Health Care Provision and Patient Mobility: Health Integration in the European Union (Developments in Health Economics and Public Policy Book 12)

"Patient mobility across Europe is markedly increasing and new generations will actively ask to be treated by the health-care system that best meets their needs. At a political level, the EU issued the EU Directive no. 24/2011/CE of 9th March 2011 concerning the application of patients' rights in cross-border health care and has contributed to improving the level of freedom of choice for the European citizen, but it does not seem to have increased actual patient mobility across Europe. Freedom to choose is necessary to grant the people of Europe the same access to public-sector health-care services. The latter is a key instrument for an efficiently functioning 'single market' ensuring real mobility within the EU. The aim of this book is to study the current European health care market and discuss the hypothesis of a European right of citizenship with reference to health-care services. It examines patients' mobility from several perspectives: determinants of patient mobility, governance of cross-border mobility at EU level as concerns patients and health-care professionals, policy implications, and case studies. It is intended for health researchers, decision-makers and professionals concerned with health-care provision and patient mobility. The goal is to provide, through scientific and methodological rigor, new informative tools useful for the implementation of new policies in the health-care sector in order to implement effective health-care integration in the European Union"--Provided by publisher Preface 5 Contents 8 1 Patient Choice, Mobility and Competition Among Health Care Providers 10 Abstract 10 1...Introduction 11 2...Theory 11 2.1 Health care Provider Objectives 13 2.2 Profit Constraints 15 2.3 Soft Budgets 16 2.4 Specialization 17 2.5 Information on Quality 18 2.6 Gatekeeping 19 2.7 Cost-Containment Effort 20 2.8 Cream-Skimming 20 2.9 Interjurisdictional Mobility 21 2.10 Dynamic Analysis 21 3...Empirical Evidence 22 3.1 Patient Choice and Quality 23 3.2 Hospital Competition 29 4...Conclusions 32 References 33 2 Using Discrete Choice Experiments to Understand Preferences in Health Care 36 Abstract 36 1...Introduction 37 2...Measuring Preferences 38 2.1 Theory of Discrete Choice Experiments 39 2.2 Practical Issues in Conducting a DCE 42 2.2.1 Identifying Attributes 43 2.2.2 Assigning Attribute Levels 44 2.2.3 Applying an Experimental Design 44 2.2.4 Generating and Visualizing Choice Sets 45 2.2.5 Collecting Data 45 3...Eliciting Preferences in Health Care 46 3.1 Preferences for Health Insurance 47 3.2 Preferences for Pharmaceuticals 49 3.3 Preferences for Providers 51 4...Concluding Remarks 54 References 54 3 Implications of the EU Patients’ Rights Directive in Cross-Border Healthcare on the German Sickness Fund System 58 Abstract 58 1...Introduction 59 2...The German Sickness Fund System and Cross-Border Healthcare 60 2.1 The German Sickness Fund System 60 2.2 Regulation of Cross-Border Healthcare 61 2.3 Sickness Funds and Cross-Border Healthcare 63 3...Germany’s Experience with EU Cross-Border Healthcare Prior to the Directive 64 3.1 Users of Planned EU Cross-Border Healthcare and Destinations 65 3.2 Treatments Provided 66 3.3 Motivation for Planned Cross-Border Treatment 67 3.4 Satisfaction with Planned Cross-Border Care 67 3.5 Summary 68 4...Possible Effects of Increased EU Cross-Border Healthcare for the German Sickness Fund System 68 4.1 Cross-Border Care and Expenditure Control 69 4.2 Cross-Border Care and Equal Access to Care 70 4.3 Cross-Border Care, Cost Savings and Risk Selection 71 5...Policy Implications 72 6...Conclusions 73 References 74 4 The Possible Effects of Health Professional Mobility on Access to Care for Patients 76 Abstract 76 1...Introduction: Why a Chapter on Health Professional Mobility? 77 2...Methodology 78 3...The Link Between Health Professional Mobility and Service Delivery 78 4...The Perspective of Destination Countries 79 5...The Perspective of Source Countries 81 6...Increasingly Interdependent Countries 82 7...Crisis and Competition: Is There a Role for Solidarity? 