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Irene A Glinos - One of the best experts on this subject based on the ideXlab platform.
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worrying about the wrong thing Patient Mobility versus Mobility of health care professionals
Journal of Health Services Research & Policy, 2012Co-Authors: Irene A GlinosAbstract:Patients and health care professionals in the European Union (EU) benefit from legislation on the freedom of movement between Member States. In relative terms, many more doctors and nurses move within the EU than Patients. Despite this, Patient Mobility has attracted more attention from policy-makers and the public while workforce Mobility remains largely ignored. This is paradoxical and imprudent. On the one hand, the scope of Patient Mobility is narrow and self-limited. On the other hand, current and forecasted health care workforce shortages across the EU, global competition for health care professionals, and current economic pressures are all good reasons to start worrying about the Mobility of health care professionals and its implications for health systems.
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travelling home for treatment and eu Patients rights to care abroad results of a survey among german students at maastricht university
Health Policy, 2012Co-Authors: Irene A Glinos, Nora Doering, Hans MaarseAbstract:Abstract Empirical evidence on Patient Mobility in Europe is lacking despite widespread legal, policy and media attention which the phenomenon attracts. This paper presents quantitative data on the health care seeking behaviour of German students at Maastricht University in the Netherlands. A cross-sectional survey design was applied with a mixed-methods approach including open and closed questions. Questionnaire items were based on a theoretical model of Patient Mobility and input from focus group discussions with German students living in Maastricht. 235 valid surveys were completed, representing ca. 8% of the target population. Data collection took place in Oct–Dec 2010. Of respondents who received medical care over the last two years, 97% returned to Germany; of these, 76% travelled to their home city for medical treatment. 72% received care only in Germany, i.e. not even once in Maastricht. Distance partly influenced whether students travelled to Germany, returned home or stayed in Maastricht, and the type of care accessed. Key motivations were familiarity with home providers/system, and reimbursement issues. In the context of the new EU Directive on Patients’ rights, the findings call into question whether Europeans use entitlements to cross-border care and what the real potential of Patient Mobility is. The results demonstrate the existence and magnitude of return movements as a sub-group of Patient Mobility.
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a typology of cross border Patient Mobility
Health & Place, 2010Co-Authors: Irene A Glinos, Rita Baeten, Matthias Helble, Hans MaarseAbstract:Abstract Based on systematic observation and analysis of available evidence, we propose a typology of cross-border Patient Mobility (rather than the so-called ‘medical tourism’) defined as the movement of a Patient travelling to another country to seek planned health care. The typology is constructed around two dimensions based on the questions ‘why do Patients go abroad for planned health care?’ and ‘how is care abroad paid for?’ Four types of Patient motivations and two funding types have been identified. Combined in a matrix, they make eight possible scenarios of Patient Mobility each illustrated with international examples.
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purchasing health services abroad practices of cross border contracting and Patient Mobility in six european countries
Health Policy, 2010Co-Authors: Irene A Glinos, Rita Baeten, Hans MaarseAbstract:Abstract Objectives Contracting health services outside the public, statutory health system entails purchasing capacity from domestic non-public providers or from providers abroad. Over the last decade, these practices have made their way into European health systems, brought about by performance-oriented reforms and EU principles of free movement. The aim of the article is to explain the development, functioning, purposes and possible implications of cross-border contracting. Methods Primary and secondary sources on purchasing from providers abroad have been collected in a systematic way and analysed in a structured frame. Results We found practices in six European countries. The findings suggest that purchasers from benefit-in-kind systems contract capacity abroad when this responds to unmet demand; pressures domestic providers; and/or offers financial advantages, especially where statutory purchasers compete. Providers which receive Patients tend to be located in countries where treatment costs are lower and/or where providers compete. The modalities of purchasing and delivering care abroad vary considerably depending on contracts being centralised or direct, the involvement of middlemen, funding and pricing mechanisms, cross-border pathways and volumes of Patient flows. Conclusions The arrangements and concepts which cross-border contracting relies on suggest that statutory health purchasers, under pressure to deliver value for money and striving for cost-efficiency, experiment with new ways of organising health services for their populations.
