EESC and the Pharmaceutical Package

The European Economic and Social Committee (EESC) had a hearing on “Pharmaceuticals” on the 20th of April. The purpose was to ensure a good discussion on the 4 preliminary opinions with regards to the Pharmaceutical package. Those four opinions were then adopted at their plenary session on 10 and 11 June 2009 and have today been published on the EESC website. I didn’t attend their plenary session but the hearing I did manage to attend – I did find it quite interesting with some new perspectives on pharmaceutical information (on the difference between info and advertising) and distribution (internet sales) being highlighted.

At the hearing I found Mr Michel Nakache, Chairman of the Health Communication Council of the European Association of Communications Agencies (EACA) especially refreshing. He stated that he could not understand when people claimed it hard to legally differentiate between information and advertising, that his professionals could do quite easily since it is their profession and that maybe they should have been asked for this explanation earlier. Now I might have misunderstood him since in the report from the event it only says that Mr Nakache “also welcomed the pharmaceutical package. On information to patients he stressed the need to clearly differentiate advertising and non-promotional information.”

All too often good discussions in Brussels end up in quite PC standpoints or summaries. But not always. In the EESC pressrelease one can find that the plenary session “called for free movement of medicines and for the completion of a Single Market in the pharmaceuticals sector”. Must mean they are not too happy with the ECJ decision on the Italian market regulation with regards to pharmacies. The final documents and more can be found here.

How to demonstrate to policy makers that medical devices give value for money in healthcare

A couple of years back the European Health Technology Institute for Socio-Economic Research was initiated. Via research pooling and sharing of knowledge between 3 very well established universities the aim is to increase knowledge about medical technology enabling better healthcare decision. (The 4th partner is Eucomed – the trade association for the medical device industry.)

Now the 3 research partners have presented some preliminary findings on The Socio-Economic Value of Medical Devices. If you reed their press release you learn that:

• In the UK the London School of Economics find that medical technology gives good value for money delivering lower rates of mortality and major adverse events, and shorter hospital stays in cardiovascular disease treatments
• In German the Berlin University of Technology research finds after having studied real world data from the German Sickness Funds (i.e. instead of abstract modelling based on assumed figures) that innovations in stenting yields considerable improvements in lives saved and costs avoided.
• The Bocconi University data highlights importance of non-financial drivers (i.e. instead the experts do drive innovation based on their experience exchange) in reimbursement context by looking at the introduction of Drug Eluting Stents.

The findings are interesting but I must say that I do not really understand from this summary how they are pooling and sharing knowledge in their research? But its early jet – 2 years is hardly a long time when it comes to mapping out, analysing and understanding healthcare organisation. Maybe you need this early findings first before you can start compare findings. And for me the most interesting is to see if they can take the findings to the next step – i.e. how the group will work to ensure that their findings can be and are used by the policy makers. This is said to be part of their aim.

My advice would be that if they will be able to reach the decision makers the next time they send out an interesting press release they make sure that those interested actually can find more indebt material on the topic on the organisations website.

Italian or Norweigian pharmacy model best for the citizens?

Italian MEP Stefano Zappalà claims, with referral to the ECJ decision, that "The Italian pharmacy model has also won in Europe". Not sure what he means with "also". Clear is that he is happy that ECJ "has put a halt to the push for the liberalisation of pharmacies by the European Commission in recent years." He continues: "The Italian pharmacy system, which is also the continental system, has been designed to protect citizens and to ensure their health is not endangered. " Now one of the issues with the Italian system is that only pharmacists are allowed to own pharmacies.

As reported earlier on this blog the European Commission have started infringement processes against member states with systems restricting ownerships in various ways. The lobby against liberalization have been fierce and Zappala is only one example of those fighting hard to avoid modernization of the sector. Whatever their arguments we know it can be done differently.

