At the time of the project, surprisingly little was known of how access to appropriate health services is facilitated within the Member States (including the new Member States) and between Member States. This was, and is all the more problematic as both regulations and measures facilitating and prohibiting access within countries will have a direct impact on cross-border access to health care and therefore, health care in other countries.
The project did map: 1. Access issues within 10 selected countries which either encourage or prohibit cross-border flows; 2. Structures, contracts and procedures established within these countries to ensure access to health services between countries.
The project was based on a framework of access issues (within countries) which may act as hurdles for obtaining accessible, appropriate and acceptable health services (1. insurance cover for health care; 2. contents of the health basket; 3. geographical accessibility of providers offering appropriate services; 4. cost-sharing arrangements; 5. capacities of providers; 6. acceptability of services due to quality, cultural issues etc.).
- Analysed the extent to which the six hurdles (listed above) within the selected countries affect the demand for health services between those countries;
- Collected, categorised and analysed approaches for improving access to health services across borders, independent of their intention (e.g. to substitute for lack of appropriate providers, to lessen capacity problems or simply to allow more choice);
- The systematisation differentiated between contractual arrangements – between countries, between sub-national regions of different countries or between payer in country A and provider in country B – on the one hand, and internal regulations – e.g. facilitating hassle-free reimbursement for privately paid health services across national borders for individual patients – on the other.
The project started on November 1, 2004, and was conducted in three phases: An initial 9-month phase devoted to access issues within countries, a second 11-month phase systematising, collecting and analysing measures aimed at improving access across borders, and a final 4-month phase for developing conclusions and disseminating the project results. Methodologically, the project utilised a mixture of methods. These included a thorough review of the literature (which was not only based on literature data bases but included books and “grey” literature), two questionnaires aimed at collecting and interpreting structures, contracts, regulations etc., as well as impact data in relation to access, workshops to systematise the analysis of measures and to facilitate their EU-wide interpretation, and finally a dissemination strategy aimed at reaching the relevant decision-makers.
The final report is available HERE .