Cross-border healthcare in the European Union – prospects and challenges to the Health Tourism

Product Offer of NORDA

Stella Tsartsara Gerontologist, Integrated Long Term

Care, Cross Border Healthcare - Senior Tourism expert

NOU NORDA Sustainable Development Strategy 2020

• Tourism and leisure is the 1st choice for territorial development

• Production, services and port logistics

Assets for Health Tourism around the year in NORDA region

• The longest beaches in Europe,

• Varying proportions of area covered by forests – 0.2 in Puck, up to 74.4% on the Hel Peninsula

• Moderately warm summers, with the mean atmpospheric temperature of ca. 17-17.5o C.

• Mild winters – ca. 0-0,5o C, 1 650 sunny hours

Natural trails : Across the ravines and cliffs of Rozewie: - the Łebskie Błota nature and ornithology path

- the educational trail in Rąbka Protection District

NOU NORDA – an appealing offer for sports and leisure

• The total planned length of bicycle routes is 450 km

• 28 surfing schools

• 4 golf courses

5

Proximity of Gdynia with Urban Centres of Poland

38% of Polish tourists visited the region of Pomerania 24% of foreign tourists visited the region of Pomerania – Poland’s

second most frequently visited region

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NOU NORDA Main Health Tourism Product Offer

1. Integrated Long Term Care for Active and Healthy Ageing

(AHA) and 2. Wellness, Rehab, Spa

Wellness & Spa Centres in NOU NORDA

11

30 centres

Integrated Long Term Care as a Destination Asset to

Senior Tourism Development

“Hans and Gretel are on vacation”

Profile of elderly travellers

• John 75, post-stroke frailty, he is insecure with slow gait

• Mary 65, suffers from post cancer CHF and slight frailty

…but they have not lost appetite for life!

“Where to this year Gretel?”

Cost benefit in the 2 Senior Tourism destinations A & B – for customer

Destination A

• No elderly support upon arrival (care plan, health monitoring etc.)

• Expensive MTF

• Extra paid one off access to nurse or GP, or medical devices (wheel chair)

• Extra paid travel agents for tour packages

What is behind…

• Segregated, expensive lines of businesses, coordinated by an MTF

• And yet more is not provided out of cost (dietary info, internet cards, etc.)

But, Hans and Gretel are only middle income retirees just as other 71 million other baby boomers…

William J. Schroer: the Social Librarian

Cost benefit in the 2 Senior Tourism destinations A & B – for provider

Destination B

• Patient Advocacy Community centre offers: – Welcoming and AFE Housing

What is behind… • Senior Tourism Centralized

information, administration, management, and coordination of – local businesses, AFE housing etc.

– Senior Tourism Packages from trained community professionals

– Home care monitoring & support to John and Mary just as they provide to local elderly people

An Integrated Senior Tourism Service Proposal

Cost benefit in the 2 Senior Tourism destinations A & B – for provider

Destination B

• Patient Advocacy Community centre offers: – Care Plan e-Monitoring

– Trained social workers paying visits to John and Mary, aligned nurse and GP (if needed)

– Medical devices provision

What is behind… • Senior Tourism Centralized

information, administration, management, and coordination of – E- health monitoring system for

occasional visits of elderly population

– GP, nurse, social worker aligned just in case

– Alert system linked with the elderly (alarm watches from AAL trials, etc.)

An Integrated Senior Tourism Service Proposal

Cost benefit in the 2 Senior Tourism destinations A & B – for Local Authorities

and business Destination B

• Patient Advocacy Community centre offers: – Aligned tourism packages

designed for elderly with local community businesses

– Assures FIT vacationing

What is behind… • Senior Tourism Centralized

information, administration, management, and coordination of – Senior Tourism Packages from

trained professionals, as part of the Local Development Plan and Territorial Branding activities

– Capacity built and business development programs.