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health systems governance in europe enabling Patient Mobility in the eu between free movement and coordination
2010Co-Authors: Willy Palm, Irene A GlinosAbstract:Introduction Free movement of Patients – or Patient Mobility, as it is commonly referred to – implies people accessing health care services outside their home state. Although health care normally is delivered close to where people live, in some instances the need for medical care arises while away from home or Patients decide to seek care elsewhere. Patients’ readiness to travel for care, especially across borders, is determined by a mix of factors linked to the specific situation of the Patient, to the specific medical needs and to availability of care at home and abroad. Motivations for travelling abroad for care vary from the search for more timely, better quality or more affordable health care to treatment responding better to the Patient's wants or needs – including when care is inexistent or even prohibited at home. While citizens in the EU, in principle, are free to seek health care wherever they want and from whatever provider available, in practice this freedom is limited by their ability to pay for it or by the conditions set out by public and private funding systems for health care. Traditionally, countries have confined statutory cover for health care delivered to their population to providers established in their territory. Whereas initially, bilateral conventions derogated from this territoriality principle to ensure access to care for people living and working in different Member States, a more general derogation was established in the context of European integration under Article 42 EC, based on the fundamental principle of free movement of persons.
Hans Maarse - One of the best experts on this subject based on the ideXlab platform.
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travelling home for treatment and eu Patients rights to care abroad results of a survey among german students at maastricht university
Health Policy, 2012Co-Authors: Irene A Glinos, Nora Doering, Hans MaarseAbstract:Abstract Empirical evidence on Patient Mobility in Europe is lacking despite widespread legal, policy and media attention which the phenomenon attracts. This paper presents quantitative data on the health care seeking behaviour of German students at Maastricht University in the Netherlands. A cross-sectional survey design was applied with a mixed-methods approach including open and closed questions. Questionnaire items were based on a theoretical model of Patient Mobility and input from focus group discussions with German students living in Maastricht. 235 valid surveys were completed, representing ca. 8% of the target population. Data collection took place in Oct–Dec 2010. Of respondents who received medical care over the last two years, 97% returned to Germany; of these, 76% travelled to their home city for medical treatment. 72% received care only in Germany, i.e. not even once in Maastricht. Distance partly influenced whether students travelled to Germany, returned home or stayed in Maastricht, and the type of care accessed. Key motivations were familiarity with home providers/system, and reimbursement issues. In the context of the new EU Directive on Patients’ rights, the findings call into question whether Europeans use entitlements to cross-border care and what the real potential of Patient Mobility is. The results demonstrate the existence and magnitude of return movements as a sub-group of Patient Mobility.
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a typology of cross border Patient Mobility
Health & Place, 2010Co-Authors: Irene A Glinos, Rita Baeten, Matthias Helble, Hans MaarseAbstract:Abstract Based on systematic observation and analysis of available evidence, we propose a typology of cross-border Patient Mobility (rather than the so-called ‘medical tourism’) defined as the movement of a Patient travelling to another country to seek planned health care. The typology is constructed around two dimensions based on the questions ‘why do Patients go abroad for planned health care?’ and ‘how is care abroad paid for?’ Four types of Patient motivations and two funding types have been identified. Combined in a matrix, they make eight possible scenarios of Patient Mobility each illustrated with international examples.
