A new EU law, which will enable more travel for treatment and open comparisons between the healthcare systems of member states, could be a wake-up call for the HSE, writes Honor Mahony
Patients in the Republic will in the future have clear guidelines about when they can travel abroad for hospital treatment, while a more open system of information sharing is expected to shame the healthcare system into brushing up its act.
A new EU law, set to be unveiled next year, will oblige local health officials to tell patients how long they will have to wait for a particular operation, such as cardiac surgery.
If the waiting time then runs on longer than this, the patient will be entitled to travel abroad for the same operation and be refunded to the extent of what it would cost here.
"It's not so much telling health providers what to say, but requiring people to be upfront with patients about what is a doctor's reasonable waiting period," says Robert Madelin, director general of health and consumer protection in the European Commission.
The commission, which says it wants to keep a light regulatory touch in this area, has been forced to act following a series of judgments by the European Court of Justice which have pushed forward the integration possibilities in EU healthcare but left major questions unanswered.
In its latest judgment in May, the court ruled in the case of British woman Yvonne Watts that patients facing "undue delays" in their waits for operations should be entitled to have treatment in other EU countries - but it failed to specify what an undue delay was.
Watts had been waiting more than a year for a hip operation under the NHS. She then travelled to France for the treatment and claimed for the operation's cost from the British health system.
Under the commission's plans, patients' rights in non-hospital treatment areas will also be clarified. Irish citizens wanting to travel to France for cosmetic surgery or to Poland for dental treatment, for example, can go without having to get permission first and can still be refunded.
"Let's say something doesn't require hospital attention: then normally you don't need to get prior authorisation and can get reimbursement. What we need to make clearer there is that reimbursement is of the cost that your local provider would have faced," says Madelin.
"If the [ treatment] costs €100 in Ireland and you go and get it done at a cost of €500, you can't present a bill for €500," he explains.
However, people will not be entirely free to pick and choose from a range of treatments abroad and expect the bill to be paid back home. Only services available here will be refunded; all other costs will be borne by the patient.
At the moment, if an operation abroad goes wrong, patients are left in a legal black hole, with no rules on who should pay or which country needs to provide after-care treatment. The commission is planning to make the health departments spell out exactly what patients' rights are if they need compensation.
Brussels will also clarify how member states - particularly those countries where the state contributes a significant amount to the healthcare system, thus making treatment cheaper - can protect themselves from a large increase in patients.
Madelin indicates that the commission is hoping that better quality of information will result in national healthcare systems being shamed into improving their services because patients, armed with information, will be able to make direct comparisons more easily.
At the moment, it still requires some effort and research on the part of the patient to gather the information needed to assess hospitals in terms of care and services.
"The effect of knowing what's going on somewhere else will strengthen the hands of those trying to improve access to care and health services," says Madelin.
"What we want to do is enable national providers and patient groups to compare them. It is not possible, sitting in Brussels, to say, 'five out of 10 for Ireland, something else out of 10 for France'."
The Government got a taste of the public whipping that can result from clear public information when a Swedish company in June published a report putting Ireland second-last in Europe for healthcare, and last in terms of value for money. Soon patients will be able to make these kind of comparisons themselves.
Another value of information sharing is expected to come in form of sharing of knowledge. Down the line, the commission wants Europe to be linked electronically to share medical expertise.
"If you were in a hospital in the Republic and you could see the problem but you didn't have an expert on it, you'd know more easily where to find the expertise," says Madelin.
Five years down the line, and the life of the average patient "can expect to be better", says Madelin.
Outlining what he expects, he says: "Most changes will come at home. Firstly, patients will get more explicit advice as to what they have a right to expect.
"Secondly, quality of service will be improved because those who are working at national level, for example on patient safety, will be working together so you will have all the lessons of Europe and not just the lessons of one country."
He adds: "On difficult diseases and conditions, you will have opposite you your local doctor or consultant or nurse, who will have access to broader expertise across Europe. For those reasons, you could expect that life would get better."
But in line with the more hands-off regulatory stance of the commission as a whole, and the fact that the commission is stepping into an area that governments hold close to their sovereign hearts, Madelin stresses that the intention is not to harmonise healthcare systems. Nor is it Brussels' intention to say that EU citizens are entitled to a certain level of healthcare and to lay it down in law.
"We don't think the judgements of the [ European] court require a centralised policy of health service provision, but we do think it needs to be made a bit clearer how open a health service provider should be with their clients," he says.
The commission is expected to start a public consultation on the issue in the coming weeks, allowing governments and other stakeholders to have their say on the issue, which is expected to produce a long and heated debate.
The legislative proposal is expected to be published next year and the European Parliament and member states will then have to approve it.
But those expecting a Brussels solution for the long queues for few hospital beds will be disappointed.
The commission's new proposals "will not mean that suddenly the provisions of beds per citizen or beds per 100,000 citizens will be doubled in any given period", says Madelin.