The Europeanisation of national health care systems: creative adaptation in the shadow of patient mobility case law

This paper examines the actual (as opposed to potential) impact of European Integration on national health care systems as a result of rulings of the European Court of Justice (ECJ) with regard to patient mobility. These rulings provoked a number of similar but far from identical responses across the Member States. Adaptation processes are indeed not straightforward. Member States, confronted with the deregulatory dynamic of the applications of the free movement rules, try to uphold their steering instruments as much as they can, whilst allowing patients to be treated abroad. This empirically driven paper provides a detailed assessment of how the Europeanisation of health care systems through ECJ cases sets off a dynamic process of creative adaptation at the national level. Through leverage (and some learning) actors alter the policies and politics of domestic health care systems. Factors that may explain the considerable differences between the reactions of Member States - also between Member States with similar health systems - include the likelihood of an exodus of patients, the compatibility between the European Union Law (EU) and national health care systems as well as the presence of reforms in the domestic system. The process of creative responses to EU law includes – for Member States confronted with long waiting lists – attempts to reduce the demand for exit, for example through contracting the domestic commercial sector. The study furthermore shows the agency by domestic actors who draw legitimacy from the EU setting to reinforce their position (or acquire one) at the national level. It thereby confirms the assertion that the effects of these ECJ rulings regarding patient mobility go beyond the narrow issue of patient mobility itself and that it can have an important impact on the domestic health care systems

La réforme des systèmes nationaux de santé sous la gouvernance économique de l’Union européenne

La crise économique et financière qui a éclaté en 2007 a engendré un changement radical dans la manière dont l’Union européenne (UE) intervient en matière de réforme des systèmes nationaux de santé. Les États membres ayant toujours répugné à céder des pouvoirs à l’UE en matière de politique sanitaire, son rayon d’action se limite à soutenir une coopération volontaire entre les autorités nationales. À la suite de la crise, en particulier dans la zone euro, les institutions de l’UE ont acquis d..

The new political economy of healthcare in the European Union: The impact of fiscal governance

We argue that the political economy of health care in the European Union is being changed by the creation of a substantial new apparatus of European fiscal governance. A series of treaties and legal changes since 2008 have given the EU new powers and duties to enforce budgetary austerity in the member states, and this apparatus of fiscal governance has already extended to include detailed and sometimes coercive policy recommendations to member states about the governance of their health care systems. We map the structures of this new fiscal governance and the way it purports to affect health care decisionmaking.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/120416/1/New political economy as accepted.pdfDescription of New political economy as accepted.pdf : Main articl

The role of the 2011 patients' rights in cross-border health care directive in shaping seven national health systems: looking beyond patient mobility

Reports on the implementation of the Directive on the application of Patients' Rights in Cross-border Healthcare indicate that it had little impact on the numbers of patients seeking care abroad. We set out to explore the effects of this directive on health systems in seven EU Member States. Key informants in Belgium, Estonia, Finland, Germany, Malta, Poland and The Netherlands filled out a structured questionnaire. Findings indicate that the impact of the directive varied between countries and was smaller in countries where a large degree of adaptation had already taken place in response to the European Court of Justice Rulings. The main reforms reported include a heightened emphasis on patient rights and the adoption of explicit benefits packages and tariffs. Countries may be facing increased pressure to treat patients within a medically justifiable time limit. The implementation of professional liability insurance, in countries where this did not previously exist, may also bring benefits for patients. Lowering of reimbursement tariffs to dissuade patients from seeking treatment abroad has been reported in Poland. The issue of discrimination against non-contracted domestic private providers in Estonia, Finland, Malta and The Netherlands remains largely unresolved. We conclude that evidence showing that patients using domestic health systems have actually benefitted from the directive remains scarce and further monitoring over a longer period of time is recommende

Obstacles to the recognition of medical prescriptions issued in one EU country and presented in another

A study involving the presentation of 192 Belgian or Finnish prescriptions in pharmacies in five other member states was undertaken to assess whether, as envisaged by European Union law, prescriptions issued in one member state are recognized by pharmacists in another and to identify factors that influence such decisions. Overall, pharmacists were willing to dispense in 108 cases. Detailed results show important differences depending on the country where prescriptions are presented and whether prescriptions were written by INN and in English, as opposed to prescriptions written by brand in a national language

Exploring the scope of practice and training of obstetricians and gynaecologists in England, Italy and Belgium:a qualitative study