Kai Finsnes from the Norwegian Pharmacy Association recently gave a presentation in Athens of how the pharmaceutical distribution system can be improved for the citizens. He described the results of the Norwegian pharmacy deregulation in 2001. Before 2001 the government decided when and where new pharmacies were to be established. Only pharmacists were allowed to own pharmacies and they could not have more than one. Pretty much the system Zappala defends. Between 1991 and 2000 there were 3-11 new pharmacies established each year. With the introduction of free establishment (no need to be a master of pharmacy to own a pharmacy and legal persons may own pharmacies in combination with no limitation of the number of pharmacies that can be owned) in 2001 Norway have had 15-61 new pharmacies opened each year. So there are fewer inhabitants per pharmacy and an increased consumer focus. Pharmacies are thus easier accessible for every Norwegian.

Maybe even more important to explain to the defenders of the old time systems is that the competence in pharmacies have actually increased despite all the warnings about what happens when ownership etc are deregulated! Take a look at the statistics below.

So if quality is better and access is better, what do the citizens wants? The Swedish Co-operative Union (KF) (uniting the 48 regional consumer co-operative societies in Sweden, with over 3 million individual members) in a survey of their clients/members found that 90% states that they want to have pharmacy services in their organizations stores.

So whose interest was Zappala defending in his election campaign? If it is the citizens, I would say that he is very off the target.

21 UK time on BBC 2 tonight - on the value of life in healthcare budgets

Already the 7th it was possible to read Adam Wisharts excellent article The unbearable cost of living. Tonight on BBC you can see the documentary the article is based on. It is dealing with the issue of what is a life worth and how that figure is set and managed within the healthcare system. The article is seriously good. So stop reading this and switch on the TV.

The work on patient rights

PatientView is a research-and-publishing organization that surveys the opinions of patients and health advocacy groups. In their Health and Social Campaigners' News International, you can read about the activities of health campaigners worldwide. Its usually a fantastic source of knowledge about healthcare issues. In the last issue the efforts by the Active Citizenship Network (ACN) leading up to the pan European celebration of the Patient Rights Day on April 18th and the European Commission and the current presidency trio campaign Europe of the Patients is described. ACN, originating from the Italian civic group Cittadinanzattiva, is campaigning for the legal basis of patients’ rights to be accepted as EU law and embraces 14 rights—called the European Charter of Patients’ Rights.

An important step towards this is as discussed in the magazine the Patient Rights at cross border care directive. For the first time the European Union is codifying the right to choose provider no matter borders etc. A choice that is not obvious in some countries that now will be given to the patients without borders. The costs covered by insurer and thus the purchase power patients can bring will still be the one stipulated by the healthcare system in their home country.

This makes the “correction” sent by ACN to Patient View and distributed by them to the subscribers very strange. In this correction it is said that their original aim with supporting this directive was to “guarantee that the rights are not only for the people that travel but all European citizens. This is an important aspect that is not included in the Directive on Cross border care and a reason the socialist are sustained from voting.” Now this must mean they have not read the directive and been seriously fooled by the socialist group.

(Now I will repete myself a bit - you who read my previous postings on this issue can jump to the end of this blog post directly.) The directive is dealing with those travelling for care – tourists and business travelers catching a cold or a more serious illness while travelling is already covered by other regulations. This directive aims to give patients the right to seek care cross border among others if they have to wait too long for treatment in their own country or if the treatment is not offered in their particular country. It does also put in place a framework for how much money one can bring – basically a care voucher system – and how to deal with quality and insurance issues etc. The socialist group has been fighting the directive all the way from autumn 2007 when the chairman of European Socialists Poul Nyrup Rasmussen wrote to all commissioners with a socialist background asking them to stop the directive on the grounds that it would make healthcare part of the common market. Later objections have been - also from quite many conservative governments - that this would mean that EU would decide on how healthcare is organized. This is not due to the directive not being for only those travelling but due the difference in beliefs of who should be in power in the healthcare system. The citizen or the government.

This is exemplified in a couple of issues. The first being that an EU law would give patients the right to go abroad and choose providers including private ones, which you do not have in all countries today. The second being the fears that the law could undermine the gatekeeper function. In the EP the socialists went so far that they tried to postpone the vote whishing for the new parliament to be a “better” one. In the end they was forced to negotiations when they was told that there would be a vote on the issue either with their co-operation or not. When they then had several of their demands meet they still did not vote for the final proposal. In the final vote, they abstained. So now a proposal have been voted upon that are quite weakened on for example the rights for patients to go abroad without prior authorization and the socialists have lost even more power in the newly elected Parliament.

