European patients were once passive recipients of medical care, content to get treatment that was free or largely reimbursed – and grateful for what was on offer locally.
But today's patients are more demanding. A small but significant number are even prepared to pack their bags and go abroad in search of faster public healthcare, or cheaper private healthcare. Patients' rights have been codified.
The starting point is the EU's Charter of Fundamental Rights, which says that the Union must guarantee “a high level of protection of human health”, including the right to preventive healthcare and medical treatment.
Access to services
Last year saw the second European Patients' Rights Day (18 April), which aims to put these elevated concepts into practice.
It is the brainchild of the Active Citizenship Network, an Italian civil society group that has drawn up a 14-point patients' rights charter. These include access to health services and to timely information tailored to the individual, as well as rights to consent, choice, innovation, privacy, to make complaints and to be spared unnecessary suffering and pain. Observance of these rights is patchy, but they are generally seen as a way to drive up healthcare standards and are being imported into the EU's candidate countries.
At EU level, access to health services is the main battleground for patients' rights. The European courts have repeatedly upheld patients' rights to receive public-funded treatment in other EU countries. But this has not meant that drawing up an EU law is simple.
For years, the EU institutions have clashed over balancing the individual's demands for the best possible treatment against the collective wish for an affordable, efficient healthcare system. The debate has been intensified by governments' fears that the EU is ‘interfering' beyond its competence. Although healthcare remains a national competence, EU court rulings have introduced a European dimension that can not be ignored.
Mobile patients
Mobile patients are not the only source of tension in the debate over access to healthcare. The ‘right' to certain drugs or medical procedures is also a hot topic. Patients' groups tend to see rights to treatment (and healthcare budgets) as being unlimited. “Each individual has the right of access to innovative procedures...independently of economic or financial considerations,” according to the Active Citizenship Network.
Likewise, every individual should get personalised treatment where the “criteria of economic sustainability does not prevail over the right to healthcare”. But even the wealthiest countries have finite resources. Not every treatment can be a top priority.
Healthcare managers face difficult choices: should they spend money on the latest cancer drug, improve geriatric care, or introduce or increase charges for healthcare? Health technology assessment, a subject of growing importance at European level (see Page 22), can help, but offers no escape from hard choices.
Many complexities lurk behind the declarations and slogans on patients' rights.
