UEHP Newsletter - January 20th, 2017  
  January 20th, 2017  
Happy new year?
Yes, but…!
What are the major challenges of an important new year? Since 2007, uncertainty is becoming a regular partner in our agenda. In all EU Member States, major elections could change government and policy choices during 2017. The reaction to Brexit is to be measured without actual clear solution. A new elected president in the United-States willing to change world trade regulation, including international relationships within Europe.
In this context, social policy and healthcare system organisations can be shocked by new constraints. We have to propose solutions and not passively suffer from hard decisions. May we repeat that UEHP is an actor of changes, offering an efficient service dedicated to patients, limiting waste and adverse events. An economic regulation must now include quality indicators and performance measurement to assess sustainability in healthcare system. Please read with the highest interest the OECD recommendations recently published. Private sector is engaged in a positive competition to offer the best service, following performance engagement.
To fight waiting lists, to enhance patient mobility, a European perspective is required. We will organise this year an important meeting with the support of the Portuguese Health Minister to discuss of a renewed collaboration between providers, offering the best services to all citizens. We will be the partner of an informed decision including IT in our “smart hospitals”, information is the strongest force we know for a free choice of patients.
Accept the message of all the UEHP Board Members, the Secretary General and all private hospital managers as partners of our association, we wish you the best perspective and success in this challenging year.
Dr Paul Garassus
President of the UEHP
The Board agreed in Rome that the event on Patient Mobility to be organized in Lisbon would be a European Conference organized by the UEHP with the support of the Portuguese Association of Private Hospitals (APHP) and with the endorsement of the Portuguese Health Ministry.

It would, in principle, take place on the 9th of March, the day before the UEHP General Assembly. The Board would have a work dinner on the 9th and the General Assembly would take place on the 10th. Please, save the dates.

Ilaria Giannico, Secretary General of the UEHP spoke at the 3rd annual COCIR summit in December 2016: “Digital Health Innovation, Define, Measure, Impact” in order to present the positions of the UEHP. COCIR is the European Trade Association representing the medical imaging, radiotherapy, health ICT and electromedical industries. The annual summits gather policymakers, academia, civil society and the eHealth industry to develop a shared vision on the value of Digital Health Innovation to Europe.

The UEHP has recommanded in its presentation an alignment of European national legislation on data protection and privacy; better resources allocation and more investments in new technologies; scientific research and comparative studies on Big Data in healthcare supported by EU; more integration in healthcare (enhanced cooperation between healthcare providers); more education and training on handling large amounts of data and strategy analysis of Big Data for hospital management; permanent attention to safety procedures on confidential data.

