What information do patients want when choosing a hospital at home or abroad? A case study from Germany

Eurohealth OBSERVER Eurohealth incorporating Euro Observer — Vol.19 | No.4 | 2013 14 Conclusion Overall, the provisions on medical prescriptions in the Directive do safeguard patient safety. Yet, clear information and guidelines for pharmacists and prescribers on the legal framework are indispensable to ensure effective implementation. References 1 Directive 2011/24/EU of the European Parliament and the Council 9 March 2011 on the application of patients’ rights in cross-border healthcare. Official Journal of the European Union, L 88/45 – 65. 2 European Parliament and Council. Article 71(2) of Directive 2001/83/EC of 6 November 2001. 3 European Commission. Implementing Directive 2012/52/EU of 20 December 2012 laying down measures to facilitate the recognition of medical prescriptions issued in another Member State. Official Journal of the European Union, L 356/68 – 70, 22 December 2012. 4 San Miguel L, Baeten R, Remmen R, et al. Obstacles to the recognition of medical prescriptions issued in one EU country and presented in another: An observational study. European Journal of Public Health 2013. doi: 10.1093/eurpub/ckt071. 5 San Miguel L, Augustin U, Busse R, et al. EU wide recognition of pharmaceutical prescriptions: A comparison of legislation and practices in 5 Member States. Health Policy. Available at: http://dx.doi.org/10.1016/j.healthpol.2013.11.003. WHAT INFORMATION DO PATIENTS WANT WHEN CHOOSING A HOSPITAL AT HOME OR ABROAD? A CASE STUDY FROM GERMANY By: Michela Tinelli, Zlatko Nikoloski and Dimitra Panteli Summary: The European Union (EU) is keen to promote patients’ rights, and to ensure that an informed choice is pursued when seeking health care in EU Member States. The 2011 Directive on the application of patients’ rights in cross-border health care is aimed at supporting the achievement of these goals. This article investigates German patients’ experience regarding their access and use of quality information when choosing hospital care in their own country and abroad. The findings could be used to inform the implementation of the Directive and the provision of quality information to patients, via the establishment of National Contact Points. Keywords: Cross-Border Care, Patients’ Rights, Patients’ Choice, Hospital Care, Quality Information Michela Tinelli is Research Fellow and Zlatko Nikoloski is Research Officer at LSE Health and Social Care, The London School of Economics and Political Science, London, United Kingdom. Dimitra Panteli is Research Fellow at the Department of Health Care Management, Berlin University of Technology, Germany. Email: m.tinelli@lse.ac.uk Introduction Ensuring patients have access to quality information is crucial to help them make informed choices, not only when they are in their home country, but also before going abroad for health care. One of the key objectives of the European Union's (EU) 2011 Directive on the application of patients’ rights in cross-border healthcare is to make sure that people have clear information on their rights to Cross- Border Care and relevant knowledge on quality and safety standards enforced in the country of interest, as well as specific medical, organisational and financial aspects of the health care services and the treatment options on offer. 1 Such information should be provided by so- called National Contact Points (NCPs) which are to be established in all Member States (MS). This case study investigated what type of information German patients accessed and what source they used when choosing a hospital for their care. Two scenarios were compared, one examining patients seeking care in their own country Eurohealth OBSERVER Eurohealth incorporating Euro Observer — Vol.19 | No.4 | 2013 15 and one investigating patients planning to receive care in another MS. Two separate patient surveys conducted in Germany in late 2012 were used for this purpose. Scenario 1 – Patients seeking care in their own country The Making Choice in Health Care Survey collected data from a series of EU countries, including Germany. 2 , 3 A total of 128 German patients from two General Practitioner (GP) practices completed the survey whilst waiting for their consultation. They were asked about their personal experience of accessing information when choosing hospital care. Key findings are summarised in Table 1. Patients used different sources of information when making a decision on their hospital care, be it media (i.e. newspaper, internet or television), personal contacts (i.e. friends, family, or neighbours) or health care providers. The latter were reported as the preferred source of information compared with the others (health care professionals (74%), personal (3 – 21%), and media (5 – 12%)) for care received in Germany. Patients were also interested in a variety of topics regarding their