Freer trade in European and Spanish health care services

Spanish patients, like all Europeans, will now be able now choose which EU country to seek treatment in. The Cabinet last week approved a decree that implements an EU directive on cross-border healthcare. Under the system, patients will advance the money for their treatment abroad, but can request a reimbursement from their own country.

The directive aims to go one step beyond the emergency treatment already covered by the European Health Card and let patients choose another member state for specific, non-emergency treatment.

Spain however has concerns:

The State Council, the government’s key advisory body, has this week warned the government that the measure may put a major strain on Spain’s resources. “Given that our country is a recipient country for tourists, it seems likely that this could lead to an increase in demand for healthcare,” the State Council report on the law change says, which could result in “longer waiting lists.”

Additionally, reimbursement will not necessarily cover the total amount charged by the foreign hospital; instead Spanish authorities will use the official rates of each regional health service. Spain does not have a common set of rates; rather, each regional government sets its own public tariffs.

It might over time lead to higher prices.  Here are some other possible implications:

Spain’s private health system could be the main beneficiary of this new system…This is because “prestigious and renowned” private health centers could get added clients now that member states have to reimburse their citizens. Of course foreigners could choose the public health system, but it would mean long waiting lists under the same conditions as Spanish patients.

Medical fees at both public and private hospitals in Spain are lower than in many other European countries. “It could well be that for Scandinavia it is cheaper to send patients to Spain,” notes Rivero.

There is more here.  There is plenty of further information here, but only very recently has this cross-border directive been moving to a scale where it might make a real difference.  Spain for instance seems to be a country which is cheap enough, sunny enough, and reliable enough to draw significant business.


'This is because “prestigious and renowned” private health centers could get added clients now that member states have to reimburse their citizens'

This sounds quite wrong, at least in a context as it applies to gesetzliche Krankenkassen and private Krankenversicherung in German terms. In Germany, there is a distinct split between two styles of health care treatment payment - and there is no way, in broad terms, that the gesetzliche Krankenkassen are going to pay for 'private health centers,' since they don't do that in Germany.

But then, the entire article seems a bit confused, a likely combination between translation and the fact that Europe has a wide variety of health care systems. Just this line from the first paragraph - 'Under the system, patients will advance the money for their treatment abroad, but can request a reimbursement from their own country.' is simply not correct. No one in Germany is reimbursed by the German government for health care costs. The same applies to the French government managed system, though if one twists the idea of 'country' enough, then maybe the UK's NHS applies. They could, however, request a reimbursement from their own health insurer.

Which sounds just like the American system, when phrased that way. Except that the odds of an American health insurer actually providing reimbursement are close to nil.

As usual, people in the USA want to criticize public health plans, but not face the music of free markets: Euthanasia for patients who are both aged and terminally ill.

If we went to a pure free-market system in the united States, we would have better and cheaper care--and when Grandma was dying, you would be given a choice: "We can keep her alive for a few months, and that will cost you $360,000. Or we can keep her comfortable, opiates, and let nature take its course in one week, no charge."

Insurers would call the shots, and you can bet they will not pay for extended care of the aged and terminally ill without getting compensated.

It would be refreshing if someone on the right-wing would face facts. Bashing Obamacare is fun, and bashing waiting lists in Canada is fun. I think Obamacare is a complicated disaster.

But I am honest. I recommend we accept euthanasia as the norm. Euthansia may, or may not be, moral. It is what the free enterprise system would dictate, and I accept that.

No one wants to pay several hundred thousand dollars to keep someone confined to a bed for a few more months and then they die. That is what we do now, because Medicare pays for it. If you think keeping people alive is moral, then you should get down on bended knee and genuflect to Medicare. Keeping Grandma alive won't happen in free markets, and I admit it.

Libertarianism and free markets are not moral, they are amoral. I love free markets for the freedom and higher living standards. Morals has nothing to do with it.

If you think the GOP is going to fix matters, please recount the Terri Schiavo episode for me.

The question whether to keep a terminally ill patient alive for a few more weeks and a lot of extra money is a crucial one, regardless of the healthcare system. Someone has to pay that money, and that money could be used to cure someone who still has a chance to live. The morality isn't so streamlined here.

Plenty of people decide for themselves - a significant portion of gun suicides in the USA are older guys who put a bullet through their head when they learn about a serious health condition.

You have a source for this?

Euthanasia is *not* the same as hospice care combined with not using extraordinary methods to resuscitate or keep alive. Euthanasia proactively kills. I still support legalizing it, with the consent of the patient obviously, but it's highly unlikely in a U.S. of the future that insurers will actually try to incentivize euthanasia.

What insurers? They're just the middle-man now, or the front.

My understanding is that it's not unusual for hospice services to include 'soft' euthanasia.

If Medicare would reimburse up to what it would have paid in the US for health care services performed in foreign countries, we could save a lot. Is this because of opposition from higher cost US doctors and hospitals?

Under what political model will the US gov't be incentivized to pay for medical care outside of it's own jurisdiction?

Things would have to get pretty bad (and we're not close to that) for that lever to be pulled.

The NHS already pays for treatment in French hospitals.

Economist Dean Baker has outlined a roughly similar, but global in scope concept for US recipients of Medicare:

(And, this bears some relevance to earlier discussions about immigration to the US, at least from countries with lower cost health care services. I mean, such a question could at least be considered: Does it make sense for a person from, say, Thailand, to relocate to the US and use the health care system here when such costs are much lower in Thailand? And what if Dean Baker's Medicare proposal were actually implemented? Would we see a time when people would immigrate to the US and then, later in life, return to their country of origin for medical treatment paid for by the US Medicare system? But it's only an academic question, at best, because Baker's concept will never be realized.)

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