Read the article on www.cocirehealthsummit.org

Five years after its approval, the 2011/24 directive, which aims to liberalise access to healthcare for citizens throughout the Union, did not take off, as evidenced by the small number of applications filed in 2014 (109,223 for Europe).
Published reports (2015 Commission report on the operation of the cross-border healthcare Directive and the Eurobarometer on Patient Rights published in May 2015) as well as ongoing discussions, show that concerns around patient information and National Contact Points (NCP) performances persist and continue to be identified as critical issues still to be addressed.
Among the obstacles, it is important to remember that some Member States appear to be deliberately complicating cross-border healthcare processes for patients. According the report of the Commission, the States do not inform enough citizens (all patient groups including vulnerable patients) and the Eurobarometer survey reveals that fewer than two out of ten Europeans are informed of their rights to cross-border access to care. « A big obstacle is the necessity in 21 out of the 28 european countries to become a prior authorisation, especially for hospitalisations and high-tech health care provision » explain Alberta Sciachi, from the Italian Federation Private Hospitals (AIOP).
In order to follow-up on the transposition of the Directive, a questionnaire collecting data for the year 2015 has been elaborated and submitted to all National Contact Points of the European Countries. 23 countries only answered and no replies have been received from Austria, Finland, France, Iceland, Latvia, Lithuania and Portugal. Despite the difficulties to collect data in some countries, some common concerns could be identified:
- Low citizens awareness
- Low reimbursement tariffs
- Burdensome administrative work
- Extended systems of Member States implementation
- Healthcare subjected or not to prior authorisation
- Differences between Directive 2011/24/UE and Regulation 987/2009
European Patients Forum’s point of view LINK :
There is not much practical experience among patient organizations yet and there is little involvement of patients, mainly due to the lack of information, the barriers to access in cross-border healthcare, as well as the lack of awareness of the Directive. Moreover, there is a lack of awareness by medical professionals who should at least have general awareness on cross-border healthcare.
The Benelux countries on the contrary have a longstanding cross-border cooperation, which shows that it is necessary to fill the directive with life and enhance cooperations.
(Written in cooperation with Alberta Sciachi, AIOP)
Since the beginning of January 2017, Malta assumes the six-month rotating Presidency of the Council of the European Union for the first time ever.
Among the health priorities of the Maltese Presidency, two areas of action are particularly of interest for the UEHP : enhancing cross-border cooperation and eHealth. « The Maltese Presidency will also focus on enhancing cross-border cooperation through the promotion of centres of excellence, for example in the area of rare diseases. With other EU initiatives such as the European Reference Networks kicking off in March, it is expected that cross-border cooperation will remain high on the EU health policy agenda throughout 2017. Within the framework, the Maltese Presidency intends to launch a structured, cross-border post-graduate training programme for doctors that would support sustained cooperation between European hospitals. Finally, Malta will host an eHealth conference in Valletta, with a focus on Data for Health, in the context of the eHealth week in May.»
Health issues in the Council agenda :
- 1-2 March - Workshop on structured cooperation between health systems
- 10-12 May - eHealth week
Prof. Dr Gabriele Pelissero, President of AIOP, and Dr Nicola Bedin, CEO of the San Donato Hospital Group represented Italy at the 12th National conference on Health Economy in Germany.
The conference took place in Rostock, Germany, on the 13th and 14th of July 2016, in presence of the German Federal Minister of Health, Herman Grohe, and the Prime Minister of the federal state of Mecklenburg-Vorpommern, Erwin Sellering.
Brief overview of the Italian healthcare system
The Italian healthcare system is also regulated at a regional level, with 19 regions and two autonomous provinces having legislative power on healthcare. Public and private operators are cohabiting to deliver healthcare services to almost 60 millions inhabitants.
The amount of public healthcare spending in relation to the GDP (2013) is below the average of the 15 first members of the EU and almost equal to this of Croatia. It decreased in the past years due to the economic crisis. Italy also has the highest percentage of people over 65 years (21.4%) in Europe.
Despite economic and financial constraints, the Italian healthcare sector is seeking for efficiency and has progressively since 2006 shifted to more ambulatory care delivery by  developping outpatient centres. Moreover Italy made available for everybody an efficient national information system which enables to trace with a single card each of the annual nine millions admissions in hospitals.
Patient mobility within regions has grown considerably in Italy, where patients are free to chose the structure they think to be superior in quality and more appropriate to their needs.
The private sector in Italy
The share of the private sector has grown substantially since the 70s. Today, 28 % of health services delivered to patients under the national healthcare system are offered by accredited private operators. Italy counts 592 private hospitals of all kinds and sizes. The same trend like in France and Germany can be observed with the birth of important private hospital groups. However, the private sector faces iniquities of financial treatment compared to the public sector due to repeated deficits in certain regions.
The private healthcare sector is also very dynamic in terms of investment, level of technicality and specialization of healthcare provision offered, with a national index rate superior to the public sector.

The Council of State has condemned the French State and cancelled orders fixing the funding rates for private non-profit healthcare institutions for the years 2015 and 2016.
The French government had offered operators a reduction of social contributions as part of the Responsibility Pact. The benefit of this pact was neutralised for private institutions by a reduction in the tariff set for procedures. The family of private non-profit health institutions has benefited from this reduction in charges without quid pro quo. The French Federation Private Hospitals (FHP) has filed an appeal, not to contest the benefit received by fellow institutions but to qualify for the same treatment. The Council of State has condemned the French state, in favour of private institutions, but does not order reimbursement of the monies unduly received by not-for-profit health institutions.