care, including health-related information such as quality standards (e.g. hospital performance or professional qualifications), safety (e.g. risk of treatment and infection rates) and organisation-related information (e.g. how to contact the health care provider and its location). Health-related and organisational-related information were equally important when making choices on hospital care (e.g. “professional qualifications” and “how to contact the health care providers” accounted for 65% of the responses). Scenario 2 – Patients planning their care abroad The Europa-Survey 2012 was designed by the Techniker Krankenkasse (TK) sickness fund in collaboration with the Berlin University of Technology to collect information from the 45,000 insured individuals who obtained services abroad and had them processed by the fund in 2010. 3 Of the 17,543 respondents, about 19% (3,307/17,543) reported having received planned care abroad, and 11% (1,888/17,543) indicated that they used cross-border services on a regular basis. The majority of those receiving planned care at a hospital abroad (mainly seeking care for musculoskeletal conditions, renal failure (dialysis), or cancer) were keen to access guidance on their rights to Cross- Border Care (59%; see Table 1). They reported that health care professionals were used as sources of information more frequently than personal contacts or media (health care professionals (49%), personal (18%), media (22%)). Most respondents used services provided by the health insurer as a source of information before seeking hospital care abroad (62% contacted TK customer service;* 42% contacted the TK hotline†). Information related to health (e.g. hospital performance (38%) and professional qualifications (41%)) and financial issues (e.g. coverage of costs by insurers (42%) and reimbursement modalities (49%)) was sought more frequently by patients compared with organisation-related information, in particular “language of staff” (7%). Scenarios 1 and 2 For both patients seeking care in their own country (Scenario 1) and planning care abroad (Scenario 2) health care professionals were reported as a preferred source of information compared with personal contacts or media. When looking * Local contact points for those insured by the TK; they can be contacted by phone or visited by appointment. † 24/7 hotline providing information on TK services free for national calls; however, it can also be reached from outside Germany. Table 1: Sources and types of information sought by patients when seeking hospital care at home and abroad Scenario 1 Hospital care in their home country (Making Choice in Health Care Survey; percentage of responses) Scenario 2 Planned Hospital care abroad (The Europa-Survey 2012; percentage of responses) Source of information Media (Newspaper/Internet/Television) 12 / 20 / 5 3 / 19 / n.a. Personal (Friends/Family/Neighbours) 21 / 20 / 3 18 Health care providers 74 40 Health insurers (TK customer service/TK hotline) n.a. 62 / 42 Type of information Health-related Professional qualifications Risk of treatment/Rates of infection. Quality of medical care/Hospital performance 65 57 47 41 3 38 Organisational-related (How to contact the health care provider/Location/ Language staff) 65 / 50 / n.a. n.a. / n.a. / 7 Financial-related (Savings, Coverage of costs by insurer, Reimbursement modalities) n.a. 7 / 42 / 49 Source: Authors. Note: n.a = not available as the survey did not collect this particular information. Eurohealth OBSERVER Eurohealth incorporating Euro Observer — Vol.19 | No.4 | 2013 16 at the type of information accessed, health-related and organisation-related information were valued by resident patients, whilst patients seeking care abroad valued information related to health and financial issues (see Table 1). Results from the German case study showed that patients do value the support received by health care providers and health care insurers when making choices about health care, and want to access clear information about their rights to Cross- Border Care when planning to obtain care abroad. On the basis of the German case study more effort should be made to help patients seeking treatment in another MS to make contact with the health care providers from the MS of treatment, and to inform the referring health care providers in their home country about the potential health care opportunities of patients when they go abroad. According to the Directive, health insurers from the MS of treatment are not expected to provide information to patients coming from other MS, although evidence suggests that they do so for their own patients when the latter seek care abroad. In addition, whether health care providers in the MS of treatment are already used to sharing quality information with resident patients may have an impact when supporting patients to make informed choices about health care available in another