However, the debate on this is still very low key – probably partly because organizations like ACN have bought the PSE description and defends the election talk from the PSE group.

But beside this the ACN Patient Charter is very good and the campaign for getting Patient Rights recognized by the European Union now running on its eight-year can see some signs that the goal is getting closer. There is quite a lot of support in the European Parliament for the idea – the liberal group has launched their own campaign on the issue. More and more countries do have Patient Rights legislations. However, I would like to end by pointing out that maybe it would be better if we stopped talking about patient and instead used people with HIV, people with rheumatism etc. If healthcare could be looked upon as normal services and products we would have rights, consumer rights, already now.

PGEU in Stockholm to develope the core values for the next 50 years

The Pharmaceutical Group of the European Union (PGEU) is the European association for pharmacists. Right now in Stockholm their annual meeting take place under the theme:
"The Next Fifty Years, Developing Our Core Values for a Changing World".

I hope the next 50 years will be about modernisation and meeting consumer demands but Im not convinced. Take a look at this programme for guests and accompanying persons - does it seem like its developed for the members of an forward looking organisation? First day they think their guests and accompanying persons should be bussed to the most posh store in town NK, then next day a bit for history with the Vasa museum to be followed by a day at the royal castle. The congress program is being put together by the Swedish state monopoly company Apoteket. I must admit I'm suspicious by any organisations that have this type of programs.

12 people die every day waiting for organs

56 000 patients are waiting for an organ transplant in Europe. 12 people die every day while waiting for transplantation according to the European Commission. One of those that were waiting, my children’s cousin, got his heart last week. A little boy who luckily was not one of those that died while waiting. Others just run out of time because there is not organs enough.

A European Commission proposal for a directive is on the table and the Spanish Presidency who takes over after Sweden 1 of January 2010 will prioritize this issue. Spain has reason to be proud over their work in this field having managed to increase the rate of transplantations quite substantially by ensuring a good organization of the healthcare system with regard to this issue. The Commission has also put forward a 10 points action plan. Most of the points are purely organizational for the healthcare system and there is a lot to be done to ensure the well needed maximum efficiency from staff and administration.

But out of these 10 no 4 is being a little different since it says, “improve the knowledge and communication skills of health professionals and patient support groups on organ transplantation.” And this is really key to actually get the organs needed. In some countries, the government does assume that diseased are willing to donate unless they have stated otherwise but it is not the general rule. It is just not enough with the best possible organization of healthcare to ensure enough transplants – people has to be willing to donate as well! Therefore, people need to be recruited to the donation registers. The issue is how to do this.

The obvious way is to put a face on those 56 000 waiting. Daniel Westerling who is soon to be married to the crown princess of Sweden has recently undergone an acute kidney transplantation. The media attention around his operation led to 5 times as many people as normal signing up for the Swedish transplantation registry. Similar increases occur every time there is real media attention around transplantations. The Swedish record in new registrations of donors is from 2006 when an 8 year old girl died in the queue for a new heart. If 12 people die every day while waiting for a new organ, why do we learn about so few of them? And why do people have to die before we register?

If you want to find out how to register in your country this link summary from Scandiatransplant is excellent.

Financial Incentives got the administrators to get their act togheter

Last year 130 000 patients where queuing for treatments in Sweden. The government at that point decided that the counties that manage to cut their queues as a reward will share a reward of approx 90 million Euros. Already after 5 months the number of patients waiting too long (now I would not necessarily agree on their definition of too long but anyway) for treatments has been cut in half. Right now 16 out of 21 counties are qualified to be in on the slit of the money – the deadline is the 30th of November. The incentives are combined with educational and informational efforts enabling patients to better know their rights as well as to find a healthcare provider with shorter waiting times.

Rare Diseases EU Communication decision

The EU communication on rare diseases was adopted today at the Council of Health Ministers. The decision basically means that the countries have agreed to adopt national plans or strategies for rare diseases before the end of 2013. The aim is also that research should be promoted and a better infrastructure for rare diseases treatments should be created. Identifying Centres of Expertise will be key in this process.