Graz Ragnitz Private Clinic
Boys’ Day as investment in the future of the nursing profession

Each year in May, Boys’ Day is held throughout Austria, for the 9th time in 2016. The figures show that the event still makes sense: the nursing team at the Graz Ragnitz private clinic comprises only 7%. Director of Nursing, Friederike Günther MSc, wants to take positive action against this!
“We are using this opportunity to show young people the broad spectrum of the medical and social care professions. And, of course, we want to encourage the lads to consider a career in nursing”, said Friederike Günther, Director of Nursing at the Graz Ragnitz private clinic about the clinic’s participation in Boys’ Day.
The aim of the campaign day is thus not only to offer insights into the world of work of the various professions, but also to share the sense of enjoyment that the professionals experience while at work. The boys taking part also had ample opportunity to ask everyone at the clinic, from theatre nurses and physiotherapists to the male nurses, everything they were itching to know.
And as experts have been forecasting for years staff shortages in the health sector, Boys’ Day is an excellent investment in the future.

How to define quality ?

The Ministry of Health has launched in 2015 the Institute for quality assurance and transparency in healthcare (IQTIG), which goal is to develop scientific stable quality indicators to compare the quality of medical treatment between hospitals, physicians and nursing homes. Hospitals have to provide annual data for public reporting. A ranking list of hospitals is planed and this model is the first step to a pay for performance payment model.
As regard to transparency in quality management, private hospital groups have taken the lead with the creation of two institutes, IQM and Qualitätskliniken.de-4QD joined under an umbrella organization, the SIQ foundation for quality management (Stiftung Initiative Qualitätskliniken). The work of the foundation offers a solid base to develop a new model of quality assessment, which might lead to legislation improvements. Today, patients can consult a web platform (qualitätskliniken.de),which includes data of more than 450 private, private-non profit and public hospitals. Data related to quality of medical treatment, patient safety, patient satisfaction, physicians satisfaction, ethics are collected through declarative statements and verify by audits, and a ranking list facilitates the choice of a hospital.
« Quality in Germany is not just a matter of improving patient safety, it is also a powerful tool to regulate the market as the government will have to close about 300 hospitals in a near future. Members of IQM and Qualitätskliniken.de are better prepared for the upcoming focus on quality, as the government will increasingly establish strong quality specifications for hospitals », declares Thomas Bublitz, director of the German Federation Private Hospitals (BDPK) and Director of both quality management institutes, IQMG (Institut für Qualitätsmanagement) and 4QD-GmbH.

First prophylactic gastrectomy with robotic support in the world
The General Surgery Service of the private hospital HM Sanchinarro in Madrid, directed by Dr Yolanda Quijano and Dr Emilio Vicente, have performed two prophylactic gastrectomies with robotic support on September 7. 2016. These are the first cases of Hereditary diffuse gastric cancer (HDGC) in the world treated with this technique. The intervention lasted 350 minutes and did not require transfusion of blood products.
The patients were mother and daughter and both had an inherited predisposition syndrome to cancer with an autosomal dominant inheritance pattern. Hereditary diffuse gastric cancer (HDGC) is caused by germline mutation of the CDH1 gene. Mutation carriers have a more than 80% lifetime risk of developing gastric cancer as well as an elevated risk of lobular breast cancer. Once an individual has been identified as a healthy career of a disease-causing mutation, the advice is to consider performing prophylactic total gastrectomy regardless of the endoscopy findings.
Robotic surgery system (RSS) was introduced as an advanced platform studied to overcome the technical limitations of conventional laparoscopy with many advantages: articulated movement of the robotic instruments, the elimination of tremor and the 3-D vision.
“ The most interesting aspect of the surgery performed is to have been able to associate two modern concepts that have revolutionized medicine in general and surgery in particular: Preventive surgery and minimally invasive surgery, where robotic surgery is the most important component”, say the experts.
To our knowledge, these patients represent the first cases of HDGC detected by robotic prophylactic gastrectomy in the world. Both patients are actually in good clinical condition.
1 Mars
Conference “Exploring areas and benefits of cooperation in cross-border healthcare to protect patients’rights”
3-5 May
Healthio 2017
10-12 May
eHealth Week 2017
25-27 May
Intercare - International Medical Tourism Exhibition