Wednesday, 15 September 2010: 12:15-15:30
European Parliament, Room: Paul-Henri Spaak P1A002

CROSS BORDER HEALTHCARE: 
AN UNMET NEED FOR CANCER PATIENTS

Beyond the political debates about the EU's policy on cross border healthcare lies a series of important questions on how to develop and manage the best services for patients crossing borders.

The FACE workshop taking place on 15 September gathers speakers such as the Health Commissioner John Dalli, from the European Parliament, DG Internal Market and DG Employment and Social Affairs and Research Organizations and the cancer patients’ community. The adoption of a proposal for a directive in the field of cross-border healthcare in 2008 was an important moment at Community level in the field of public health.

MEPs Nessa Childers and Ria Oomen-Ruijten are chairing the workshop. See the preliminary Workshop Agenda and the Press Release of 16th September 2010.

Objectives

The FACE workshop should address the issues, shed light on practical examples of patients that had difficulties in getting CBH, and give a bureaucratic and technical issue a human FACE. It will try to achieve a consensus on the above issues, making MEPs aware about their responsibility in deciding on this important issue that decides upon life and death of cancer patients across the EU -- paving the way for an agreement of the Cross Border Directive.

Concept of Workshop

Many have been trying to put the CBH topic into the corner of "all some poorer Member State often in Eastern Europe are then trying to go to Western Europe for healthcare ". This is simplistic and puts CBH into an awkward defensive position of "the poor want more money from the rich" or simply from the rich western European perspective as “this is not OUR issue”. Cancer survival stories show that CBH is everyone’s issue no matter where they are in Europe. The fact is that we have large inequalities even within Western Europe, and thus “purely monetary issue” is actually just a footnote in the discussion of CBH. Patients prefer to be treated as close to home as possible. However, sometimes the healthcare that patients need is better provided abroad: it could be closer to home (in border regions); there might be a lack of capacity in the home country; or there could be a need for specialised care (e.g. in the case of rare diseases). This currently applies to 1% of those seeking healthcare.

FACE would like to bring the attention back to the real issues of CBH:

• We need to acknowledge that we are far from the dreamed European market for healthcare - especially if we look at the difficulties confronted by patients wanting to participate in lifesaving clinical trials.
• We also cannot deny that European cancer patients, in particular for rare cancers, are still not receiving the best care and often dying because of longstanding bureaucratic hurdles that can be addressed today..

This workshop will focus on some of the most pressing issues surrounding CBH:

• Cross Border Healthcare is not an east-west issue, it is an issue of concern for all Europeans - from Brussels to Paris, from Bucharest to Warsaw, from the Netherlands to the UK, from Greece to Italy.
• CBH is about promoting patients’ right to have free movement for increased survival and free movement of knowledge, not about controlling a movement of healthcare costs. For cancer patients, moving across borders for healthcare is a personal strain (to move away from family and their safe personal environment) that is undertaken only if it is absolutely necessary to receive the best treatment and enhance survival The free movement of patients across borders is also about "worst healthcare" to improve for all EU members, to avoid losing patients to other countries. More transparency and less bureaucracy in CBH directives will create competition that will spread quality across the EU.
• If we want for cancer care and cancer research to benefit from the existing European diversity of knowledge on cancer, barrier-free CBH movement is essential. Given the trend towards personalized medicine, targeted therapies and fragmentation of diseases by genetic subtypes, groups of diseases are breaking up into distinct diseases and treatments. We should thus talk about Cancer. To create sufficient evidence for new therapies required by the EMA and other competent authorities, patients especially with rare diseases / cancers need to be able to move across borders to join trials. Imagine that the average centrally approved multi-national clinical trial (across all diseases) in the EU is activated in only 4.5 countries - this means this trial (and subsequently, treatment) on average is not available in the other 22,5 EU countries! So what if you have a progressive cancer where a phase III study in the UK would be your last chance to survive - but the EU does not allow it? And what if you live in a country where trials are hardly run?
• CBH is also about promoting access to treatment and trial information for doctors and patients that is clear, in all languages, with clear quality and ethical standards (e-health?)

Background of Legislative Journey for the Cross Border Health Care:

The key starting points for EU action include the 2006 Council Common values and principles of EU health system (i.e. universality, solidarity, access to good quality care and equity) and the right to free movement for patients, as established by the ECJ. It has to be underlined that the principle of subsidiarity applies, i.e. respect for Member States’ responsibilities for the organisation and delivery of healthcare.

Therefore, the European Commission's 2008 proposals for a draft Directive on patient's rights in cross border healthcare has made it one of the most contentious areas of EU health policy.   In December 2009, the European Council failed to agree a compromise text on the draft Directive which has been a personal source of regret for the outgoing health commissioner, Mrs Vassiliou. However, under a new Commissioner (John Dalli) and the Spanish Presidency of the European Council a new compromise text was proposed.

On 8 June 2010, the new compromise text was backed by the EPSCO Council (EU's ministers of Health and Social Affairs). The agreement is an important step for the future of the Directive. The new text will now be sent to the European Parliament for a second reading.

The Directive will complement Social Security Regulation 1408 (1971), which provides for the possibility of obtaining urgent care in another Member State, as well as for planned care (where prior authorisation is granted in cases where there is ‘undue delay’).