coheur alain : mutualités socialistes de belgique coheur alain : mutualités socialistes de...

Coheur Alain : Mutualités Socialistes de Belgique Coheur Alain : Mutualités Socialistes de Belgique

Common Challenges for Health and Care

A Europe of patients ? European Health Systems in a changing environment

Co-operation in the Members States, possibilities and constraints

Healthcare without frontiers in the Meuse-Rhine Euregio

- general context- results- general conclusions- recommendations

IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT

• What are the needs of a Europe without frontiers in terms of healtcare ?– Already regulated :

• Recourse to healthcare for persons temporarily spending time abroad

• Recourse to healtcare for cross-border workers

• According to the needs, a case-by-case decision

– Not yet regulated :• Needs in border areas,

• Retire cross border worker

– The judgements made by the ECJ lay down new criteria in favour of healthcare without frontiers in Europe


• General context – Five years of collaboration

– For the mutual health funds, the objectives were :• To be able to efficiently facilitate, accelerate and adapt access to care abroad

according to the needs and the desire of the persons to resort to cross-border care

• To simplify the administrative procedures for the insured persons

• To ensure as much transparency and communication between the insurers and the insured persons

– The project began in september 2000 covering a cross-border geographical zone

– The project is the result of consultation procedures => co-operation protocol between mutual health funds and national institute for health insurance


• A few basic solutions – The project was carried out within the framework of the internatinal

agreement (1408/71 and 574/72). The legal provisions on health insurance and tariffs as well as the procedures in each country have been applicable

– Agreement of a validity period for the E 112 form

– Provisions completed by accords and agreements

– Identification of all documents by IZOM EMR 112+

– Supply of required documents to the offices of the mutual health funds

– Information for all target groups, health insurance employees, doctors, hospitals


• Transposition into practice – Documents supplied to the services

• E 112, 113, 114, 125, 126 (specific) forms under international law on health insurance,

• Certificates (for instance, treatment book, prescriptions for the specialist in Germany

• The project was carried out within the framework of the internatinal agreement (1408/71 and 574/72). The legal provisions on health insurance and tariffs as well as the procedures in each country have been applicable

• Patient’s passeport

• Directories of adresses

– Information• Leaflets giving succinct information and

• Detailed information (for the doctor, the pharmacist, the hospital)


• Improvements and advantages – Population

• Facilitated access for all insured persons from countries involved in the project

• Procedures– Insured persons from Belgium obtain autorisation with/without prior autorisation from the ??

– Insured persons from the Netherlands obtain autorisation with a transfert order from their general practionar

– The reimbursement sheets required by the German health insurance fund are made available to insured persons from bordering crountries

• Shorter waiting times for treatment and examinations

• Possibility of treatment close to the place of residence

– Medical care provider• Exchange of information in the medical sector

• A better use of capacities

– Mutual health insurance funds• Knowledge of insured persons ’ needs with a view to carrying out targeted activities

• Customer satisfaction

– Political level • Awareness of the obstacles to a Europe without frontiers, indication of actions field


• The services in question were – General care provided by specialist doctors, at diagnostic and therapeutic

level

– The precription of medecines as part of this treatment

– The relevant hospital care

– The additional E 112 and/or 114 autorisation forms were necessary • Equipement and services provided by paramedical professions

• Cutting edge medical care specific to each country


• The assessment – General objectives

• To obtain an overall idea of the mobility of the population in the EMR

• To determine the effects of opening up the borders and thus the creation of an open space

• To make recommandations in line with policy to the authorities and their competent bodies

– The methodology• Using og a uniform questionnaire

• Distinction between the general characteristics of the respondents and characteristics relating to the existing needs (three categories)

– Information

– Reasons for travelling abroad

– satisfaction


0100200300400500

Belgian

dutch

germ

anoth

ers

Nationality


Category by age for EMR

13,59%

16,68%

17,28%23,38%

12,89%

3,70%0,30%

4,10%

3,50%

4,60%

0-9

9-19

20-29

30-39

40-49

50-59

60-69

70-79

80-89

90+


0,00%

5,00%

10,00%

15,00%

20,00%

25,00%

30,00%

35,00%

%

0-9

9-19

20-2

9

30-3

9

40-4

9

50-5

9

60-6

9

70-7

9

80-8

990

+

category by age

Catégory by age and country of residence

Belgique

Pays-Bas

Allemagne


Status of insured persons

36,50%

3,70%

13,30%

12,60%

2,80%

19,90%

0,80%

10,30%

insured person in employment

self-employed insured pers.

holder

dependent

member of CB family

retired cross-border w orker

cross-border w orker

others

Cat

egor

y

%


0,00%5,00%

10,00%15,00%20,00%25,00%30,00%35,00%40,00%45,00%

%

Sources

Sources of information


0,00%

10,00%

20,00%

30,00%

40,00%

50,00%

60,00%

%

Sources

Sources of information by country of residence

Belgium

Netherlands

Germany


bad

23

4good

0,00%

5,00%

10,00%

15,00%

20,00%

25,00%

30,00%

35,00%

40,00%

45,00%

50,00%

Category

%

Opinion on the information obtained

bad

2

3

4

good


reasons for cross the border to receive care (average)

3,844,1

3,633,34

3,94

4,454,27

2

2,5

3

3,5

4

4,5

5


2 2,5 3 3,5 4 4,5 5

Proximity of the care

Waiting time

Mother tongue

Travel costs

Personal contributions

Approriate care

Greater attention

Motivations par pays

Germany

Netherlands

Belgium


0,00%

5,00%

10,00%

15,00%

20,00%

25,00%

30,00%

medical disciplines in the Euregio

Série1 19,10% 29,90% 18,30% 8,50% 29,30% 8,60% 27,70% 9,50% 26,70% 20,90% 19,60%

Gynéco Ortho Neuro RevaliChir gén

Pédia OphtalNeuro chirur

Med int.

Imag méd

Autres


BelgiumNetherlandsGermanyOther

0,00%

20,00%

40,00%

60,00%

80,00%

100,00%

Satisfaction

Belgium

Netherlands

Germany

Other

• General conclusions– Possibility of obtaining medical care is attractive :

• Shorter distance to travel• Shorter waiting times• Communication in mother tongue• A different mode of treatment• A more personal approach

– Two groups of users :• Homogenous group of cross-border workers and retired• Less homogenous group of people who :

– Prefer the way that they are treated abroad– Are not satisfied with the care they received– Want an alternative solution


• General conclusions– The three mains factors :

• The lack of care available in the country of origin

• An awareness of the care available abroad

• The amount of information about cross-border care distributed in other countries


• Recommendations– The three mains action fields :

• With regard to mobility

• With regard to information

• With regard to transparency


coheur alain : mutualités socialistes de belgique coheur alain : mutualités socialistes de...

Documents

health insurance slide

europe slide

health insurance employees

hospital slide

european health systems

crossborder care

izom emr

changing environment