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purchasing health services abroad practices of cross border contracting and Patient Mobility in six european countries
Health Policy, 2010Co-Authors: Irene A Glinos, Rita Baeten, Hans MaarseAbstract:Abstract Objectives Contracting health services outside the public, statutory health system entails purchasing capacity from domestic non-public providers or from providers abroad. Over the last decade, these practices have made their way into European health systems, brought about by performance-oriented reforms and EU principles of free movement. The aim of the article is to explain the development, functioning, purposes and possible implications of cross-border contracting. Methods Primary and secondary sources on purchasing from providers abroad have been collected in a systematic way and analysed in a structured frame. Results We found practices in six European countries. The findings suggest that purchasers from benefit-in-kind systems contract capacity abroad when this responds to unmet demand; pressures domestic providers; and/or offers financial advantages, especially where statutory purchasers compete. Providers which receive Patients tend to be located in countries where treatment costs are lower and/or where providers compete. The modalities of purchasing and delivering care abroad vary considerably depending on contracts being centralised or direct, the involvement of middlemen, funding and pricing mechanisms, cross-border pathways and volumes of Patient flows. Conclusions The arrangements and concepts which cross-border contracting relies on suggest that statutory health purchasers, under pressure to deliver value for money and striving for cost-efficiency, experiment with new ways of organising health services for their populations.
Rita Baeten - One of the best experts on this subject based on the ideXlab platform.
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the role of the 2011 Patients rights in cross border health care directive in shaping seven national health systems looking beyond Patient Mobility
Health Policy, 2018Co-Authors: Natasha Azzopardimuscat, Rita Baeten, Timo Clemens, Triin Habicht, Ilmo Keskimaki, Iwona Kowalskabobko, Anna Sagan, Ewout Van GinnekenAbstract:Abstract Reports on the implementation of the Directive on the application of Patients' Rights in Cross-border Healthcare indicate that it had little impact on the numbers of Patients seeking care abroad. We set out to explore the effects of this directive on health systems in seven EU Member States. Key informants in Belgium, Estonia, Finland, Germany, Malta, Poland and The Netherlands filled out a structured questionnaire. Findings indicate that the impact of the directive varied between countries and was smaller in countries where a large degree of adaptation had already taken place in response to the European Court of Justice Rulings. The main reforms reported include a heightened emphasis on Patient rights and the adoption of explicit benefits packages and tariffs. Countries may be facing increased pressure to treat Patients within a medically justifiable time limit. The implementation of professional liability insurance, in countries where this did not previously exist, may also bring benefits for Patients. Lowering of reimbursement tariffs to dissuade Patients from seeking treatment abroad has been reported in Poland. The issue of discrimination against non-contracted domestic private providers in Estonia, Finland, Malta and The Netherlands remains largely unresolved. We conclude that evidence showing that Patients using domestic health systems have actually benefitted from the directive remains scarce and further monitoring over a longer period of time is recommended.
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a typology of cross border Patient Mobility
Health & Place, 2010Co-Authors: Irene A Glinos, Rita Baeten, Matthias Helble, Hans MaarseAbstract:Abstract Based on systematic observation and analysis of available evidence, we propose a typology of cross-border Patient Mobility (rather than the so-called ‘medical tourism’) defined as the movement of a Patient travelling to another country to seek planned health care. The typology is constructed around two dimensions based on the questions ‘why do Patients go abroad for planned health care?’ and ‘how is care abroad paid for?’ Four types of Patient motivations and two funding types have been identified. Combined in a matrix, they make eight possible scenarios of Patient Mobility each illustrated with international examples.
