). The specificities of rare diseases - limited ...number of patients and scarcity of relevant knowledge and expertise - single them out as a unique domain of very high European added-value.The legal instruments at the disposal of the European Union, in terms of the Article 168 of the Treaties, are very limited. However a combination of instruments using the research and the pharmaceutical legal basis and an intensive and creative use of funding from the Health Programmes has permitted to create a solid basis that Member States have considered enough to put rare diseases in a privileged position in the health agenda.The adoption of the Commission Communication, in November 2008, and of the Council Recommendation, in June 2009, and in 2011 the adoption of the Directive on Cross-border healthcare., have created an operational framework to act in the field of rare disease with European coordination in several areas (classification and codification, European Reference Networks, orphan medicinal products, the Commission expert group on rare diseases, etc.).Rare diseases is an area with high and practical potential for the European cooperation.
This study reviews national-level policies regulating cross-border healthcare in mainland China after it acceded to the World Trade Organization (WTO). Policy documents from official websites of the ...State Council and 19 ministries were screened, from which 487 policy documents were analyzed. WTO's five modes of trade and WHO's six building blocks of healthcare system were used to guide the analysis of policymaking patterns, charting of policy evolution process, identification of key policy areas, differentiation of 29 detailed policy themes, and identification of major countries/regions involved in cross-border healthcare. The findings lead to four policy recommendations: (1) to establish a national-level committee to govern cross-border healthcare, (2) to build an information system to comprehensively integrate various information on cross-border healthcare consumption and provision, (3) to take more proactive policy actions in healthcare internationalization, and (4) to carry out reform experiments in key sub-national regions to fully explore various possibilities in developing and regulating cross-border healthcare.
In line with the genuine spirit of scientific research, notably cultivating discussion, we make some reflections on the article of Stan et al. The main purpose of our commentary is to nuance but also ...to refute some of their observations and conclusions. First, the original purpose of both the European Health Insurance Card (EHIC) and of the European legal framework it forms part of seem to have been overlooked. Therefore, we argue that the assumption made by the authors, which served as the basis of the article, namely the European legislature’s promise the EHIC would contribute to European social integration, is erroneous. Second, we argue that there is insufficient evidence that the EHIC would amplify social inequalities across regions and classes. One could even argue that the EHIC is a visual symbol of the social dimension of the European Union. In practice, not only the EHIC but also the reimbursement principles as defined under the Coordination Regulations 883/2004 and 987/2009 are of great importance. Without these rules, there would be a major barrier for all EU citizens in terms of access and affordability of unplanned necessary cross-border healthcare, and consequently to the free movement of persons.
Abstract Objectives To develop a framework that parsimoniously explains divergent patient mobility in the United States and Europe. Method Review of studies of patient mobility; data from the 2007 ...Flash Eurobarometer and the 2001 California Health Interview Survey was analyzed; and we reviewed government policies and documents in the United States and Europe. Results Four types of patient mobility are defined: primary, complementary, duplicative, and institutionalized. Primary exit occurs when people without comprehensive insurance travel because they cannot afford to pay for health insurance or directly finance care, as in the United States and Mexico. Second, people will exit to buy complementary services not covered, or partially covered by domestic health insurance, in both the United States and Europe. Third, in Europe, patient mobility for duplicative services provides faster or better quality treatment. Finally, governments and insurers can encourage institutionalized exit through expanded delivery options and financing. Institutionalized exit is developing in Europe, but uncoordinated and geographically limited in the United States. Conclusions This parsimonious framework explains patient mobility by considering domestic health system characteristics relating to cost and quality.
Public health concerns in Europe demonstrate the necessity of building a health policy that could contribute to the long-term sustainable development of the European Union (EU), as stated in the ...European Health Union (EHU) manifesto. The main desire to create an EHU is embodied in the launch of the European Health Data Space (EHDS). The EHDS seeks to foster a genuine single market for digital health services and products by, among other things, accelerating the uptake and implementation of harmonised and interoperable electronic health record (EHR) systems across the EU. In the context of primary and secondary use of EHR data, developments in Europe have thus far resulted in patchy and, in some places, non-interoperable solutions. Taking the gap between international ambitions and national realities as a starting point, this paper contends that both EU level and Member State level circumstances should be considered to make the EHDS a reality.