What I find the most interesting is the decision to”organise healthcare pathways for patients”. Also cross border if needed. It’s a modern approach that will be interesting to see what it results in. For more info check the EU Commission website.

What the EU Health Ministers will discuss next week

European health ministers will meet on Tuesday in Luxemburg to decide on a range of proposals from the Commission. It is quite a wide range of issues from rare diseases over patient safety including the prevention and control of healthcare associated infections to the so called “pharmaceutical package”.

The most controversial part of the ‘pharmaceutical package’ seems to be patient information. Most people I talked to assumed that the proposal is politically dead since lots of EU Member States don’t like it. The main reason the increased possibility for pharma companies to inform patients about their products. Other countries such as Sweden and Denmark have serious issues with the proposal due to their constitutional rights on freedom of speech as the proposal would demand a system where governments censor companies’ information. As a Swede I must say I find the proposal quite restrictive and don’t really understand what it is in the current Swedish system that the Commission thinks needs to be limited. On this topic, there was quite good presentation held by Per Manell, at conference organized by the European Commission and EPF, "The Pharmaceutical Forum – Delivering for Patients" about the Swedish pharma industry web site for information on pharmaceutical products. The presentation can be found here.

Another issue to be discussed is the Commission communication on organ donation. The proposal went through the European Parliament this spring and is not very controversial. I therefore find it a bit surprising to see that some Member Stateswant to specifically exclude organ donations from the proposal on patient rights at cross border care! The full proposal for patients is highly controversial starting from the first ECJ case in 1995, continued via the proposed service directive where MEPs excluded medical services in the end in 2006 until today when the Commission first postponed several times and then most recently with the PSE group in the parliament trying to obstruct a decision in the Parliament.

Given how long this issue has been discussed, it´s a surprise to find, in the material put forward by the Council to the EU Member States, the phrase: “Due to the lack of time, the WP did not examine this revised compromise in detail”....

One should have expected that after a compromise on the patients rights Directive was found in the European Parliament, the Council’s decision on the issue should be easier, but that is obviously not the case: First of all, a large number of EU Member States are still very much the whole idea of patients receiving treatment abroad.

Secondly, when one looks at the details one notices that they want to further strengthen the rights of national administrations to forbid travel for treatments Member States want to increase the obligation to seek “prior authorization (or rather “prior refusal”) and even to exclude certain treatments. Since the assessment is that the proposal as it stand right now in the council is not supported by the ECJ case law one of the issues to discuss on Tuesday is how to “tackle the legal uncertainty for patients and its negative impacts on providing cross-border healthcare that may arise? (e.g. by means of adopting new legislative proposals on the excluded types of healthcare?)” Very important question indeed!

Thirdly, quite a lot of Member States wish to exclude private providers from the scope of the Directive. Now there is not really any legal ground for this policy so the sitting Czech presidency wants to find a compromise where they Member States have the right to exclude providers only if it is on the basis of quality (i.e. exclude unsafe and low quality private providers). Would it be worthwhile to try to work with a solution enabling a system excluding those providers who do not meet some quality and safety standards? The answer is clearly Yes. That is fine. Obviously it is not so easy for some of the more dogmatic EU Member States (which prefer to keep healthcare only for public providers).

The second question raised by the Czech Presidency is what mechanism for other co-operations between EU Member States should be put in place. The MS have decided they do want more cooperation in other matters (eg e-health, health technology assessments, quality) – not that easy since they of course know very well that every new formal European co-operation is a step closer to a single European healthcare system. It is slow, it is painful but it is where we heading – the governments are already in agreement on the vision and basic values that should be guiding our healthcare systems. Now we are on to practicalities, starting with allowing patients freedom to seek care in the various countries and continuing with co-operation on general issues.

If you want any of the background material you would have to send me an email.

The EU Health Prize for Journalists an exceptionally bad idea.

