Coheur Alain : Mutualités Socialistes de Belgique

1. Coheur Alain : Mutualités Socialistes de Belgique Common Challenges for Health and CareA 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

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22. IZOM EXPERIMENTAL PROJECT • 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

23. IZOM EXPERIMENTAL PROJECT • 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

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