To Brussels on the 26th and 27th April to participate in two of the four workshops we are organising on behalf of the European Commission to explore the impact of its proposed new strategy on health services. The idea was to prepare a document setting out the current situation in Member States and then invite a group of senior policy makers to consider the implications of the Commissions proposals – which would have been fine except that the Commission doesn’t actually have any concrete proposals yet. Still, it was a very good opportunity to thrash around some very difficult questions that have defied the combined intellectual might of Europe’s health policy community for at least a decade.
The two I was involved with were on quality of care and patients’ rights. I had also been involved in preparing the report on quality of care. This was a combined effort by three EU projects, Europe for Patients (focusing on patient mobility), MARQuIS (on quality of care, and SIMPATIE (on patient safety.
A key question we had to grapple with was who should be responsible for the quality of care provided when a patient from country A is sent by his or her health authority/ fund to country B. One thing was clear – it could not be the patient as, given the major asymmetries in information, patients are simply not in a position to assess whether the care they get is of good quality. There are far too many examples of smooth-talking charlatans helping vulnerable patients to part with their money. Even with the (totally unregulated) internet, except for a small number of people with longstanding chronic illnesses, the fully-informed patient remains an aspiration. There was considerable initial support for the authorities in country A taking the lead, until it was pointed out that this would mean that, potentially, a hospital would need to comply with the standards in place in each of the 27 Member States – hardly practical. What’s more, we were able to draw on the experience of the contracts between the English NHS and hospitals in France, Belgium, and Germany. This had never been a serious project anyway, but rather an attempt by ministers to show British hospitals that there were alternative providers so they had better do something about waiting lists. The English authorities sent a small number of patients abroad, with the first batch accompanied by almost as many newspaper reporters. They specified in excruciating detail how the patients should be treated, including access to English newspapers and afternoon tea. Given the abysmal quality of food in most British hospitals compared to those in France, the patients may have wished the authorities had not interfered. Anyway, as one might have expected, the foreign hospitals soon got fed up with the mass of bureaucracy, not to mention the lack of co-operation from English referring hospitals, who knew that the whole initiative was simply a way to get at them.
So the obvious answer is that quality must be the responsibility of the country where the health facility is situated. This is already implicit in EU law. However, it also implies that any country sending someone abroad should be assured that their patients will get high quality care. The answer seems to be some form of EU legislation to require countries to put in place mechanisms to ensure quality and then let them get on with it.