International Health Care Systems

Cross-border medical care in Europe

In Europe, some patients are able to seek medical care in other countries. Reasons for doing so include shorter waiting times, access to treatment that is no obtainable in their home country’s public health care system, quality of care, and costs. Cross-border medical care affects many people: “20 to 24 million patients worldwide spending an average of 3410 U.S. dollars annually, sizing the market at 65–87.5 billion U.S. dollars “

A paper by Amuedo-Dorantes et al. (2022) divides care received in other countries into two types: “medical tourism” and “cross-border medical care”. In the former case, patients receive care elsewhere out of their own volition and often have to pay out-of-pocket. On the other hand:

cross-border medical care is often reimbursable or paid for directly by the responsible government under pre-established regional agreements. Yet, because nations vary in the extent of health coverage offered to their residents, these expenditures are rarely fully reimbursed. The resulting financial burden for countries providing the care can be large and not reciprocal, straining regional and country-level finances.

Cross-border medical care is especially common in the European Union since nationals from any EU country are entitled to the same health care treatment as nationals from those countries. France and Spain rank first and second in terms of the number of medical interventions performed on foreigners within the EU.

Amuedo-Dorantes et al. (2022) examine the effectiveness of a legislative measure adopted by the Spanish comunidad autónoma of Valencia in January 2012. This measure charged non-residents directly for care provided in hospitals with the explicit goal of curbing cross-border medical care. Previously, cross-border medical care was common as many individuals traveled to tourist areas such as Alicante for medical care. The authors use administrative data from the Spanish Minimum Set of Basic Data (MSBD) between 2008 and 2015 to track hospitalization rates by Spanish residents and non-residents. MSBD is anclinical and administrative database provided by the Ministry of Health, Consumption and Social Welfare. Using this approach, the authors the authors find that:

…the reform significantly curtailed non-resident hospitalizations by 98% and lowered medical cost by 4.8 million euros/trimester.

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