A call for action to establish a research agenda for building a future health workforce in Europe

This Call for Action is closely linked to the European Public Health Association (EUPHA) and its new section ‘Health Workforce Research’. The idea was first developed during a pre-conference and two workshops at the EUPHA Conference in November 2016 in Vienna and further investigated at the EUPHA Conference in November 2017. We wish to thank all participants for inspiring discussions and for sharing ideas and knowledge.Peer reviewedPublisher PD

Travelling home for treatment and EU patients' rights to care abroad: Results of a survey among German students at Maastricht University

Empirical evidence on patient mobility in Europe is lacking despite widespread legal, policy and media attention which the phenomenon attracts. This paper presents quantitative data on the health care seeking behaviour of German students at Maastricht University in the Netherlands. A cross-sectional survey design was applied with a mixed-methods approach including open and closed questions. Questionnaire items were based on a theoretical model of patient mobility and input from focus group discussions with German students living in Maastricht. 235 valid surveys were completed, representing ca. 8% of the target population. Data collection took place in Oct-Dec 2010. Of respondents who received medical care over the last two years, 97% returned to Germany; of these, 76% travelled to their home city for medical treatment. 72% received care only in Germany, i.e. not even once in Maastricht. Distance partly influenced whether students travelled to Germany, returned home or stayed in Maastricht, and the type of care accessed. Key motivations were familiarity with home providers/system, and reimbursement issues. In the context of the new EU Directive on patients' rights, the findings call into question whether Europeans use entitlements to cross-border care and what the real potential of patient mobility is. The results demonstrate the existence and magnitude of return movements as a sub-group of patient mobility

Purchasing health services abroad: Practices of cross-border contracting and patient mobility in six European countries

Objectives Contracting health services outside the public, statutory health system entails purchasing capacity from domestic non-public providers or from providers abroad. Over the last decade, these practices have made their way into European health systems, brought about by performance-oriented reforms and EU principles of free movement. The aim of the article is to explain the development, functioning, purposes and possible implications of cross-border contracting.Methods Primary and secondary sources on purchasing from providers abroad have been collected in a systematic way and analysed in a structured frame.Results We found practices in six European countries. The findings suggest that purchasers from benefit-in-kind systems contract capacity abroad when this responds to unmet demand; pressures domestic providers; and/or offers financial advantages, especially where statutory purchasers compete. Providers which receive patients tend to be located in countries where treatment costs are lower and/or where providers compete. The modalities of purchasing and delivering care abroad vary considerably depending on contracts being centralised or direct, the involvement of middlemen, funding and pricing mechanisms, cross-border pathways and volumes of patient flows.Conclusions The arrangements and concepts which cross-border contracting relies on suggest that statutory health purchasers, under pressure to deliver value for money and striving for cost-efficiency, experiment with new ways of organising health services for their populations.Cross-border contracting Health services Patient mobility Competition Performance Waiting lists EU

A typology of cross-border patient mobility

Based on systematic observation and analysis of available evidence, we propose a typology of cross-border patient mobility (rather than the so-called 'medical tourism') defined as the movement of a patient travelling to another country to seek planned health care. The typology is constructed around two dimensions based on the questions 'why do patients go abroad for planned health care?' and 'how is care abroad paid for?' Four types of patient motivations and two funding types have been identified. Combined in a matrix, they make eight possible scenarios of patient mobility each illustrated with international examples

A typology of cross-border patient mobility

Based on systematic observation and analysis of available evidence, we propose a typology of cross-border patient mobility (rather than the so-called 'medical tourism') defined as the movement of a patient travelling to another country to seek planned health care. The typology is constructed around two dimensions based on the questions 'why do patients go abroad for planned health care?' and 'how is care abroad paid for?' Four types of patient motivations and two funding types have been identified. Combined in a matrix, they make eight possible scenarios of patient mobility each illustrated with international examples

Analysing arrangements for cross-border mobility of patients in the European Union: a proposal for a framework.

This paper proposes a framework for analyzing arrangements set up to facilitate cross-border mobility of patients in the European Union. Exploiting both conceptual analysis and data from a range of case studies carried out in a number of European projects, and building on Walt and Gilson's model of policy analysis, the framework consists of five major components, each with a subset of categories or issues: (1) The actors directly and indirectly involved in setting up and promoting arrangements, (2) the content of the arrangements, classified into four categories (e.g. purchaser-provider and provider-provider or joint cross-border providers), (3) the institutional framework of the arrangements (including the underlying European and national legal frameworks, health systems' characteristics and payment mechanisms), (4) the processes that have led to the initiation and continuation, or cessation, of arrangements, (5) contextual factors (e.g. political or cultural) that impact on cross-border patient mobility and thus arrangements to facilitate them. The framework responds to what is a clearly identifiable demand for a means to analyse these interrelated concepts and dimensions. We believe that it will be useful to researchers studying cross-border collaborations and policy makers engaging in them