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Access to healthcare services within and between countries of the European Union.

Busse R, van Ginneken E, Wörz M
In: Wismar M, Palm W, Figueras J, Ernst K, van Ginneken E (eds.) Cross-Border Healthcare in the EU: Mapping and Analysing Practices and Policies. Copenhagen: WHO on behalf of European Observatory on Health Systems and Policies, S. 47-90





European citizens in general are universally covered for a broad range of health services. However, an "erosion" of coverage for dental services in combination with co-payments may threaten access to dental services. This may also apply to certain types of medical examination and treatment. Cost sharing represents a visible access problem for a minority of people in a small number of countries. Geographical access problems do not seem to constitute a major hurdle. No information was found on the role of accreditation and contracting of providers in terms of access. There are countries that seem to constrain "choice" to a regional or national level. Waiting lists seem to be less important as a barrier to access than cost sharing and/or financial difficulties, but are more significant than geography. Personal preferences and the aforementioned barriers can motivate patients to use the coexisting frameworks of Council Regulation (EEC) No. 1408/71 (that is, the EHIC for occasional care and the E112 for planned care), cross-border contracts and the "Kohll/Decker" case law to seek reimbursed care abroad. However, lack of information and problems surrounding the benefits that are available, the conditions required in order to obtain services (for example, pre-authorization), cost sharing, contracting and accreditation (available providers), quality of care, as well as reimbursement under these frameworks can all pose barriers to cross-border access that may not be easy to overcome, especially in terms of self-managed care.