Commissioner for Health, Androulla Vassiliou has in February as part of the "Europe for patients" campaign announced a prize for journalists. To win certain criteria should to be meet: “The jury will judge the articles in relation to the objectives of promoting Europe for Patients campaign. Therefore, preference will be given to those articles that particularly raise awareness of the issues of Europe for patients' campaign.”. So now journalists can write articles that supports the commissions ambitions and submit them in the hope of winning 5000 euros. That is not the way to foster a good critical and investigating press – its just a way for the commission to pay for PR. What European healthcare needs are more investigating and analytical healthcare journalism. Journalism that dare question if governments and providers are delivering according to claims. Journalists that patient can trust because they know that they write objective. Not journalist that help the EU institutions campaigning.

At least one healthminister supports patientsrights at cross border care

Here you find information about the upcoming ministerial meeting 6-7th of July in Jönköping including a video where the Swedish Minister of Health Göran Hägglund explains his aim with the meeting. His position on the issue of rights of patients to healthcare cross borders is good – wish more states would support his view. But most countries just do not want to allow for choice cross borders.

New EU communication on HIV/AIDS in September

The European Aids Treatment Group (EATG) had in late May their general assembly and elected a new board of Directors. EATG works a in a different way compared to most pan-european patient associations. It is a European network of nationally-based activists defending the treatment-related interests of people living with HIV and AIDS.

They have their work cut out for them since in September the EU Communication on combating HIV/AIDS in the EU and neighbourhood - strategy and second action plan (2010-2014) is supposed to be adopted after a consultation process now in July. More info on that work here. The Communication replaces the 2006-2009 one you find by clicking here.

I hope this can give some new attention to HIV. It is still a disease you die from - it just takes longer than before. And not that long if you live in one of the countries where HIV treatment is not a priority. But what countries that is I cannot tell you and that is because when the World Bank did a measuring and ranking of for example quality of treatments in various countries it in the end was not made public...

Wolfgang Philipp is the person to contact at DG Sanco. If you want to contact EATG Anna Zakowicz from Lithuania is the new Chair with Luis Mendao from Portugal as vice Chair then Thandi Haruperi from the UK is Secretary, Stefan Stojanovic from Macedonia is Treasurer and Alain Volny Anne from France is Director. Acting executive director is Smiljka de Lussigny.

Danish magazine to rock the European healthcare silos?

You should never underestimate the impact Danish magazine Monday Morning has on national politics. Denmark has set the standard for consumer friendly healthcare information in Europe the last couple of years with their public quality ranking of hospitals etc. A lot of these initiatives started soon after MM late 2006 and early 2007 published healthcare reports on consumer friendly healthcare and patient choice. So watch out when they now take on the healthcare sector again! In Marsh, they published a report on the future healthcare with a focus on the healthcare professional. It’s in Danish but you can find it here. The report use the Physiotherapists as an example and starting point for how specific groups in healthcare can ad value and help solve the issues for the future healthcare system. I think they are spot on even if report at a first glance is not very ground breaking.

One of the main points of the report is that in the future there is a need to ensure a better continuity for the patients. The various professions in the healthcare sector just has to start co-operate. One might think this was obvious but its not. Power plays in between various groups are sad to stay in the way. The report also points out that physical activity is the next generation pharmaceuticals and the need to recognize physical activity as an integral part of healthcare. Another point is that new competences are needed to be thought through for the professionals. As an example; training in patient management leading to the profession being “experts in empowerment”. Here its suggested that the physiotherapists should take a lead since it is more obvious for them than others that if patient do not believe in a treatment it does not work and all patients have different needs. The reports ends in taking on the healthcare silo management mentality – it claims that the healthcare sector needs to be looked up!

This may be obvious truths for healthcare policy specialists. However, messaging is not only about the fact and about figures it is also about finding the right channel and audience. This is the right channel: it is a report from a seriously heavy political magazine and think tank. They reach and change the mindset of a wider audience than is common for healthcare reports. Reaching this wider audience is essential for abolishing the silo mentality in care. Since this is not a concern only for the traditional healthcare providers – it is an issue of ensuring that parts that traditionally belongs to social care, the social insurance system etc join forces with the traditional healthcare part. It gives me hope and I’m curious to see the effects. They might certainly with some years delay, really rock European healthcare silos. I hope MM have more in the pipe-line.

