Treatment abroad: Greater choice, greater risk
Jetting off to the sunny climes of the Cote d'Azur for a hip replacement may seem like a good way of combining much needed treatment with a relaxing holiday.
It conjures up images of lying by the pool afterwards and maybe enjoying some excellent cuisine - but in this week's Scrubbing Up, Dr Stephanie Bown of the Medical Protection Society warns patients should think carefully before going abroad for treatment.
A new directive on cross-border healthcare adopted by the European Commission earlier this year will give citizens greater choice and access to medical treatment anywhere in the EU.
But new choices may bring new risks.'Hidden costs'
The directive enables UK patients to receive treatment abroad which they would have been entitled to under the NHS, provided they obtain prior authorisation through their GP.
But, as with any medical treatment, people need to do their research before taking that step.
The standard, culture and quality of care differs from country to country.
It is intended that each member state will eventually have a 'national contact point' holding all relevant information about healthcare providers to enable patients to make an informed choice.
In the meantime patients will have to take a 'caveat emptor' approach and do their homework, to check that the service provider has the appropriate qualifications, indemnity and expertise to carry out their treatment.
There may also be hidden costs for patients.
Although they will be able to claim reimbursement of the cost of treatment up to the cost of receiving that healthcare on the NHS, there are other factors such as travel, accommodation, travelling companions and the possibility that treatment may be more expensive or take longer than anticipated - leaving the question of whether the true cost of treatment abroad is equal to that at home.Extra pressure
There are also likely to be difficulties arising from language and cultural differences.
Those with an idealistic viewpoint of combining treatment with a holiday should look before they leap ”
For example, what language will the prescription or medical records be written in? Will the patient, pharmacist or their GP at home be able to read it? Will they feel comfortable and safe being treated by people that are speaking another language?
There is also the extra pressure this may put on GPs, if they have to conduct their own research to ensure the treatment is right for their patient and liaise with the service provider abroad where necessary.
GPs are already extremely stretched, with many feeling challenged to manage their patient lists and needs, but they may also now have to be prepared for the possibility of urgent and unexpected requests, for example, a service provider may ask for additional information if a problem arises with one of their patients during treatment abroad.
Once patients return home after treatment, they may require further follow-up and aftercare. And what if something goes wrong once they are back on home soil?
The patients may not necessarily be able to return to where they received the treatment. Complaints will be dealt with under the system, if any, in operation in the country of treatment.
Similarly, negligence claims are usually brought in the jurisdiction in which the treatment was provided and are therefore subject to the civil law procedures in that country.
Although this may not be something people want to think about before receiving treatment, it could present practical difficulties for a potential claimant, and they should certainly check that the clinic or doctor providing the treatment holds appropriate indemnity.
Although the EU Directive is a step forward in terms of offering more choice and greater accessibility, the healthcare systems of the 27 countries involved are of differing sophistication and there are a lot of details to be clarified.
For doctors, it will be a case of managing another task and set of expectations, and raising awareness of the directive, in an already busy clinical setting.
For UK citizens living and working abroad the new directive may make it easier to access treatment, but for those with an idealistic viewpoint of combining treatment with a holiday, they should look before they leap.