83 8...Conclusions 86 References 86 5 Patient Choice and Mobility in the UK Health System: Internal and External Markets 90 Abstract 90 1...The Modern UK National Health Service (NHS) and Development of Health Care Markets, Patient Choice and Mobility 91 1.1 The Evolution of Patient Choice in the Changing NHS Health Care Economy 93 2...Analysis of Patient Choice and Mobility in the NHS Internal Market 96 2.1 Attitudes, Adoption and Consequences of Patient Choice 96 2.2 Patient Mobility within the NHS 100 2.2.1 Frequency of Mobility for Health Care Utilization 100 2.2.2 Travel Distances and Journey Times for Health Care Visits 101 2.2.3 Cross Border Flows of Patients Within the UK 103 2.2.4 Cross Regional Flows of Patients in England Before and After the Introduction of Patient Choice 104 2.2.5 The Impact of Choice and Market Competition on Patients’ Location of Treatment 108 3...The Influence of External Markets on UK Patients and the NHS 109 3.1 Outward Patient Journeys from the UK to Exporting Countries 111 3.1.1 Public Satisfaction and Comparative Performance of Health Care in the UK 111 3.1.2 Willingness to Travel and the Factors Influencing the Propensity to Seek Treatment Further from Home 114 3.1.3 Magnitude and Characteristics of Patient Mobility of UK Residents to Health Care Providers Outside the UK 116 3.1.4 Safety, Regulation and Ethical Concerns 119 3.1.5 Case Study: UK NHS Outsourcing to Foreign EU Providers 120 3.1.6 UK NHS Policy Response to EU Legislation and Internal Demand 124 3.1.7 The Costs of Cross Border Health Care to the UK 125 3.1.8 Opening up the NHS Care Market to Private and External Foreign Providers 126 3.2 Patient and Health Care Mobility into the UK NHS from Importing Countries 127 3.2.1 Exporting NHS Health Care into Foreign Countries 130 4...Conclusions 131 Acknowledgments 136 References 136 6 What Drives Patient Mobility Across Italian Regions? Evidence from Hospital Discharge Data 142 Abstract 142 1...Introduction 143 2...Related Literature 145 3...Data 147 3.1 Patient Mobility in Italy 147 3.2 Origin and Destination Characteristics 149 4...Empirical Analysis 155 4.1 Economic Framework 155 4.2 Results 156 5...Conclusions 161 Acknowledgments 162 References 162 7 The Impact of Federalism on the Healthcare System in Terms of Efficiency, Equity, and Cost Containment: The Case of Switzerland 164 Abstract 164 1...Introduction 165 2...General Theory of Fiscal Federalism: A Short Literature Review 165 2.1 The Theoretical Economic Background: Advantages of Decentralization 166 2.2 Challenges of a Decentralized System with Respect to Equity 168 2.3 Challenges of a Decentralized System in terms of Efficiency 169 3...The Swiss Health System 171 4...Fiscal Federalism and Efficiency in the Swiss Healthcare System 174 5...Fiscal Federalism and Equity in the Swiss Healthcare System 179 5.1 Equity of Health Status and Equity of Access 180 5.2 Equity of Financing 181 6...Conclusions 183 References 185 8 Patients’ Mobility Across Borders: A Welfare Analysis 188 Abstract 188 1...Introduction 189 2...Patient Mobility 190 3...The Model 191 3.1 The Environment 192 3.2 Equilibrium Without Mobility 194 3.3 Patient Mobility 195 3.3.1 Regulated Mobility 195 3.3.2 Region 0 196 3.3.3 Region 1 196 3.3.4 Welfare Analysis 197 3.4 Patient Choice 198 3.4.1 Region 0 198 3.4.2 Region 1 199 3.4.3 Equilibrium 199 3.4.4 Welfare Analysis 200 3.5 Numerical Example 201 3.6 Discussion 203 4...Long-Run Considerations 203 5...Conclusions 204 A.x(118). Appendix 205 A.x(118).1 Derivation of the Optimal Quantities 205 A.x(118).2 Welfare Analysis for the Patient Choice Case 207 References 209 9 Quality Competition and Uncertainty in a Horizontally Differentiated Hospital Market 210 Abstract 210 1...Introduction 211 2...The Model 213 2.1 Hospitals 213 2.2 Patients 214 2.3 Social Welfare 215 3...The Simultaneous Nash--Cournot Equilibrium 216 3.1 Benchmark 216 3.2 Symmetric Objectives but Asymmetric Costs 216 3.3 Asymmetric Objectives and Asymmetric Costs 217 4...The Sequential Stackelberg Equilibrium: Symmetric Objectives but Asymmetric Costs 218 5...Uncertainty 220 6...Simulations 221 6.1 Simulation 1: Symmetric Objectives but Asymmetric Costs 221 6.2 Asymmetric Objectives and Asymmetric Costs 223 6.3 Sequential Stackelberg