In a recent article for CancerWorld, ECPC Director, Antonella Cardone, discussed access to quality cancer care with Tit Albrecht, Senior Health Services and Health Systems Researcher at the National Institute of Public Health of Slovenia. In conversation with Simon Crompton, he asked them both to put forward their arguments regarding the EU cross border healthcare directive.
This directive, officially the ‘Directive on the application of patients’ rights in cross border healthcare’, has been in force across member states for more than five years now and upholds the right of EU citizens to access healthcare in any EU country. As a result, patients can travel abroad specifically for treatment that they are entitled to in their own countries and be reimbursed later on.
The question posed is; how much are patients actually benefitting?
Tit set the scene by highlighting the fact that the motivation behind the directive was to equalize social services, but the difficulties of how this would work with a complex condition like cancer were not defined. It is more suited to simple, he feels, to one-off procedures. It becomes a lot more complicated with long-term, expensive processes like cancer treatment which can cost up to 100,000 euro but can be impossible to predict. There are also extra costs like travel and accommodation, which are not included in the directive. He argues that where cancer is concerned, there is a great deficiency and encourages inequality with only those with a higher socio-economic status benefitting.
While Antonella agrees with much that Tit says, she disagrees that the negatives are enough to see that the directive is not necessary and more so a reason to strive to improve it. It is potentially very valuable for cancer patients if it can be implemented properly. This is what the European Cancer Patient Coalition aims for. While recognising that there are social disparities between the wealth and poorer individuals, she highlights that each country of origin could allocate a budget to reimburse the travel and accommodation costs for its citizens. She also raises attention to the fact that there may be different medications available in different countries and once patients have returned home, the medication may not be available or reimbursed in their home country. This highlights the need for cross-border harmonization.
Alternatively, Tit feels that a budget allocated could be better used for capacity building at home and believes that funds were less likely to be earmarked for cancer treatment abroad as favoring one condition over another would not be allowed under law. Drug reimbursement from country to country would have to be harmonized and Tit believes that such disparities, due to different economies, cannot be overcome in the short term.
As another route and an alternative to the directive, Tit believes the European Reference Networks offer more hope to patients. They were set up to ‘’facilitate discussion on complex or rare conditions that require highly specialized knowledge and treatment’’ and work on helping countries build their capacity in cancer care. This, he believes, would be better long term in helping with training and education of professionals and carers.
The problem with this approach, as described by Antonella, is that patients need treatment now and cannot wait for a better situation. The directive enables immediate treatment because its gives people that right. Capacity building should also be underway but for now the directive is an immediate answer. While recognising that we should be pushing more towards this, they too also have their problems with funding and sustainability. While training is crucial, this too can take time and is not an immediate answer.
In conclusion, while both believe that the directive should exist but has major flaws, there are many interesting points to be explored. There is no doubt that it should be improved but it is a good starting point with both capacity building at a national level and at a European level needed. As pointed out by Antonella, work on all areas may be slow but ‘’the directive establishes that all patients have the right to access the best treatment available in Europe regardless of the limitations of their own health system. This could be a powerful lever to drive up quality of care for everyone’’.
So, how can we move forward? Antonella sees that harmonizing Health Technology Assessment can help to avoid delays and duplications and allow patients to move between countries and be reimbursed at the same levels everywhere. This will also help promote equality.
What is clear is that there is a need for National and EU funding, high quality assurance and training of professionals. As stated by Antonella, there is still a lot of work to be done. ‘’We want all patients across Europe to receive the best quality of care available’’ and here at ECPC, this is what we strive to achieve.
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