Today is World MS Day

The way in which Multiple Sclerosis is managed throughout Europe varies greatly depending on one’s location. To learn more about the situation in your country in the MS Barometern click here

To check the today launched Pocket Guide to the European Code of Good Practice in MS click here

Should the EU deliver the one shop stop for health info?

European Voice yesterday organised a debate on patient choice. Since all agreed that some choice is good and necessary it was more a discussion about how patients can be helped to make the right choice. On the panel was - Mrs. Katja Neubauer, European Commission, Mr Christoph Talheim, European multiple-sclerosis platform, Dr Günther Jonitz, president of the Berlin chamber of physicians, Professor Josep Figueras, European Observatory on Health Systems and Policies.

At one point it felt like one where transferred to the HC Andersen saga The Emperor's New Clothes. Albena Arnaudova from the WHO Brussels asked what’s next with regard to the patient information proposal from the European Commission now in the hands of the European Parliament and Council. It’s quite controversial with some countries finding it way to liberal (!) and some countries not being able to support it since it goes against their constitution on freedom of speech so the panel didn’t really want to take the discussion on the proposal - Katja Neubauer from DG Sanco, in the picture to the left, just declined to comment explaining that it is something that can be said a lot about but it’s a proposal from DG Industry. Then as always in Brussels the question was raised if good unbiased information isn’t something the EU should deliver? Well what could the panellists do but agree and mention the good use patients can have already now of the EU Health Portal and that this of course is a good solution.

All business as usual until Tim King from European Voice, the organizers of the discussion, who himself admitted that he usually do not follow healthcare matters, like the child in the saga who asked why the Emperor is naked asked the panel if the European citizens who usually are not very keen on EU information really would seek and trust healthcare information from the European Commission? Silence.

He might not know healthcare matters but there are surveys supporting his suspicion. Both Euro barometer polls and the Health Consumer Powerhouse 2020 survey shows that patients do not think European Union healthcare information would be trustworthy. Patients seem also here to want to do their own choices with regards to information thus multiple sources are needed …

Swine Flu and the media hype - the role of government

We get regular media hypes around new not so known diseases, Bird Flu, SARS etc. And for good reasons: In end April a global outbreak of Swine Flu was "imminent" according to the WHO. Dr Chang said "It really is all of humanity that is under threat in a pandemic." The European Commission’s highest ranking civil servant on health issues, Robert Madelin Director General at DG Sanco pointed out at the same time that "Every year 2,500 people die of the flu in Europe. The question now is not whether people will die, but whether it will be thousands, tens of thousands or hundreds of thousands.".

When statements like this lands in the inbox of journalists it would be surprising if they didn´t get going telling the world what’s happening. But the effects for other healthcare areas are devastating - how much money is spent now on Swine Flu that could be used better elsewhere? We could hope that the civil servants and politicians before we find the next new disease have stopped following the PR consultancies handbooks for issue management (they are created for corporations and excellent for them just not aimed at being used by governments) and instead try responsible leadership.

Hans Rosling at Gapminder always has interesting statistics:

Trying to find wet AMD treatments info

My grandmother called yesterday and was worried about her deteriorating eye sight. She thinks the issue this time, she has already been operated on both eyes, it might be the so called yellow spot - wet AMD. She now wanted to be a bit prepared before going to the eye clinic and wanted to check if it was correct that there was treatment but it had not been approved jet.

Well some checking showed that since a couple of years back there are a couple of treatments approved across the EU. But its not that strange she didn´t know this - the authorities have a tendency to not inform overly much about new expensive treatments and the industry is basically not allowed to to tell. Now there are of course allways ways to see what medicines are available, how they work and should be used, who produce them etc - in Sweden you find the information on http://www.fass.se/. I checked for approved treatments and Novartis Lucentis and Pfizers Macugen but only Lucentis is reimbursed in Sweden.

