1. Coheur Alain : Mutualités Socialistes de Belgique Coheur Alain : Mutualités Socialistes de Belgique Common Challenges for Health and Care A Europe of patients ? European Health Systems in a changing environment

2. Co-operation in the Members States, possibilities and constraints Healthcare without frontiers in the Meuse-Rhine Euregio - general context - results - general conclusions - recommendations

4. IZOM EXPERIMENTAL PROJECT What are the needs of a Europe without frontiers in terms of healtcare ? –Already regulated : Recourse to healthcare for persons temporarily spending time abroad Recourse to healtcare for cross-border workers According to the needs, a case-by-case decision –Not yet regulated : Needs in border areas, Retire cross border worker –The judgements made by the ECJ lay down new criteria in favour of healthcare without frontiers in Europe

5. IZOM EXPERIMENTAL PROJECT General context –Five years of collaboration –For the mutual health funds, the objectives were : To be able to efficiently facilitate, accelerate and adapt access to care abroad according to the needs and the desire of the persons to resort to cross-border care To simplify the administrative procedures for the insured persons To ensure as much transparency and communication between the insurers and the insured persons –The project began in september 2000 covering a cross-border geographical zone –The project is the result of consultation procedures => co-operation protocol between mutual health funds and national institute for health insurance

6. IZOM EXPERIMENTAL PROJECT A few basic solutions –The project was carried out within the framework of the internatinal agreement (1408/71 and 574/72). The legal provisions on health insurance and tariffs as well as the procedures in each country have been applicable –Agreement of a validity period for the E 112 form –Provisions completed by accords and agreements –Identification of all documents by IZOM EMR 112+ –Supply of required documents to the offices of the mutual health funds –Information for all target groups, health insurance employees, doctors, hospitals

7. IZOM EXPERIMENTAL PROJECT Transposition into practice –Documents supplied to the services E 112, 113, 114, 125, 126 (specific) forms under international law on health insurance, Certificates (for instance, treatment book, prescriptions for the specialist in Germany The project was carried out within the framework of the internatinal agreement (1408/71 and 574/72). The legal provisions on health insurance and tariffs as well as the procedures in each country have been applicable Patient’s passeport Directories of adresses –Information Leaflets giving succinct information and Detailed information (for the doctor, the pharmacist, the hospital)

8. IZOM EXPERIMENTAL PROJECT Improvements and advantages –Population Facilitated access for all insured persons from countries involved in the project Procedures –Insured persons from Belgium obtain autorisation with/without prior autorisation from the ?? –Insured persons from the Netherlands obtain autorisation with a transfert order from their general practionar –The reimbursement sheets required by the German health insurance fund are made available to insured persons from bordering crountries Shorter waiting times for treatment and examinations Possibility of treatment close to the place of residence –Medical care provider Exchange of information in the medical sector A better use of capacities –Mutual health insurance funds Knowledge of insured persons ’ needs with a view to carrying out targeted activities Customer satisfaction –Political level Awareness of the obstacles to a Europe without frontiers, indication of actions field

9. IZOM EXPERIMENTAL PROJECT The services in question were –General care provided by specialist doctors, at diagnostic and therapeutic level –The precription of medecines as part of this treatment –The relevant hospital care –The additional E 112 and/or 114 autorisation forms were necessary Equipement and services provided by paramedical professions Cutting edge medical care specific to each country

10. IZOM EXPERIMENTAL PROJECT The assessment –General objectives To obtain an overall idea of the mobility of the population in the EMR To determine the effects of opening up the borders and thus the creation of an open space To make recommandations in line with policy to the authorities and their competent bodies –The methodology Using og a uniform questionnaire Distinction between the general characteristics of the respondents and characteristics relating to the existing needs (three categories) –Information –Reasons for travelling abroad –satisfaction

11. IZOM EXPERIMENTAL PROJECT

22. General conclusions –Possibility of obtaining medical care is attractive : Shorter distance to travel Shorter waiting times Communication in mother tongue A different mode of treatment A more personal approach –Two groups of users : Homogenous group of cross-border workers and retired Less homogenous group of people who : –Prefer the way that they are treated abroad –Are not satisfied with the care they received –Want an alternative solution IZOM EXPERIMENTAL PROJECT

23. General conclusions –The three mains factors : The lack of care available in the country of origin An awareness of the care available abroad The amount of information about cross-border care distributed in other countries IZOM EXPERIMENTAL PROJECT

24. Recommendations –The three mains action fields : With regard to mobility With regard to information With regard to transparency IZOM EXPERIMENTAL PROJECT