Healthcare Reform - Legal & Policy

Healthcare Tourism: The Mosaic of Patient Referrals

Healthcare Reform - Legal & Policy

International patient referral constitutes a major channel for health travel between different parts of the world. Hospitals partner with public or private healthcare groups, or public healthcare ministries between countries partner to create referral programs to allow patients receive healthcare services in partner hospitals.

In Europe, such channels of health tourism have been established for decades and partnerships within and outside the EU28 has fostered the growth of the health tourism market in Europe, with referring countries improving and extending their healthcare services, and the receiving countries boosting revenues from such collaborations.

Primary drivers for international patient referrals have been unavailability of expertise or enough medical professionals to provide healthcare in a particular specialty locally, shortage of bed spaces, and the need for hospitals to expand their international reputation.

Europe has experienced a massive boost in cross-border patient referral consequent to a number of factors including the directive allowing socially insured patients access to free healthcare services in other countries within the EU as well as other legislation, and financial support encouraging patient mobility across borders.

In addition, the EU directive on cross-border collaborations has allowed for professional mobility within the EU28, since the professional qualifications of doctors trained in the EU28 are mutually recognized. This has, on the one hand, impacted negatively on cross-border collaborations to a certain extent due to unstandardized training and practice between countries, as well as diverse standards.

The challenges

Problems that often mar such referral systems are the plurality of the government bodies involved in providing and financing such services, the procedural delays and complexities between the participating countries, and communication barriers.

An example of such referral systems is one between France and Belgium, which allowed pregnant women to be referred to Belgian hospitals for prenatal and natal care. This referral pattern slowed down over the years, as a result of the inherent financial demands and the low ROIs the French government had from such referrals.

Experts note, however, that referrals must be based on need and mutual benefits, citing that what drives the success of referral systems is sustained benefits for both parties involved.

As typified by the referral system and collaboration between Hungary and Austria, a referral may be marred by lack of follow-up care and failure to treat complications adequately.

Hungary has been established as a leader in dental care in Europe, providing dental care to a large number of patients from different parts of Europe, notably Austria. Due to the distance and financial implications, Austrian patients who have received dental care in Hungary do not return for follow up and this has resulted in a lot of post-dental surgery complications.

In the light of this development, experts have noted that strict regulations allowing follow-up care should be instituted for Austrian patients who receive dental care in Hungary. Recommendations have been made to ensure a continuous flow of information across countries on management and follow-up plans for every patient.

The Sucess Stories

However, not all referral systems have shown average or poor results.

On a larger scale, Emirates Hospital Groups, one of the leading providers of healthcare in the United Arab Emirates (UAE), signed an agreement in 2017 with the Dubai Health Authority (DHA) to refer adults and pediatric patients with specific neurological disorders to ADELI Medical Center in Piestany, Slovakia for neurorehabilitation.

ADELI Medical Center is one of the few Institutes in Europe providing advanced restorative therapy for neurological disorders and is part of the Emirates Hospitals Group.

ADELI Medical center has become the leader in advanced neurorehabilitation programs with well-trained therapists, neurologists, speech therapists, and other professionals. The center specializes in rehabilitation as part of management for stroke, traumatic brain injury, congenital brain anomalies, and cerebral palsy.

This system has led to tremendous results with fast recuperation of adult and pediatric patients with neurological diseases and better healthcare partnerships between Europe and the UAE.

In a discrete move in 2016, UK’s South Kent Coast Clinical Commissioning Group signed an agreement with Calais Hospital in France to receive UK patients for elective surgical procedures. This collaboration became essential due to the unavailability of bed spaces in many of NHS hospitals and a growing need to cut down on the long waits patients have to experience in the UK.

Calais Hospital, in the agreement, planned to accept referral of 100 patients every two years for procedures ranging from elective gastrointestinal surgeries to orthopedic procedures such as knee replacement surgeries.

NHS hospital trusts agreed to ensure its Accidents and Emergency departments were available to full capacity to attend to patients with more urgent healthcare problems such as patients with cancer and those needing acute care surgeries, as well as in preparation for the looming health crisis in winter. This led to the NHS’ cancellation of about 55,000 elective surgical procedures in January this year.

Patients referred to Calais under this scheme will receive medical care free of charge, and payment made for the services received by the NHS.

The European Reference Networks

To build a secure network of referral for patients with complex diseases, the European Commission July last year, established the European Reference Networks (ERNs). ERNs were developed as a cross-border collaboration platform between specialists for referral of patients diagnosis and treatment of rare and complex diseases.

The development will see thousands of patients with such diseases receive referral and consultation by EU’s best healthcare professionals from different specialties. The ERNs number 24, one which is the ERN in Rare and Complex Urogenital Diseases and Conditions, uROGEN.

One priority of the establishment, as noted by experts, is to boost knowledge transfer to Member States with less expertise as well as to boost the quality of healthcare outcomes across Europe while reducing the cost of healthcare delivery.

Referral systems are taking a different turn, as it were, with countries, hospitals, and patients are taking a closer look at the broader aspects of international travel. For example, according to a report by EuroHealth, the European Center for Disease Prevention and Control (ECDC) has placed as one of its top concerns regarding medical travel the “Antimicrobial Resistance and Healthcare-Associated Infections Programme” to mitigate against hospital-acquired infections for its referred patients.

The programme takes more proactive steps in ensuring that collaboration between European hospitals across border follows a proper risk communication which entails the standard precautions employed by health care providers for infection control measures.

While international referral remains a critical factor in health tourism, it may be marred by specific problems ranging from political factors, variations in standards of care, and financial irregularities. However, as countries begin to take more proactive steps in curbing the problems associated with referral, it will guarantee mutual benefits and growth in the medical tourism market of both countries.

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