16th September 2008, Velden, Austria
Carinthia is a stunningly beautiful part of Europe. Its lakes, mountains, and traditional towns and villages make it an ideal holiday destination. Unfortunately my stay was for just over 12 hours but long enough to put it on the list for future visits. Situated in the south of Austria, it borders Italy and Slovenia and, since the 2004 enlargement of the European Union enlargement, links across these borders have strengthened greatly. This is especially true in the health sector, with the Carinthian authorities establishing a formal system of collaboration with colleagues in Slovenia and in the Friuli and Veneto regions of Italy. I was speaking at the Austrian Health Economics Forum, sharing a session with my colleague Luigi Bertinato from the Veneto region. I was talking about the three way relationship between health systems, health and wealth (see Tallinn Conference) while he was discussing the changing nature of international health tourism. Veneto Region has been developing links with Dubai, where an international “medical city” is being built with the intention of attracting patients from across the world to what will be a first class medical facility.
Two weeks before I had been speaking about the Dubai venture on BBC World Service TV. I confess that I was not entirely optimistic. There is no doubt that there is a growing market for medical tourism but I’m not sure that Dubai can compete with the much lower costs in countries such as South Africa, India and Thailand. There is, of course, a potentially large American market, given the increasing unaffordability of care even for those Americans who have coverage. However, I’m not sure how many will be prepared to fly to he Arabian peninsula in the current political climate, especially when they can get care for rather less in Mexico.
Both in the presentations and discussions over coffee a key issue to emerge was that of quality of care. In Austria, as in many other countries with social insurance systems, it has proven extremely difficult t get the medical profession to engage in effective mechanisms to assess and improve the quality of the care they provide. There are, of course, lots of small scale individual efforts but there is still a lot of opposition to anything more systematic. As we have shown in our new book reviewing the mechanisms to promote quality in all 27 EU Member States, Austria is not alone.
This is becoming an important issue at a European level. The proposed framework directive on patients’ rights in relation to cross-border care will require that each country establish systems to ensure quality of care, and while they will be free to decide how to do this, future work is planned to monitor whether they are doing it (See our recent BMJ editioral). A further issue is the introduction, in a few countries of revalidation of the right to practice medicine. Again, this is something we have looked at in a recent paper and, in some more a detail, in a policy brief. Clearly this is an area where some discussion at a European level is needed, not least to ensure that the arrangements are workable (but also to ensure that they are not hijacked by bureaucrats who believe that the larger the pile of paperwork, the better the system (as seems to be happening in the UK)). Unfortunately, and as usual, the Commission’s DG Internal Market doesn’t agree. It invariably sees any attempt at regulation that would protect the public as a constraint on free movement. It is essential that its views are not allowed to prevail.