Cross-border healthcare: principles and considerations from a Medical Doctor Brussels, February 29, 2016 Prof.Dr.Dr.h.c. Felix Unger President European Academy of Sciences and Arts

VISION FOR EUROPE: HEALTH FOR ALL in a convenient distance normal medical care – as business model – misuse European Institute of Health of the European Academy of Sciences and Arts EIH

Health in the Regions Report to the European Commission European Institute of Health of the European Academy of Sciences and Arts EIH

Integrative medicine Comprehensive medicine Prevention - Medical Centres – Hospitals – Rehabilitation – Long term care - Aging homes European Institute of Health of the European Academy of Sciences and Arts EIH

Cross-border: indicated - new principles for care - lack of provisions - embedded in families “short distances” - embedded in a medical and nursing environment - prerequisite: standards, outcome an the will of all partners -admission and will by a referring doctor -it works based to a friendship European Institute of Health of the European Academy of Sciences and Arts EIH

Cross-border healthcare a) acute b) medium c) long term All indications are based to a referring MD – he is the gate-keeper for a cross-border healthcare. There is the duration limited, mostly 10 – 15 years. European Institute of Health of the European Academy of Sciences and Arts EIH

European Institute of Health of the European Academy of Sciences and Arts EIH Acute care: Close frontiers: -my experience in 30 years with Bavaria distances short, systems similar -share of provisions: (difficult) hospitals in close cooperation, main advantage for patients and families -travel: accidents, acute illness – problems in remuneration -prerequisite: permission of the insurance -political will

European Institute of Health of the European Academy of Sciences and Arts EIH Bavaria, disaster on February 9 th, 2016

European Institute of Health of the European Academy of Sciences and Arts EIH Medium care Planned care as in -Orthopaedics -Urology -Dentology: Hungary -Neurology -Cardiac Surgery – personal experience -Neurosurgery – chiasma opticus -Rare disorders - Indication enlarging, no limit of age “Case share” for multicentre studies - Special care

European Institute of Health of the European Academy of Sciences and Arts EIH

European Institute of Health of the European Academy of Sciences and Arts EIH Cross-border healthcare is feasible: when the distances are very close f.e. Bad Reichenhall – Salzburg Simbach – Braunau, Lower Austria – Slovakia - Main prerequisite: refunding of the insurances - Advantage: saving of equipment and personnel - Cost reduction – shared institutions as “Regional Hospitals” (this is unlikely) - Lessons and practice from different medical schools

European Institute of Health of the European Academy of Sciences and Arts EIH Source: Health in the Regions, Cross Border Healthcare: Harmonization in European Regions, Felix Unger, Edition Weimar 2012, ISBN: „Future dream“today

European Institute of Health of the European Academy of Sciences and Arts EIH Long term care Care of the elderly Hospices, nursing homes Germany – Czechia Slovakia – Austria

European Institute of Health of the European Academy of Sciences and Arts EIH Reimbursement: most critical Basic: provision is paid fully where it is delivered -Primary costs -Secondary costs -Tertiary costs General: The costs arise where the patient is treated. But there are unequal systems. The insurances manage it on a day by day basis

European Institute of Health of the European Academy of Sciences and Arts EIH Summary Main problems: - reimbursement (e.g. ambulances) - costs of care, provision and nursing - language - will from patients and MD - political will - all EU-countries are “medical homeland”

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European Institute of Health of the European Academy of Sciences and Arts EIH MISUSE OF CROSS-BORDER HEALTHCARE TRANSPLANTATIONS outside of the EU and Europe

European Institute of Health of the European Academy of Sciences and Arts EIH Cross-border: possible, done, but temporarily

European Institute of Health of the European Academy of Sciences and Arts EIH Conclusions -Cross-border is feasible in neighbouring regions acute – planned – long term advantage: close distances contribution to Europe share of facilities hindrances:remuneration and language -Cross-border healthcare outside the European regions only in selected cases development of regional facilities (unlikely) Source: Health in the Regions, Cross Border Healthcare: Harmonization in European Regions, Felix Unger, Edition Weimar 2012, ISBN: