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Breaking the European information barrier
EU citizens won’t have real healthcare choices until better information is available

Johan Hjertqvist
Medical Progress Today
June 16, 2005

Europe is integrating as never before. People, services and goods cross borders, leading to improved quality of life and economic growth.

The European Court of Justice has even ruled that patients can travel to other EU member countries to obtain quicker access to care or better quality of care. At the same time, EU citizens are demanding access to new health care technologies and medicines, and even EU policy makers recognize that health care costs cannot be contained without consumer friendly, market-based mechanisms.

Still, those mechanisms are largely lacking. The European ban on direct-to-consumer advertising for prescription drugs is only the most evident example of how consumer choice is stymied; health care information is hard to come by in many vital fields that limits the freedom of consumers.

Without comparative information on providers and outcomes, the right of mobility won't offer EU consumers much real health care choice.

This is why the Health Consumer Powerhouse has released the 2005 EuroHealth Consumer Index. Launched on June 15, 2005 in Brussels, the Consumer Index ranks national health care systems across 20 indicators, covering five areas that are key to consumer choice – patients' rights and access to information; waiting times for common treatments; health care outcomes; customer friendliness; and access to pharmaceuticals. Unlike typical public health studies, the Index takes a decidedly consumer-centered position—excluding vague health metrics emphasized by international organizations and EU governments.

European health care is, for many Americans, a utopian ideal. What Americans don't know is that access to health care, and even access to health care information, is rationed by government bureaucrats. Consequently, Europeans lack many of the health care choices available to Americans.

In building the EuroHealth Consumer Index we have found – to pick just one example – that while it is quite easy to locate comparative information in the US on diabetes outcomes, such a task is far more complicated in the European Union. For diabetes patients to control their disease effectively, they must be able to compare outcomes, identify best practices, and research state of the art therapies and medications. But there are no open sources in Europe that provide consumers with such knowledge.

The WHO and many European governments favour abstract statistics like the number of hospitals beds, life-expectancy, or the number of smokers in a given population. These figures might be of interest to public policy makers but hardly to the consumer—who must worry about long waiting times, lack of services, risk of hospital infections and restricted access to new medicines for heart disease and cancer.

In fact, the only EU country to offer consumer health information is the United Kingdom, which, although it is centrally funded by the government, and has long waiting times for services, has well developed Internet provider catalogues that allow consumers to make better choices among public and private care givers. The Netherlands – the top performer in the 2005 Consumer Index – has launched a similar service. The other two top 2005 scorers were Germany and Switzerland.

What did these three top performers have in common? Each of those national systems had a pluralistic approach to funding and providing healthcare. The existence of many public and private health care insurance and provider options undoubtedly contributed to their relatively consumer-friendly environment.

Otherwise, our survey found that consumers across Europe are heavily dependent on their general practitioners (GPs) to uncover information on health care alternatives

This is an especially weak strategy since, according to our own and others market research, Europeans display a growing mistrust of their GP's. Why is this the case? Consumers fear that doctors loyalty is to the government, not the patient. The extreme is Sweden where no less than 96 percent of respondents with a college degree say they rely on the Internet to gather information to make a choice among providers. Only one percent said they would trust their GP to provide accurate information. Though Swedes are unusually sophisticated Internet-users, consumers across the EU voiced the same active distrust of their own doctors—an enormous departure from the old physician-patient relationship.

Our assumption that European patients need better information to turn into empowered health consumers is confirmed by other research outcomes, showing that, on average, every second European (Powerhouse 2005 polling in Germany, France, UK, Spain and Poland) lacks the knowledge of how to find an appropriate hospital other than the geographically closest one. Four out of five Europeans believe that waiting times are a good indicator of care quality, but only one out of four think their current access to health care is acceptable (Impatient for Change 2004). Two out of three Europeans are ready to go to another EU country to shorten the wait (if their insurance is accepted by providers in the host country).

Americans who admire the European "right" to health care should read the 2005 EuroHealth Consumer Index and be prepared to cast a critical eye on claims of European superiority. At the same time, Europeans are showing an increased willingness to act as health care consumers if they have access to better comparative information.

But as long as European citizens lack the ability to compare quality outcomes across states, there will be very little pan-European health care "shopping" except for a small, well-connected elite.

Hopefully, tools like the EuroHealth Consumer Index will help spur change by challenging bureaucrats' monopoly on health information and power in favour of consumers.

Johan Hjertqvist is the President of the Health Consumer Powerhouse, located in Brussels, Belgium. The 2005 EuroHealth Consumer Index is available here.

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