•This study analyses the implementation of Directive 2011/24/EU in Austria.•It examines corporatist stakeholders’ positions towards the Directive throughout the policy process.•Despite national law ...facilitating cross-border care, Austria's reservation towards the Directive persists.•Austria remains restrictive in applying the Directive seven years after its transposition.
After a series of ECJ rulings, Directive 2011/24/EU was finally adopted to regulate access and reimbursement of planned health care in another member state. Several studies have analysed the Directive's implementation and impact on national health care systems around the time of the transposition. The case of Austria is particularly interesting. Along with Portugal, Poland, and Romania, Austria voted against the Directive, even though major elements were already in line with national legislation. This paper investigates the implementation of the patients’ rights Directive in Austria through the lens of public key stakeholders. The analysis goes beyond the legal implementation and traces the policy process from the Directive's adoption at EU level to the time after its national transposition. Based on a rigorous policy document analysis, the study discusses the reasons of Austria's initial denial of the Directive and addresses the perceived tensions in its application, both from a patient and health systems’ perspective. Results include the stakeholders’ critical opinion towards the Directive's ability to provide legal clarity and show that its practical application remains restrictive even years after transposition. By providing evidence from Austria and discussing the findings in the context of other country examples, this paper offers new insights into the role of EU health policy-making and the practical controversies concerning its implementation on national level.
Este artículo tiene por objetivo identificar los cuellos de botella o restricciones que afectan a la movilidad de pacientes en las zonas de frontera de los Estados partes fundadores del Mercosur: ...Argentina, Brasil, Paraguay y Uruguay. Se realizó un análisis cualitativo de los datos recolectados e insumos elaborados en el marco de la acción “Cooperación transfronteriza en materia de salud con énfasis en la facilitación de la movilidad de los pacientes” propuesta por el Instituto Social del Mercosur, antes de la pandemia COVID-19, al Programa para el fortalecimiento de la cohesión social en América Latina, conocido como EUROsociAL+. Como resultado de esta colaboración interinstitucional se propone una tipología de obstáculos a la movilidad de pacientes en el Mercosur.
Cerebrovascular diseases in Sicily have led to high mortality and healthcare challenges, with a notable gap between healthcare demand and supply. The mobility of patients seeking care, both within ...and outside Sicily, has economic and organizational impacts on the healthcare system. The Hub and Spoke model implemented by the IRCCS Centro Neurolesi "Bonino-Pulejo" of Messina aims to distribute advanced neurorehabilitation services throughout Sicily, potentially reducing health mobility and improving service accessibility.
The evaluation was based on calculating hospitalization rates, examining patient mobility across Sicilian provinces, and assessing the financial implications of neurorehabilitation admissions. Data from 2016 to 2018, covering the period before and after the implementation of the Hub and Spoke network, were analyzed to understand the changes brought about by this model.
The analysis revealed a significant increase in hospitalization rates for neurorehabilitation in the Sicilian provinces where spokes were established. This increase coincided with a marked decrease in interregional health mobility, indicating that patients were able to receive high-quality care closer to their residences. Furthermore, there was a decrease in both intra-regional and inter-regional escape rates in provinces within the Hub and Spoke network, demonstrating the network's efficacy in improving accessibility and quality of healthcare services.
The implementation of the Hub and Spoke network substantially improved neurorehabilitation healthcare in Sicily, enhancing both accessibility and quality of care for patients. The network's establishment led to a more efficient utilization of healthcare resources and balanced distribution of services. These advancements are vital steps toward equitable and effective healthcare delivery in Sicily.
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.
This study aims to characterize the current status of the nephrology workforce in China and evaluate its optimal capacity based on real-world patient mobility data.
Data on nephrologists in China ...were collected from two prominent online healthcare platforms using web crawlers and natural language processing techniques. Hospitalization records of patients with chronic kidney disease (CKD) from January 2014 to December 2018 were extracted from a national administrative database in China. City-level paths of patient mobility were identified. Effects of nephrology workforce on patient mobility were analyzed using multivariate Poisson regression models.
Altogether 9.13 nephrologists per million population (pmp) were in practice, with substantial city-level variations ranging from 0.16 to 88.79. The ratio of nephrologists to the estimated CKD population was 84.57 pmp. Among 6 415 559 hospitalizations of patients with CKD, 21.3% were cross-city hospitalizations and 7441 city-level paths of patient mobility with more than five hospitalizations were identified. After making adjustment for healthcare capacity, healthcare insurance, economic status, and travel characteristics, the Poisson regression models revealed that the number of nephrologists in both the source city (incidence rate ratio IRR 0.99, per 1 pmp increase) and destination city (IRR 1.07, per 1 pmp increase) were independently associated with patient mobility. An IRR plateau was observed when the number of nephrologists exceeded 12 pmp in the source city, while a rapidly increasing IRR was observed beyond 20 pmp in the destination city.
The nephrology workforce in China exhibits significant geographic variations. Based on local healthcare needs, an optimal range of 12-20 nephrologists pmp is suggested.