Equilibrium 224 6.4 Uncertainty: Symmetric Objectives but Asymmetric Costs 225 6.5 Uncertainty: Asymmetric Objectives and Asymmetric Costs 228 7...Conclusions 229 References 230 10 Cross Border Health Care Provision: Who Gains, Who Loses 232 Abstract 232 1...Introduction 233 2...The Model 234 2.1 Equality Issues 237 3...Decentralized Solution 238 3.1 Without Cross Border Supply 238 3.2 With Cross Border Supply 239 4...Welfare Improving Strategies 241 5...Discussion and Numerical Example 243 6...Conclusions 247 A.x(118). Appendix 248 A.x(118).0 Solution to the Problem Without Cross Border Supply 248 A.x(118).0 Solution to the Problem with Cross Border Supply 249 A.x(118).0 Solution to the Central Government Problem 250 A.x(118).0 Comparisons 251 0.0.0 Quantity of Health Care 251 References 252 Front Matter....Pages i-x Patient Choice, Mobility and Competition Among Health Care Providers....Pages 1-26 Using Discrete Choice Experiments to Understand Preferences in Health Care....Pages 27-48 Implications of the EU Patients’ Rights Directive in Cross-Border Healthcare on the German Sickness Fund System....Pages 49-66 The Possible Effects of Health Professional Mobility on Access to Care for Patients....Pages 67-80 Patient Choice and Mobility in the UK Health System: Internal and External Markets....Pages 81-132 What Drives Patient Mobility Across Italian Regions? Evidence from Hospital Discharge Data....Pages 133-154 The Impact of Federalism on the Healthcare System in Terms of Efficiency, Equity, and Cost Containment: The Case of Switzerland....Pages 155-178 Patients’ Mobility Across Borders: A Welfare Analysis....Pages 179-200 Quality Competition and Uncertainty in a Horizontally Differentiated Hospital Market....Pages 201-222 Cross Border Health Care Provision: Who Gains, Who Loses....Pages 223-244 2 ... Measuring Preferences2.1 Theory of Discrete Choice Experiments; 2.2 Practical Issues in Conducting a DCE; 2.2.1 Identifying Attributes; 2.2.2 Assigning Attribute Levels; 2.2.3 Applying an Experimental Design; 2.2.4 Generating and Visualizing Choice Sets; 2.2.5 Collecting Data; 3 ... Eliciting Preferences in Health Care; 3.1 Preferences for Health Insurance; 3.2 Preferences for Pharmaceuticals; 3.3 Preferences for Providers; 4 ... Concluding Remarks; References; 3 Implications of the EU Patients' Rights Directive in Cross-Border Healthcare on the German Sickness Fund System; Abstract; 1 ... Introduction 7 ... Crisis and Competition: Is There a Role for Solidarity?8 ... Conclusions; References; 5 Patient Choice and Mobility in the UK Health System: Internal and External Markets; Abstract; 1 ... The Modern UK National Health Service (NHS) and Development of Health Care Markets, Patient Choice and Mobility; 1.1 The Evolution of Patient Choice in the Changing NHS Health Care Economy; 2 ... Analysis of Patient Choice and Mobility in the NHS Internal Market; 2.1 Attitudes, Adoption and Consequences of Patient Choice; 2.2 Patient Mobility within the NHS; 2.2.1 Frequency of Mobility for Health Care Utilization Preface; Contents; 1 Patient Choice, Mobility and Competition Among Health Care Providers; Abstract; 1 ... Introduction; 2 ... Theory; 2.1 Health care Provider Objectives; 2.2 Profit Constraints; 2.3 Soft Budgets; 2.4 Specialization; 2.5 Information on Quality; 2.6 Gatekeeping; 2.7 Cost-Containment Effort; 2.8 Cream-Skimming; 2.9 Interjurisdictional Mobility; 2.10 Dynamic Analysis; 3 ... Empirical Evidence; 3.1 Patient Choice and Quality; 3.2 Hospital Competition; 4 ... Conclusions; References; 2 Using Discrete Choice Experiments to Understand Preferences in Health Care; Abstract; 1 ... Introduction 4.1 Cross-Border Care and Expenditure Control4.2 Cross-Border Care and Equal Access to Care; 4.3 Cross-Border Care, Cost Savings and Risk Selection; 5 ... Policy Implications; 6 ... Conclusions; References; 4 The Possible Effects of Health Professional Mobility on Access to Care for Patients; Abstract; 1 ... Introduction: Why a Chapter on Health Professional Mobility?; 2 ... Methodology; 3 ... The Link Between Health Professional Mobility and Service Delivery; 4 ... The Perspective of Destination Countries; 5 ... The Perspective of Source Countries; 6 ... Increasingly Interdependent Countries