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Referring abroad
Full text linkSummary
Cross-border health care is an issue of growing importance in the European Union. It offers
health care services and products to patients in other countries than the country which
covers their residency or insurance. Through rulings of the European Court of Justice, the
possibilities for patients to receive cross-border care have been clarified. Although data on
patient mobility within the EU is limited, the extent of cross-border health care is estimated to
be around 1% of total health care expenditure in the EU. The numbers of patients seeking
cross-border care can vary enormously per border and the direction can be either
unidirectional or bidirectional depending on the border. Though cross-border care is unlikely
to become a dominant activity in any country’s health care system, there is scope for
increased patient mobility. ZorgSaam hospitals believes that there is greater scope for crossborder
care and therefore wishes to attract Belgian patients. One of the ways through which
patients seek cross-border care, is through their GP. The role of GPs is important in two
ways: as referrers they can channel patients, and as the professionals that patients usually
trust most and being the first contact point, GPs can influence patients’ choices about where
to be treated. This has lead to the following main research question of this study:
How can ZorgSaam increase referrals from Belgian GPs?
In order to be able to answer this question, the concept of cross-border care has first been
looked into. The conceptual model that followed from this consists the interlinked elements of
the institutional factors, processes, contextual factors and actors on various levels
(European, national, regional). This model helped develop the research method used.
This method consisted of semi-structured interviews held with GPs in the border region (most
of whom had Dutch patients and therefore had some experience with ZorgSaam) and
interviews with representatives of two leading mutualities. GPs were asked about their
referral decision making. Both groups were asked about possible enablers and barriers of
cross-border care and their attitude towards it.
From the results it can be concluded that, GPs and representatives of the mutualities
have a positive attitude towards cross-border care as long as it is of benefit to the patients.
The GPs do not perceive any real advantages for Belgian patients to cross the border to
seek care in a ZorgSaam hospital, other than the extra choice it provides for patients.
However, there is adequate hospital care available in Belgium. The GPs have therefore
never referred their patients to ZorgSaam.
The results have also given some insight into the other barriers and enablers of
cross-border care. The enabling factors are the cultural and linguistic similarities and the
short distance to a ZorgSaam hospital from Belgium. However, as the GPs remarked: “It is
not so much the distance to Terneuzen that is the problem; it is rather the idea that you are
going abroad that is the problem”. That going abroad is the problem, is made evident by
other barriers found. The unfamiliarity with the Dutch health care system, differences in
organisation within Dutch hospitals and ICT applications and the unfamiliarity with Dutch
specialists too are reasons for Belgian GPs not to refer their patients to ZorgSaam. Many of
the barriers found are similar to those factors that determine whereto GPs generally refer
their patients. Therefore ZorgSaam will need to compete with Belgian hospitals on these
factors.
For ZorgSaam to be able to increase the referrals from Belgian GPs it will be
necessary that they improve the relationship between GPs and ZorgSaam specialists.
Provide information to GPs (and patients) concerning the possibilities and procedures of
cross-border care, and what patients can expect from ZorgSaam. It has also been suggested
that ZorgSaam not only puts effort in attracting Belgian patients, but also those Dutch
patients that are now more orientated towards Belgian health care services.
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Management summary
Objective
Cross-border health care, is of growing importance and through rulings of the European
Court of Justice, the possibilities for patients to receive cross-border care have been clarified.
Though cross-border care is not or is unlikely to become a great phenomena, there is scope
for increased patient mobility. ZorgSaam hospitals believes that there is greater scope for
cross-border care and therefore wishes to attract Belgian patients.
One of the ways through which patients seek cross-border care, is through their GP.
The role of GPs is important in two ways: as referrers they can channel patients, and as the
professionals that patients usually trust most and being the first contact point, GPs can
influence patients’ choices about where to be treated. This has lead to the following main
research question of this study: How can ZorgSaam increase referrals from Belgian GPs?
Recommendations
Based on this study, the following recommendations can be made:
• ZorgSaam should improve the relationship between Belgian GPs and specialist
o Inviting Belgian GPs to functions specifically aimed at them that are held at
convenient hours. This will allow Belgian GPs to get acquainted with
ZorgSaam specialists
o Encouraging ZorgSaam specialists to present at refresher courses organised
by Belgian GP associations. This too will allow Belgian GPs to get acquainted
with ZorgSaam specialists
o Enabling GPs to have direct contact with ZorgSaam specialists by handing out
a phone list with direct contact numbers. This will ease the working
relationship between GPs and specialists
o Creating an understanding of the differences in the organisation of hospitals,
making it easier for Belgian GPs and ZorgSaam specialists to work together
• Providing Belgian GPs with information concerning cross-border care: when can
patients seek cross-border care, how should they go about it, what is the procedure,
what can patients and GPs expect
• ICT solutions reducing the administrative burden put on GPs when they refer patients
to ZorgSaam
• Not only aiming to attract Belgian patients, but also aiming to attract Dutch patients
who are now more Belgium orientated. Thus showing Belgian GPs that ZorgSaam
can also provide adequate care to Belgian patients
Motivation
Interviews were held with Belgian GPs in the border region with Zeeuws-Flanders. These
interviews have covered the perceived enablers and barriers to receiving health care in the
Netherlands and the practical barriers they have encountered when having referred patients
to the Netherlands. Interviews were also held with representatives of two leading mutualities
to get a better insight in the barriers and enablers of cross-border care and differences
between the health care systems of Belgium and the Netherlands. Analysis of the data was
qualitative in nature.
The results have shown that both GPs as well as the representatives of the
mutualities are generally favourable towards cross-border care, as long as it benefits the
patient. Various barriers have been mentioned by the both the Belgian GPs as well as the
representatives of the mutualities. These barriers are concerned with the several elements of
cross-border care discussed in the theoretical framework of this study. They include the lack
of knowledge concerning the possibilities and procedures of cross-border care, differences
between systems and the organisation within hospitals, cultural differences and distance. By
taking away these barriers, ZorgSaam could increase the referrals from Belgian GPs.
However, not all barriers can be influenced by actions of ZorgSaa
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