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The Europeanisation of national health care systems: creative adaptation in the shadow of Patient Mobility case law
2010Co-Authors: Rita Baeten, Bart Vanhecke, Michael CoucheirAbstract:This paper examines the actual (as opposed to potential) impact of European Integration on national health care systems as a result of rulings of the European Court of Justice (ECJ) with regard to Patient Mobility. These rulings provoked a number of similar but far from identical responses across the Member States. Adaptation processes are indeed not straightforward. Member States, confronted with the deregulatory dynamic of the applications of the free movement rules, try to uphold their steering instruments as much as they can, whilst allowing Patients to be treated abroad. This empirically driven paper provides a detailed assessment of how the Europeanisation of health care systems through ECJ cases sets off a dynamic process of creative adaptation at the national level. Through leverage (and some learning) actors alter the policies and politics of domestic health care systems. Factors that may explain the considerable differences between the reactions of Member States - also between Member States with similar health systems - include the likelihood of an exodus of Patients, the compatibility between the European Union Law (EU) and national health care systems as well as the presence of reforms in the domestic system. The process of creative responses to EU law includes – for Member States confronted with long waiting lists – attempts to reduce the demand for exit, for example through contracting the domestic commercial sector. The study furthermore shows the agency by domestic actors who draw legitimacy from the EU setting to reinforce their position (or acquire one) at the national level. It thereby confirms the assertion that the effects of these ECJ rulings regarding Patient Mobility go beyond the narrow issue of Patient Mobility itself and that it can have an important impact on the domestic health care systems.
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purchasing health services abroad practices of cross border contracting and Patient Mobility in six european countries
Health Policy, 2010Co-Authors: Irene A Glinos, Rita Baeten, Hans MaarseAbstract:Abstract Objectives Contracting health services outside the public, statutory health system entails purchasing capacity from domestic non-public providers or from providers abroad. Over the last decade, these practices have made their way into European health systems, brought about by performance-oriented reforms and EU principles of free movement. The aim of the article is to explain the development, functioning, purposes and possible implications of cross-border contracting. Methods Primary and secondary sources on purchasing from providers abroad have been collected in a systematic way and analysed in a structured frame. Results We found practices in six European countries. The findings suggest that purchasers from benefit-in-kind systems contract capacity abroad when this responds to unmet demand; pressures domestic providers; and/or offers financial advantages, especially where statutory purchasers compete. Providers which receive Patients tend to be located in countries where treatment costs are lower and/or where providers compete. The modalities of purchasing and delivering care abroad vary considerably depending on contracts being centralised or direct, the involvement of middlemen, funding and pricing mechanisms, cross-border pathways and volumes of Patient flows. Conclusions The arrangements and concepts which cross-border contracting relies on suggest that statutory health purchasers, under pressure to deliver value for money and striving for cost-efficiency, experiment with new ways of organising health services for their populations.
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Patient Mobility in the european union
BMJ, 2007Co-Authors: Helena Legidoquigley, Rita Baeten, Irene A Glinos, Martin MckeeAbstract:Getting healthcare in another European country should be straightforward, but it often creates problems for both Patients and healthcare systems
Natasha Azzopardimuscat - One of the best experts on this subject based on the ideXlab platform.
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the role of the 2011 Patients rights in cross border health care directive in shaping seven national health systems looking beyond Patient Mobility
Health Policy, 2018Co-Authors: Natasha Azzopardimuscat, Rita Baeten, Timo Clemens, Triin Habicht, Ilmo Keskimaki, Iwona Kowalskabobko, Anna Sagan, Ewout Van GinnekenAbstract:Abstract Reports on the implementation of the Directive on the application of Patients' Rights in Cross-border Healthcare indicate that it had little impact on the numbers of Patients seeking care abroad. We set out to explore the effects of this directive on health systems in seven EU Member States. Key informants in Belgium, Estonia, Finland, Germany, Malta, Poland and The Netherlands filled out a structured questionnaire. Findings indicate that the impact of the directive varied between countries and was smaller in countries where a large degree of adaptation had already taken place in response to the European Court of Justice Rulings. The main reforms reported include a heightened emphasis on Patient rights and the adoption of explicit benefits packages and tariffs. Countries may be facing increased pressure to treat Patients within a medically justifiable time limit. The implementation of professional liability insurance, in countries where this did not previously exist, may also bring benefits for Patients. Lowering of reimbursement tariffs to dissuade Patients from seeking treatment abroad has been reported in Poland. The issue of discrimination against non-contracted domestic private providers in Estonia, Finland, Malta and The Netherlands remains largely unresolved. We conclude that evidence showing that Patients using domestic health systems have actually benefitted from the directive remains scarce and further monitoring over a longer period of time is recommended.
