With NCP:s a dead end, cross-border care still an EU illusion?

The National Contacts Points (NCP) are a flop. The NCP:s were intended to be the patient entrance to medical treatment in another EU country, according to the cross-border care directive. A new HCP study shows that with a few exceptions, these websites lack most of the information necessary for practical guidance. Is the European Commission really satisfied with this poor show?

Since 2013, every member state of the EU is obliged to support its citizens to move cross borders to access healthcare that, for various reasons, look more attractive than in the country of citizenship. Practically, this obligation means putting together the necessary information allowing consumers and patients to form an opinion, make a choice and go abroad for a treatment.

In fact, every government also has made available at the Internet what the Cross-border Care Directive [1] named “National Contact Point”, or NCP. This obligation, in power since October 2013, looks fine at first sight – but when you take a more thorough, professional look you get deeply disappointed. And less Internet- or information proficient users have even better reasons for frustration.

Dead ends

These points of information were supposed to assemble critical information to help visitors to navigate the healthcare system of each member state. The sad thing is that almost every national NCP prove to be a dead end, adding little to support mobility. Rather, they limit and confuse patient activism. And as large many governments dislike the mobility idea, maybe this is exactly the purpose?

Why go abroad?

Do we sound pessimistic or paranoid? We hope not, on the contrary, as our belief is that the shaping of an internal EU healthcare market will prove most beneficial why the present poor situation is the more disappointing. Let us show you what the Health Consumer Powerhouse (HCP) talks of.

According to a lot of hands-on experience, supported by an Eurobarometer poll [2], what drives EU citizens to look for alternatives outside of their own country essentially are these reasons:

  • In my country, the treatment I need is not available
  • In my country, the quality of care is not sufficient
  • I want access to a specific specialist (outside of my country)
  • In my country, there is too long waiting for the treatment I need.

All these reasons are covered by the cross-border care directive, today implemented in all member states. More and more alert, critical and demanding Europeans refuse to take no for an answer when national authorities tell them that they cannot access a certain treatment or that they will have to wait ages. That poor quality at home puts them at risk when treated is another most legitimate reason to look for better options abroad. A certain specialist may be the only one to meet your very specific needs. Today most citizens seem to be aware of the strong and weak sides of their national healthcare [3] and recognise the access and quality gaps within European healthcare [4].

If and when you have formed the opinion that your own town, region or country cannot satisfy your care needs, you start looking for guidance. Some people will be supported by medical professionals who recommend or even remit them to a specialist or hospital abroad. Others may be dissatisfied with the attitude of their doctor or have reasons to take action themselves. Maybe there are friends, relatives or patient advocates to support them. Regardless how, the search for information is far from easy.

A few good examples

Here you would have hope for the NCP:s to make a difference. In reality, it is hard to imagine that they generally have been of any assistance. Of course there are exceptions, where a visit to the NCP website really helps you to locate therapies and care providers, reducing your waiting offering the treatment of importance to you, under safe conditions and to reasonable value for money. Such NCP:s are organised by Germany, Ireland, UK, the Czech Republic and Slovenia. High points for these national authorities!

You could expect a country such as Germany, with a huge, well-serving health industry, demanding home market and natural contacts with large parts of Central and Eastern Europe to make an effort. UK and Ireland have a natural language advantage and UK has for a long time been a leader in health information. More surprising is the strong Czech and Slovenian performance, maybe indicating high hopes for a medical travelling future and anyhow making an example for many less ambitious member countries.

Simple criteria of user-friendliness

A much more elaborated analysis should be done (and is said to be under way in the DG Santé, i.e the part of the Commission dealing with health and consumer matters). Our very simple criteria for this analysis go for the most basic conditions:

  • Is the NCP content accessible in at least one foreign, major language, and does this multilingualism cover essential information, such as what care providers are available, and not only an opening page telling you that you better write a letter to the National Health Fund to ask for more information?
  • Is it possible to locate information about what specialists and hospitals exist and are available, preferably with web links to learn more about each provider? This is of course essential, as you otherwise hardly can make any research on your own.
  • Is there a Q&A section at the NCP? We know that this is a popular and very informative way of guiding website visitors and indicates the level of ambition behind the NCP.

