Coheur Alain : Mutualités Socialistes de Belgique Coheur Alain : Mutualités Socialistes de...
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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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
• 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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
• 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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
• 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)
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
• 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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
• 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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
• 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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
0100200300400500
Belgian
dutch
germ
anoth
ers
Nationality
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
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+
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
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
%
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
0,00%5,00%
10,00%15,00%20,00%25,00%30,00%35,00%40,00%45,00%
%
Sources
Sources of information
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
• 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
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT
• Recommendations– The three mains action fields :
• With regard to mobility
• With regard to information
• With regard to transparency
IZOM EXPERIMENTAL PROJECTIZOM EXPERIMENTAL PROJECT