An Integrated Senior Tourism Service Proposal

Expensive infrastructure for LRAs , unless it is service

driven…

By coordinating housing,

transportation, outdoor activities,

social events, community based

care and senior tourism sector

organization and delivery

…that Integrated Care can provide to augment Local

Senior Tourism Destination Value & Branding

The Community Based Integrated Long Term Care model to support

Senior Tourism in NORDA

Patient Care Advocacy centre

Geriatric assessment & monitoring provided by

nurses and social caregivers

Independent Living

Advanced and Instrumental ADL

i – ADL Community dwelling organization, welfare

society, "Home Aid" progr.

a - ADL, Community care givers, welfare society

Assisted Living

Basic ADL

* Home care programs

* Community care givers

The Community Based Integrated Care

model to support Senior Tourism in NORDA

Patient Care Advocacy centre

Senior citizens health monitoring provided by network of nurses and social caregivers

Municipal services: tourism packages, transport, events,

housing and support programs for staff

capacity and funding Local businesses and professionals, incl.

caregivers trained and contracted on demand to boost the local economy

Living Lab in the Region to test AAL, to

coordinate longitudinal or cross

sectional studies

Patient Centre acting as Domestic Management Organization for Senior

Tourism Services upon small fee as funding is

secured

Funding Schemes Investments

Incentives Clinical trials – AAL

Cross Border Healthcare Directive: the

enabling factors of Health Tourism, Senior Tourism & LTC and Rehab in

NORDA • Rehab is reimbursed (Germany, Sweden, NL

and private insurances)

• Long Term Care is reimbursed in some countries (Slovak Republic)

• The Value Proposition for NORDA: good climate, cheap prices for LTC & nursing homes, proximity to CE for LMI segment.

Division of 'competences' set by Treaty Health systems are national competence

Single Market: free movement of goods and services Healthcare not considered part of Single Market, historically

but there is an exception! Rehabilitation and Health Tourism

Directive on patients 'rights in cross-border healthcare 24/2011/EC

• Patients' rights to choose care abroad increased and clarified

• Increase in information to patients on cross-border rights and on health systems Minimum set of patient rights established for all treatment delivered in the EU, doctor/hospital liability & obligatory post operative treatment in source – country.

• Impact / potential demand growing in numbers in EC (Committee of Regions, Hearing 29/2/16)

Report From The Commission To The European Parliament And The Council

Commission report on the operation of Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare

Reimbursement for treatment not subject to prior authorisation • Of the 26 Member States who responded, only 23 were able to

provide complete data on reimbursements made for treatment not subject to prior authorisation (Germany and the Netherlands could not provide data; Belgium could not provide complete data).

Of these 23: • Finland, France and Luxembourg provided aggregate data for the

Directive and the Social Security Regulations.

– Finland reported 17 142 reimbursement claims,

– France 422 680 reimbursement claims and

– Luxembourg 117 962 reimbursement claims.

Cross border healthcare directive 24/11/EC boosting Medical & Health Travel and

Senior Travel and Long Term mobility in EU • Shared risk Insurance as in EU with reimbursed medical treatment costs in cross

border healthcare provision and compulsory post-operative aftercare provision at home will revolutionize the way healthcare is provided

• The leaked "concept paper on health care services within TISA negotiations," in the Trade in Services Agreement negotiations in Geneva last September (2014), argues there is "huge untapped potential for the globalization of healthcare services," creating massive business opportunities from what is a $US6 trillion ($7.7 trillion) per year industry.

• The proposed regime would involve health professionals authorizing patients to be treated in other TiSA countries (for reasons including long waiting times in the home country or inadequate expertise for specific medical problems); and the patient's costs being reimbursed through their home country's social security system, private insurance coverage or other healthcare arrangements.“

• 750 million Europeans will be able to travel abroad for cure and care! - Large multinational , multidisciplinary companies should manage the medical travel delivery, incl. insurance, MTF, legal, medical, tourism and other sectors’ experts to maximize efficiency and lobby for reforms.

1) Wikileaks on TiSA for Services - https://wikileaks.org/tisa/

2) http://www.smh.com.au/national/health/medical-tourism-plan-revealed-australia-leads-top-secret-push-for-globalisation-of-healthcare-20150205-13648w.html

Stella I. Tsartsara

Gerontologist, Integrated Care, Cross Border Healthcare - Senior

Tourism expert South East Europe Healthcare LinkedIn : https://www.linkedin.com/in/stella-i-tsartsara-456a8322 email: stsartsara@gmail.com skype: stsartsara tweet: @stsartsara Follow us here - https://www.facebook.com/pages/Southeasteuropehealthcare/617205301728594Fol