Die Sorge um die öffentliche Gesundheit in Europa zeigt die Notwendigkeit, eine Gesundheitspolitik zu schaffen, die zur langfristigen nachhaltigen Entwicklung der Europäischen Union (EU) beiträgt, wie es im Manifest der Europäischen Gesundheitsunion (EHU) heißt. Der Hauptwunsch, eine EHU zu schaffen, wird durch die Einrichtung des Europäischen Gesundheitsdatenraums (EHDS) verkörpert. Mit dem EHDS soll ein echter Binnenmarkt für digitale Gesundheitsdienste und -produkte gefördert werden, indem u.a. die Einführung und Umsetzung harmonisierter und interoperabler elektronischer Patientendatensysteme in der gesamten EU beschleunigt wird. Im Zusammenhang mit der primären und sekundären Nutzung von Gesundheitsdaten aus elektronischen Patientenakten haben die Entwicklungen in Europa bisher zu uneinheitlichen und teilweise nicht interoperablen Lösungen geführt. Ausgehend von der Kluft zwischen den internationalen Ambitionen und den nationalen Realitäten wird in diesem Beitrag die Auffassung vertreten, dass sowohl die Gegebenheiten auf EU-Ebene als auch auf der Ebene der Mitgliedstaaten berücksichtigt werden sollten, um die Ziele des EHDS zu verwirklichen.
•Professional mobility as means of cross-border service provision remains largely unexplored in the literature.•Visiting health professionals bestow immense value on the Maltese health ...system.•Maltese diaspora specialists are particularly valuable as they overcome cultural and language barriers.•European reference networks should consider professional mobility as a serious and attractive alternative to patient mobility.
Cross-border healthcare has become a major policy issue in the past years across the European Union. Professional mobility, as a means of providing specialised health services has not been given sufficient attention in both the research and policy agendas. This paper presents a case study of the contribution made by visiting overseas medical specialists to the health system in Malta. Twenty-five semi-structured interviews were conducted. A grounded theory approach was utilised in view of the limited amount of literature available on the subject. Qualitative content analysis revealed one superordinate theme, being the value of the service, and three further subthemes, which include the quality of the service provided, its longevity and durability, as well as the critical contributions of expatriates. The service is an integral component of the local health service. This study makes an important contribution to the literature on cross-border healthcare. Lessons learnt may be transferable to other small island states and territories. The European Reference Networks being developed at EU level may need to focus more on the benefits that can accrue through short term professional mobility than has been the case to date. The findings also serve to propose several important features that need to be in place to increase the chances of longevity, sustainability, quality and cost effectiveness in cross border health care services.
China is beginning to transform from a migrant exporting country to a migrant importing country. Our study aimed to assess risks of imported tuberculosis among travellers and to determine risk ...factors, to tailor institutional guidelines.
We conducted an observational, retrospective, population-based cohort study. Molecular epidemiology surveillance methods were used to screen travellers for cases of pulmonary tuberculosis (PTB) at Guangzhou Port in China from January 2010 to December 2016.
A total of 165,369 travellers from 190 countries and regions were screened for PTB. The rate of suspected PTB, laboratory confirmed rate, and the total detection rate in emigrants were significantly higher than those in travellers (p<0.01). There were four differences in the PTB screening process between emigrants and travellers. According to the transmission risk degree of the tuberculosis, forty high-risk PTB importing countries were divided into five levels. The travellers diagnosed with PTB were significantly younger than the emigrants (p<0.01). The distribution of genotypes differed significantly between the travellers and emigrants (p<0.001).
PTB screening process in travellers at ports should include a risk assessment of high-risk groups. It should reduce diagnosis time by rapid molecular detection methods and strengthen drug resistant (DR) transmission and monitoring of imported PTB strains through molecular genotyping at ports.
This Insight comments the judgment of the Court of Justice in Veselības ministrija (case C-243/19 ECLI:EU:C:2020:872) with a view to highlight its contribution to the effectiveness of equality in ...access to healthcare within the Union. After a brief introduction and contextualization of the case, this Insight dwells on the interpretative efforts made by AG Hogan and the Second Chamber of the Court to distinguish the scope and reach of Regulation 883/2004 on the coordination of social security systems, from those of Directive 2011/24 on patients’ rights in cross-border healthcare, as well as to determine the degree to which these two acts, read in light of art. 21 of the Charter of Fundamental Rights of the European Union, require Member States to accommodate patients’ choices based on religious beliefs. This Insight then moves on to assess the judgement taking into account that other similar, and similarly delicate, cases may reach the Court of Justice in the near future indicating a possible, readily available, normative solution capable of ensuring greater equality in access to healthcare.