MS. Conclusion Despite differences in the survey instruments adopted to describe the two separate scenarios, it is confirmed that both resident and cross-border patients want to be informed on multiple health- related aspects of care, most of them equally important between the two groups. Surprisingly, patients seem to be more worried about the risk of treatment and infection rates when receiving care in their home country than when seeking care abroad. As expected, patients going abroad are more likely to seek information on financial issues from their health insurer, whilst patients looking for hospital treatment domestically, in principle, should already have this information. The detailed results of the case study could inform possible challenges and opportunities when setting up NCPs in MSs. References 1 Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare. Official Journal, of the European Union L 88/45 – 65. 2 Tinelli M, Nikoloski Z, Kumpunen, S, Pribakovic Brinovec R, Wittgens K, Dickmann P. How do patients choose their preferred healthcare provider? A series of case studies from Europe. BMJ 2013. Electronic letter to the editor. Available at: http://www.bmj.com/ content/346/bmj.f2614/rr/652284 3 European Union Cross Border Care Collaborations project WP5 – Work package on patient choice and public reporting on quality of care. Submitted to the European Commission. London: LSE Health and Social Care mimeo, April 2013. Boosting innovation and cooperation in European cancer control: new Observatory joint publication Edited by: JM Martin-Moreno, T Albreht and S Radoš Krnel Number of pages: xix + 266; ISBN: 978-961-6911-22-1 Available at: www.euro.who.int/__data/assets/pdf_ file/0014/235211/Boosting-Innovation-and-Cooperation-in- European-Cancer-Control.pdf The cancer burden in Member States of the European Union has been on the rise for well over 30 years, with further increases expected in light of projected population ageing. Politicians and experts in Europe have long been seeking models to help address this growing public health challenge. Edited by Jose M. Martin-M oreno Tit Albreht Sandra Radoš K rnel Boosting Innovation and Cooperation in Europ ean Cancer Control Key Findings from the European Par tnership for Action Against Cancer         ISBN 978-961- 6911-21-4 The European C ommission propo sed the Europea n Partnership for Action Against Cancer (EPAAC) for the period 20 09–2013 to supp ort Member Stat es in their efforts to tackle cancer, pr oviding a framew ork for identifying and sharing info rmation, capacity and expertise, an d engaging relev ant stakeholders across the Euro pean Union in a collective effort to control cancer. W ith activities runn ing from early 20 11 to early 2014 , the EPAAC Joint Action has span ned work in the f ields of cancer p revention and he alth promotion; health communication, screening and e arly diagnosis; he althcare, coordination of c ancer research; c ancer information and data; and N ational Cancer Control Program mes. This volume desc ribes a selection of sub-projects w ithin the EPAAC Joint Action that represent outstan ding examples o f cooperation an d policy-orientate d innovation in th e various fields cov ered. This book was m ade possible by collaboration bet ween the Nation al Institute of Pub lic Health of the Rep ublic of Slovenia and the Europea n Observatory on Health Systems and Policies, alon g with EPAAC pa rtner institutions. The EPAAC Join t Action has received funding from the Europe an Union in the f ramework of the Health Program me. The editors Jose M. Martin-Mo reno is Professor o f Preventive Med icine and Public Health at the University of Vale ncia, Spain; Dire ctor of the Qualit y Assurance Unit at the University Clinical Hospital, Valencia; and Ad visor to the Worl d Health Organiz ation's Regional Office for Europe , Copenhagen, D enmark. Tit Albreh t is Head of the Cen tre for Health System Analyses at the National I nstitute of Public Health of the Re public of Sloveni a and Assistant Pr ofessor of Public Health at the Me dical Faculty of t he University of Ljubljana. Sandra R adoš Krnel is Head of the Research and Project Man agement Unit at the National In stitute of Public H ealth of the Repu blic of Slovenia. M artin-M oreno, A lbreht, R adoš K rnel Boosting Innovation and Cooperation in European Cancer Control Cancer b-f cover (original colours )_WHO Cancer cover (1).qxd 06 /11/2013 23:28 Page 1 This new book explores some of the innovative strategies being deployed against cancer in Europe and how international collaboration has assisted in combating the cancer burden. The research is a product of the European Partnership for Action Against Cancer (EPAAC) and it highlights some outstanding examples of how cooperation between national and international entities, as well as policy-oriented innovation, are contributing to the collective effort to control cancer.