From its origins as six western European countries coming together to reduce trade barriers, the European Union (EU) has expanded, both geographically and in the scope of its actions, to become an important supranational body whose policies affect almost all aspects of the lives of its citizens. This influence extends to health and health services. The EU's formal responsibilities in health and health services are limited in scope, but, it has substantial indirect influence on them. In this paper, we describe the institutions of the EU, its legislative process, and the nature of European law as it affects free movement of the goods, people, and services that affect health or are necessary to deliver health care. We show how the influence of the EU goes far beyond the activities that are most visible to health professionals, such as research funding and public health programmes, and involves an extensive body of legislation that affects almost every aspect of health and health care.
"The patients' rights and cross-border health care directive  is a landmark  in European health care politics, yet its potential to lead to a widespread impact upon Member States' (MS) health care systems is open to debate    . "
[Show abstract][Hide abstract] ABSTRACT: The patients' rights and cross-border health care directive was implemented in Malta in 2013. Malta's transposition of the directive used the discretionary elements allowable to retain national control on cross-border care to the fullest extent. This paper seeks to analyse the underlying dynamics of this directive on the Maltese health care system through the lens of key health system stakeholders. Thirty-three interviews were conducted. Qualitative content analysis of the interviews reveals six key themes: fear from the potential impact of increased patient mobility, strategies employed for damage control, opportunities exploited for health system reform, moderate enhancement of patients' rights, negligible additional patient mobility and unforeseen health system reforms. The findings indicate that local stakeholders expected the directive to have significant negative effects and adopted measures to minimise these effects. In practice the directive has not affected patient mobility in Malta in the first months following its implementation. Government appears to have instrumentalised the implementation of the directive to implement certain reforms including legislation on patients' rights, a health benefits package and compulsory indemnity insurance. Whilst the Maltese geo-demographic situation precludes automatic generalisation of the conclusions from this case study to other Member States, the findings serve to advance our understanding of the mechanisms through which European legislation on health services is influencing health systems, particularly in small EU Member States.
Health Policy 09/2015; DOI:10.1016/j.healthpol.2015.08.015 · 1.91 Impact Factor
"However, in times of financial constraint, policy discussions often circle around cutting back social protection expenditures. Only four European Union member states (Netherlands, France, Portugal, and Spain) offered undocumented migrants access to primary care [131,152,153], but recent reductions in health expenditures pose severe threats and lead to decisions limiting healthcare to migrants without sufficiently investigating the impacts on those in need . A reduction in access to primary and specialist care is indeed unlikely to be cost-effective, as use of emergency services will increase [157,158]. "
[Show abstract][Hide abstract] ABSTRACT: The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.
Journal of Hypertension 02/2014; 32(5). DOI:10.1097/HJH.0000000000000125 · 4.72 Impact Factor
"EU involvement in shaping health policy in Poland was another result of this. EU law and policies affect many aspects of health policy, such as mobility (of pharmaceuticals, patients, and medical professionals), research funding, public debate, and public health policies [Greer 2013]. The state's role with respect to health is thus infl uenced by EU regulations, and this infl uence requires further research. "
[Show abstract][Hide abstract] ABSTRACT: The article discusses the medical travel (medical tourism) of Polish women migrants based on a study conducted between 2008 and 2011 on Polish women who migrated to London, Barcelona, and Berlin. The author argues that the principal reasons for medical travel to Poland are the lower costs of private treatment, the relatively easy access to specialised health care, and personal comfort derived from linguistic and cultural competency. The women in the study who travelled to Poland for medical treatment combined the economic resources acquired while living abroad with their knowledge of the cultural and medical system in Poland to choose the best options for them. The treatments they sought included gynaecological, dental, and other specialised treatments, for which they turned to the private health sector in Poland. Some of the women also sought treatment in other countries. The women in the study highlighted the advantages of medical travel and mobility while also reflected on the dilemmas they faced in choosing the best care. The author argues that medical travel poses a challenge to the national borders of health-care systems and the national availability of medical procedures, and found that while such mobility generates inequalities it also leads to greater agency and creativeness on the part of patients when they challenge the given regulations, authority, and expert knowledge in one country.
Sociologický časopis 01/2014; 50(6):897. DOI:10.13060/00380288.2014.50.6.147 · 0.36 Impact Factor
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