&lt;p&gt;&lt;b&gt;INTRODUCTION: &lt;/b&gt;This study explores the scope of practice of Obstetrics and Gynaecology specialists in Italy, Belgium and England, in light of the growth of professional and patient mobility within the EU which has raised concerns about a lack of standardisation of medical speciality practice and training.&lt;/p&gt;&lt;p&gt;&lt;b&gt;METHODS: &lt;/b&gt;Semi-structured qualitative interviews were conducted with 29 obstetricians and gynaecologists from England, Belgium and Italy, exploring training and scope of practice, following a common topic guide. Interviews were recorded, transcribed and coded following a common coding framework in the language of the country concerned. Completed coding frames, written summaries and key quotes were then translated into English and were cross-analysed among the researchers to identify emerging themes and comparative findings.&lt;/p&gt;&lt;p&gt;&lt;b&gt;RESULTS: &lt;/b&gt;Although medical and specialty qualifications in each country are mutually recognised, there were great differences in training regimes, with different emphases on theory versus practice and recognition of different subspecialties. However all countries shared concerns about the impact of the European Working Time Directive on trainees&#039; skills development. Reflecting differences in models of care, the scope of practice of OBGYN varied among countries, with pronounced differences between the public and private sector within countries. Technological advances and the growth of co-morbidities resulting from ageing populations have created new opportunities and greater links with other specialties. In turn new ethical concerns around abortion and fertility have also arisen, with stark cultural differences between the countries.&lt;/p&gt;&lt;p&gt;&lt;b&gt;CONCLUSION: &lt;/b&gt;Variations exist in the training and scope of practice of OBGYN specialists among these three countries, which could have significant implications for the expectations of patients seeking care and specialists practising in other EU countries. Changes within the specialty and advances in technology are creating new opportunities and challenges, although these may widen existing differences. Harmonisation of the training and scope of practice of OBGYN within Europe remains a distant goal. Further research on the scope of practice of medical professionals would better inform future policies on professional mobility.&lt;/p&gt;</p

An exploratory analysis of hospital discharge summaries across Europe

Hospital discharge summaries play a critical role in ensuring safe and efficient continuity of care, particularly through transmission of key information from secondary to primary. This paper aims to explore whether discharge summaries used in European hospitals are adequate to support continuity of care. ..

The epidemiology of bacterial vaginosis in relation to sexual behaviour

<p>Abstract</p> <p>Background</p> <p>Bacterial vaginosis (BV) has been most consistently linked to sexual behaviour, and the epidemiological profile of BV mirrors that of established sexually transmitted infections (STIs). It remains a matter of debate however whether BV pathogenesis does actually involve sexual transmission of pathogenic micro-organisms from men to women. We therefore made a critical appraisal of the literature on BV in relation to sexual behaviour.</p> <p>Discussion</p> <p><it>G. vaginalis </it>carriage and BV occurs rarely with children, but has been observed among adolescent, even sexually non-experienced girls, contradicting that sexual transmission is a necessary prerequisite to disease acquisition. <it>G. vaginalis </it>carriage is enhanced by penetrative sexual contact but also by non-penetrative digito-genital contact and oral sex, again indicating that sex <it>per se</it>, but not necessarily coital transmission is involved. Several observations also point at female-to-male rather than at male-to-female transmission of <it>G. vaginalis</it>, presumably explaining the high concordance rates of <it>G. vaginalis </it>carriage among couples. Male antibiotic treatment has not been found to protect against BV, condom use is slightly protective, whereas male circumcision might protect against BV. BV is also common among women-who-have-sex-with-women and this relates at least in part to non-coital sexual behaviours. Though male-to-female transmission cannot be ruled out, overall there is little evidence that BV acts as an STD. Rather, we suggest BV may be considered a sexually enhanced disease (SED), with frequency of intercourse being a critical factor. This may relate to two distinct pathogenetic mechanisms: (1) in case of unprotected intercourse alkalinisation of the vaginal niche enhances a shift from lactobacilli-dominated microflora to a BV-like type of microflora and (2) in case of unprotected and protected intercourse mechanical transfer of perineal enteric bacteria is enhanced by coitus. A similar mechanism of mechanical transfer may explain the consistent link between non-coital sexual acts and BV. Similar observations supporting the SED pathogenetic model have been made for vaginal candidiasis and for urinary tract infection.</p> <p>Summary</p> <p>Though male-to-female transmission cannot be ruled out, overall there is incomplete evidence that BV acts as an STI. We believe however that BV may be considered a <it>sexually enhanced disease</it>, with frequency of intercourse being a critical factor.</p

For the sake of resilience and multifunctionality, let's diversify planted forests!

As of 2020, the world has an estimated 290 million ha of planted forests and this number is continuously increasing. Of these, 131 million ha are monospecific planted forests under intensive management. Although monospecific planted forests are important in providing timber, they harbor less biodiversity and are potentially more susceptible to disturbances than natural or diverse planted forests. Here, we point out the increasing scientific evidence for increased resilience and ecosystem service provision of functionally and species diverse planted forests (hereafter referred to as diverse planted forests) compared to monospecific ones. Furthermore, we propose five concrete steps to foster the adoption of diverse planted forests: (1) improve awareness of benefits and practical options of diverse planted forests among land-owners, managers, and investors; (2) incentivize tree species diversity in public funding of afforestation and programs to diversify current maladapted planted forests of low diversity; (3) develop new wood-based products that can be derived from many different tree species not yet in use; (4) invest in research to assess landscape benefits of diverse planted forests for functional connectivity and resilience to global-change threats; and (5) improve the evidence base on diverse planted forests, in particular in currently under-represented regions, where new options could be tested