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“By Passing the Directive the Trouble Starts”
Hanjo Allinger is executive director of the Institute of Empirical Economic and Social Research INWISO in Cologne. MEDICA.de talked to the health economist about patients’ rights, quality standards and unsubstantiated horror scenarios.
MEDICA.de: Mr. Allinger, would you undergo surgery abroad today?
Hanjo Allinger: I would choose the best doctor no matter where he works. Most likely, I had to pay for the surgery all alone if it was not in Germany. Clinical treatments abroad have to be allowed by health insurances in advance, which hardly happens. Only if the patient has to wait unacceptably long, he will have the right of clinical treatment abroad. In contrast to that, health insurances are obliged to reimburse costs for out-patient care up to the level it would have cost in the home country. Yet, the insurant has to pay additional administration charges.
MEDICA.de: The EU Commission discusses a directive which is to reduce obstacles to patients seeking healthcare in a Member State. What could be improved by the directive?
Allinger: By summarising the established law in a comprehensible form the directive would provide more transparency. If the insurants want to inform themselves about their rights today, they will have to study the judgments of the European Court of Justice on patients’ rights in cross border healthcare.
MEDICA.de: The new directive aims to ensure quality and safety standards for medical treatments.
Allinger: At least, the national standards are to get more transparent. Though, in my opinion, it will hardly be possible to ensure quality and safety standards throughout Europe. Probably, a tightened liability law might put more pressure on physicians to mind quality. However, you will wrong doctors abroad, if you suspect them of lower quality in general.
MEDICA.de: Will German health insurances send their insurants abroad in future because of cheaper medical treatments?
Allinger: No, that is an absolutely unsubstantiated horror scenario. Patients have to be transportable and not every insurant feels comfortable with a treatment in a foreign country. Remember, we are talking about human beings and not about cars. The patient is free in his decision. Nobody can tell him where to get treated.
MEDICA.de: Who benefits from more patients’ mobility in Europe?
Allinger: The individual patient always benefits from his greater freedom of choice in medical treatments, but health insurances do not necessarily. In Austria, for example, only a few physicians are licensed by health insurances in order to keep the insurant from making use of insurance benefits. If the insurant wants to get treated, he has to accept long ways up to 50 kilometres to the next medical specialist licensed by health insurance. That is time-consuming and leads to the reduction of treatments in general. For this reason, Austrians living in the frontier area often have treatment in Germany but the Austrian health insurance has to pay for it. Thus, additional costs might be generated as the insurant probably would not have made use of the medical service in his home country.
MEDICA.de: You oppose the current version of the EU-directive. Which requirements does it still have to meet?
Allinger: The directive should consider the enormous differences in national health systems. Obviously, these have not got around between politicians yet. By passing the directive the trouble only starts as the proposals of the EU Commission do not meet the huge challenge which is to coordinate all national health systems. A well-thought directive has to build bridges between the national systems in order to avoid unequal financial burdens.
MEDICA.de: Do you believe that a closer cooperation in healthcare will improve the efficiency of all European health systems?
Allinger: Provided that the cooperation is coordinated in a reasonable and suitable way, quality might get better and costs might be reduced.
The interview was conducted by Sonja Endres.