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the impact of the eu directive on Patients rights and cross border health care in malta
Health Policy, 2015Co-Authors: Natasha Azzopardimuscat, Christoph Aluttis, Kristine Sorensen, Roderick Pace, Helmut BrandAbstract:The Patients' rights and cross-border health care directive was implemented in Malta in 2013. Malta's transposition of the directive used the discretionary elements allowable to retain national control on cross-border care to the fullest extent. This paper seeks to analyse the underlying dynamics of this directive on the Maltese health care system through the lens of key health system stakeholders. Thirty-three interviews were conducted. Qualitative content analysis of the interviews reveals six key themes: fear from the potential impact of increased Patient Mobility, strategies employed for damage control, opportunities exploited for health system reform, moderate enhancement of Patients' rights, negligible additional Patient Mobility and unforeseen health system reforms. The findings indicate that local stakeholders expected the directive to have significant negative effects and adopted measures to minimise these effects. In practice the directive has not affected Patient Mobility in Malta in the first months following its implementation. Government appears to have instrumentalised the implementation of the directive to implement certain reforms including legislation on Patients' rights, a health benefits package and compulsory indemnity insurance. Whilst the Maltese geo-demographic situation precludes automatic generalisation of the conclusions from this case study to other Member States, the findings serve to advance our understanding of the mechanisms through which European legislation on health services is influencing health systems, particularly in small EU Member States.
Juliane C. Lessard - One of the best experts on this subject based on the ideXlab platform.
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keratin 16 null mice develop palmoplantar keratoderma a hallmark feature of pachyonychia congenita and related disorders
Journal of Investigative Dermatology, 2012Co-Authors: Juliane C. LessardAbstract:Keratin 16 (KRT16 in human, Krt16 in mouse), a type I intermediate filament protein, is constitutively expressed in epithelial appendages and is induced in the epidermis upon wounding and other stressors. Mutations altering the coding sequence of KRT16 cause pachyonychia congenita (PC), a rare autosomal dominant disorder characterized by hypertrophic nail dystrophy, oral leukokeratosis, and palmoplantar keratoderma (PPK). PPK associated with PC is extremely painful and compromises Patient Mobility, making it the most debilitating PC symptom. In this study, we show that, although inherited in a recessive manner, the inactivation of Krt16 in mice consistently causes oral lesions as well as PPK-like hyperkeratotic calluses on Krt16−/− front and hind paws, which severely compromise the animals' ability to walk. Our findings call into question the view that PC-related PPK arises exclusively as a gain-of-function on account of dominantly acting mutated keratins, and highlight the key role of modifiers in the clinical heterogeneity of PC symptoms.
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Keratin 16–Null Mice Develop Palmoplantar Keratoderma, a Hallmark Feature of Pachyonychia Congenita and Related Disorders
The Journal of investigative dermatology, 2012Co-Authors: Juliane C. LessardAbstract:Keratin 16 (KRT16 in human, Krt16 in mouse), a type I intermediate filament protein, is constitutively expressed in epithelial appendages and is induced in the epidermis upon wounding and other stressors. Mutations altering the coding sequence of KRT16 cause pachyonychia congenita (PC), a rare autosomal dominant disorder characterized by hypertrophic nail dystrophy, oral leukokeratosis, and palmoplantar keratoderma (PPK). PPK associated with PC is extremely painful and compromises Patient Mobility, making it the most debilitating PC symptom. In this study, we show that, although inherited in a recessive manner, the inactivation of Krt16 in mice consistently causes oral lesions as well as PPK-like hyperkeratotic calluses on Krt16−/− front and hind paws, which severely compromise the animals' ability to walk. Our findings call into question the view that PC-related PPK arises exclusively as a gain-of-function on account of dominantly acting mutated keratins, and highlight the key role of modifiers in the clinical heterogeneity of PC symptoms.