So having managed to find out that there is a treatment, and that its approved and also reimbursed could we feel safe that my grandmother gets the treatment? No - its a very expensive treatment so if the regional level have the drug on their lists of drugs allowed to be prescribed by the doctors is next question. Not all think the taxpayers should spend around 10000 Euros a year on medicines to a 93 year old woman... Even though keeping her sight might mean the different between going into a some kind of longterm care or her being able to continue to live on her own. Even if there is an approved treatment its not sure you can argue your case and get it due to for example silo budgeting where costs for longterm care is managed by one authority and costs for pharmaceuticals by another!

(If you live in the UK the RNIB, an patient association for blind and partially sighted people, have a support number if you have been refused treatment: 0845 766 9999.)

Cross border care - Techniker Krankenkasse survey

The Patient Directive for Cross Border Care was voted upon in the European Parliament in April but it doesn’t mean it’s a done deal. It is now in the hands of the European Council and the negotiations are said to not go to well. Most likely we will have to continue the fight for this one, in the capitals to convince the member states, call or mail your Ministry of Health with your view on this, and in the European Parliament to convince the new MEPs at the second reading in the EP.

I found some statistics that might be useful in the discussions: Techniker Krankenkasse in Germany (2n largest statutory health insurance fund) have done an analysis of cross border care by looking into the statistics around the 34000 of their members who did ask for reimbursement in 2007 having used medical services in other EU countries. When taken their figure on members that experienced cross border care 2007 and extrapolate it to all Germans this must mean that 680000 people in Germany received care cross border in the EU. It’s an issue concerning a lot of the European citizens!

40% of those served by the TK having received planned care – the rest acute care. The most popular countries to be treated in where Spain then Austria and Italy, the Czech Republic, Poland, France, Switzerland and Hungary.

The reasons given didn’t differ much from the results in the Eurobarometer 2008 and the Health Consumer Powerhouse survey from 2006 on the same topic. But the no 1 was a surprise for me – admittedly the need for better quality care in other countries might be less of a driver to seek care across the border if you live in Germany compared to some other EU countries…

Greater comfort in treatment 14%, Savings on services for which co-pay­ments are required in Germany 13%, New treatment methods 7%, Treatments not acknowledged in Germany 7%, Facilities with which TK has signed contracts 6%, European specialists, 5%, Doctor of trust based in another EU country 5 %, Special clinics in border regions 3%, Other reason 40%.

Interesting is also that only 5% of those with real experience of healthcare cross border where less satisfied or unsatisfied. It’s when it comes to the billing the problems start. Looking into detail of why there are not satisfied the high additional costs, 30%, were the main reason while low quality where 21 and language problems 18%.

Two other area you often hear a lot about the need of improvement, also from me, seems to be areas that actually are less of an issue at least if you believe this survey: Information deficits on the part of doctors or hospitals 6No follow-up treatment 5, No guarantee claims 4. Multiple answers where possible. Since direct private billing allows higher prices there is no financial incentive for the care providers to ac­cept the EHIC. I.e. EHIC is not accepted by all care providers. So 41 percent of the TK members surveyed stated that they had tried to pay for the treatment with the EHIC but failed. Jet another reason for transparent pricing of healthcare services! That member states are fighting this I really cannot understand.

Find the full survey here

ECJ decides ownership and operation of pharmacies can be restricted to pharmacists alone

The European Court of Justice has today ruled on the infringement procedures against Italy and Germany started by the European Commission. Not in a good way I must say as they declare that ownership and operation of pharmacies can be restricted to pharmacists alone.
And they do it based on such a strange perception of humans that I really don’t know where to start. To quote from their press release:

“It is undeniable that a pharmacist, like other persons, pursues the objective of making a profit. However, as a pharmacist by profession, he is presumed to operate the pharmacy not with a purely economic objective, but also from a professional viewpoint. His private interest connected with the making of a profit is thus tempered by his training, by his professional experience and by the responsibility which he owes, given that any breach of the rules of law or professional conduct undermines not only the value of his investment but also his own professional existence.”

So since the court seems to believe that profits are made by hurting others, not realising that manage any business successfully means ensuring that you have a good reputation and that you follow the rules of law etc we are stuck with the old, inefficient and very costly guilder systems in Europe for pharmaceutical distribution.