HCP has in March this year examined all the EU member state NCP websites, as listed by the European Commission [5]. What we – and probably many more visitors – have found is rather depressing:

Disappointing reality

The typical approach behind the design seems to have been “let´s put together nothing more than absolutely required by the law. If we´d add anything, let it be descriptions of the organisation of our social fund/public healthcare structure, with some nice, impressive charts describing our bureacracy”. Accordingly, every site provides in extenso information about the Cross-border Care Directive, which is necessary but tells the ordinary visitor very little of real life.

The Directive was meant to be the very base and starting point for the journey ahead, to be developed by various clarifications and supportive applications. Merely quoting the legal content of the Directive is like handing a drivers manual to somebody who wants to learn to drive hoping that would be enough to teach her how to become a safe and self-assured driver.

Mumbo-jumbo

Almost every NCP excels in legal definitions of what is a medical specialist or a primary care clinic – good to know, but nomenclature issues is hardly your main perspective when visiting these websites. Legal information about obligations, application procedures and how to appeal a decision are important, but far from enough if you lack other material pieces.

Patient safety

You may be concerned about patient safety and quality assessment aspects of care, no doubt important to make you dare go cross border. Here, many NCP:s refer to a certain medical quality standard, but with few exceptions there is zero information of the practical essence of this standard and even more striking, nothing about if and how healthcare performs according to these quality criteria. The annual publication of the Euro Health Consumer Index (EHCI) shows that behind official proclamations there are major gaps in quality and reliability between member states.

You get the strong impression that the NCP design teams – if there has ever been such functions – were given the instruction to avoid thinking of what visitors may have top of mind. Instead, the required minimum of low-value formal headlines are piled together, often without any information at all or just rubbish when you click the headline or advised link.

Foreign languages

If you want to inform foreigners about your national healthcare, it would be a good idea to translate not only a few headlines to a major foreign language but also the real stuff. When you click at “List of service providers” only to find the message “This information is not available” or, slightly better, only find a native language message, calling for a Google Translate intervention, you get a bit frustrated. Internet translation services no doubt have improved in reliability but for healthcare information, they may still be a bit insecure.

What kind of thinking – if any?

We cannot avoid suspecting that very few national authorities have ever made the reflection: “Great, now we have a golden opportunity to attract medical travelling to our country, which may become an interesting industry. Let´s make this website really user-friendly and full of relevant information”.

Even fewer seem to have advanced to the next step in the thought process: “When we´re about to look through this information, why don´t we at the same time include the scope of our own citizens, who could gain from a visitor-oriented presentation of how our national healthcare works, what are the options, how to get the best access to care services, and so on”.

High thresholds hindering patients

The whole idea behind the gradual integration of healthcare services within the EU stands and falls with the ambition of each country making available enough information to support decisions by doctors and patients in neighbour countries. As long as most countries offer very little real insights and knowledge of their own systems, patient mobility will remain hindered. And without the dynamics generated by calls for improved transparency, better outcomes and interaction with consumers and patients, increasing the pressure on healthcare systems and providers to develop, better value for money care will be delayed.

Is the European Commission really satisfied with this weak hands-on implementation of the cross-border care directive? Should you not expect much more from the member states? Can we hope for some action from Brussels?

References

[1] Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare

[2] Eurobarometer (2007), Cross-border health services in the EU – Analytical report, June 2007

[3] Patient safety and quality of care. Brussels: European Commission, 2014. Print.

[4] Euro Health Consumer Index 2014, healthpowerhouse.com

[5] National Contact Points, pdf updated : 10/12/2014