Objective
The Italian healthcare jurisdiction promotes patient mobility, which is a major determinant of practice variation, thus being related to the equity of access to health services. We aimed to ...explore how travel times, waiting times, and other efficiency- and quality-related hospital attributes influenced the hospital choice of women needing pelvic organ prolapse (POP) surgery in Tuscany, Italy.
Methods
We obtained the study population from Hospital Discharge Records. We duplicated individual observations (
n
= 2533) for the number of Tuscan hospitals that provided more than 30 POP interventions from 2017 to 2019 (
n
= 22) and merged them with the hospitals’ list. We generated the dichotomous variable “hospital choice” assuming the value one when hospitals where patients underwent surgery coincided with one of the 22 hospitals. We performed mixed logit models to explore between-hospital patient choice, gradually adding the women’s features as interactions.
Results
Patient choice was influenced by travel more than waiting times. A general preference for hospitals delivering higher volumes of interventions emerged. Interaction analyses showed that poorly educated women were less likely to choose distant hospitals and hospitals providing greater volumes of interventions compared to their counterpart. Women with multiple comorbidities more frequently chose hospitals with shorter average length of stay.
Conclusion
Travel times were the main determinants of hospital choice. Other quality- and efficiency-related hospital attributes influenced hospital choice as well. However, the effect depended on the socioeconomic and clinical background of women. Managers and policymakers should consider these findings to understand how women behave in choosing providers and thus mitigate equity gaps.
In Japan, provision of equal access to cancer care is intended to be achieved via secondary medical areas (SMAs). However, the percentage of patients receiving care within the residential area varies ...by SMA in Osaka Prefecture. We aimed to assess the effect size of factors associated with patient mobility, and whether patient mobility was affected by the COVID-19 pandemic.
Records of patients diagnosed with stomach, colorectal, lung, breast, cervical, oesophageal, liver or pancreatic cancer during 2019–2020 were extracted from multi-centre hospital-based cancer registry data. Odds ratios of whether a patient received care within the SMA of residence were set as the outcome. A multivariable model was built using generalised estimating equations with multiple imputation for missing data. Change in patient mobility after the pandemic was examined by deriving age- and SMA-specific adjusted ORs (aORs).
A total of 78,839 records were included. Older age, more advanced stage and palliative care had up to 1.69 times higher aORs of receiving care within their own area. Patients with oesophageal, liver or pancreatic cancer tended to travel outside their area with aORs ranging from 0.71 to 0.90. Patients aged ≤ 79 and living in the East and South SMAs tended to remain in their area with aORs ranging from 1.05 to 1.11 after the pandemic.
Patient mobility decreased for higher age and stage. It also varied by SMA, cancer site and treatment type.
Our results need to be linked with resource inputs to help policymakers decide whether to intervene to address current efficiency or equity issues.
•Patient mobility seeking cancer care vary widely by the catchment areas.•Patients with older age tended to seek cancer care within their residential areas.•After the COVID-19 pandemic, patient mobility decreased for those aged ≤ 79.
•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.
This paper investigates the effect of socio-economic status on interregional mobility and mortality among cancer patients. The cohort under analysis comprises patients residing in Sicily (Italy), who ...were diagnosed with lung and colon cancer between 2010 and 2011. The data was collated from the hospital discharge records of the Sicilian Region and the Regional register of the causes of death, by considering all those patients for whom information relating to socio-economic status was available. First, graphical models were applied to highlight the multivariate structure of association among socio-economic status, interregional mobility and 3-year mortality. Secondly, mediation analysis quantified the direct and indirect effect of socio-economic status relating to mortality. The results revealed that socio-economic status is associated directly and indirectly with mortality due to lung cancer, mediated by interregional mobility. On the other hand, the association of socio-economic status with mortality from colon cancer is only indirect, and also mediated by interregional mobility. The authors of this research hold that the extent of patient mobility and its relation to mortality call for a reconsideration of health policy.
•An analysis of socio-economic status, inter-regional mobility and mortality among cancer patients.•Graphical models permit the detection of the complex structure of relationships between the considered phenomena.•Causal mediation analysis facilitates the quantification of indirect effects of socio-economic status.•Policy considerations arise concerning equal access to healthcare.
Decentralized, tax-funded health systems like Italian and Spanish ones reveal relevant internal patient flows, raising concerns in terms of equity, budget imbalances, and unexploited economies of ...scale at the regional and organizational level. However, policymakers lack effective tools to rapidly identify the causes of patient outflows in Beveridgean healthcare systems. We address the gap by conducting a critical review of the drivers of patient mobility. Elaborating on existing knowledge, we propose a concise, versatile assessment matrix to help policymakers in understanding the most relevant causes of mobility. Specifically, we identify three main categories of drivers: insufficient service availability, poor (perceived) quality, and regulatory issues. We include appropriate indicators to identify each driver, or mix of drivers. For each of them, we also propose specific policy and organizational responses. The applicability of the model is proven by an empirical test using the Italian national hospital discharge database for all inter-regional inpatient mobility flows. In addition to adding to previous contributions on mobility drivers by creating a model that informs policymakers' understanding and actions, the paper provides an innovative approach to patient mobility by proposing a model that, for the first time, primarily focuses on the clinical discipline of the flows.
PDF
