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Published on 1 January 2004

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Patient mobility and healthcare development

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Brian Edwards CBE
Professor of Healthcare Development
University of Sheffield
UK

The ministerial group that is reflecting on patient mobility and healthcare development in Europe is shortly to report. There is now a significant amount of patient mobility across national boundaries. This is generating pressure for more common standards including a clearer definition of patients’ rights. One right in particular has fuelled this pressure, and it is the right to seek treatment in another country if a citizen’s access times at home are unreasonably long. Denmark has a two-month threshold, but this is still too demanding for most of the rest of the Community.

But the rights issue may go much further than access times. Some harmonisation may be appropriate in fields such as patient information, informed consent and rules about confidentiality. The first step will be a piece of work to generate an understanding on these issues across Europe.

Sharing spare capacity might be facilitated by pooling information.The development of European reference centres for rare diseases seems to be a sensible idea but it will need funding. For some countries this will be regarded as the sort of practical help the Commission should provide, but others are deeply suspicious about a further intrusion into national health systems. The same arguments will run if ministers recommend a European Health Technology assessment process. The industry will be very wary about European standards, but the evidence from NICE (National Institute for Clinical Excellence) in England and Wales seems to be that once it gets working it generates enormous pressure to use proven drugs and technologies.

Another area that ministers might comment upon is the possibility of regulating e-health providers or at least setting out some voluntary guidelines. This is difficult territory with technology moving so fast. Sorting out professional regulation might be easier, although the national regulations are enormously variable. In some countries regulation is simply a matter of proving baseline education, while in others regulation is subject to lifelong checks and removal if personal conduct or performance is shown to be beneath acceptable standards. Those with the highest standards do not want to see them diluted or, worse, professionals whom they remove from their registers for incompetence practising in a neighbouring country.

An easier target might be a recommendation to improve the quality and range of data that is available within the union about healthcare. Even here there will be controversy if this data collection goes into comparative costs, which in my view it should. The Commission could help all countries if it pushed the common standards and specification agenda and encouraged consolidated purchasing.The health industry sector might welcome such a move.

Health systems are likely to remain a national competence for some time to come, but the Commission can provide practical help and should be encouraged to do so. They will need an organisation to enable this so that they can treat health not just like any another service industry, but rather as a vital component of life in the Community. The health sector is now ready for its own Commissioner.



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