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German students want to be treated at home

Patient mobility is a hot item in ‘Brussels’. With freedom of movement within the EU, seeking healthcare across borders seems logical, at least in the minds of policy makers. But do EU citizens actually take this step?

A study by the department of Health Services Research shows that the opposite is happening: 97% of the surveyed German student population at Maastricht University go to their home country to receive healthcare. “It’s not that they want to avoid healthcare in Maastricht. They just prefer going home.”

Irene Glinos is doing a PhD at Maastricht University on cross-border healthcare. “I study anything related to healthcare across borders, whether it’s a service, a patient or a professional. I’m mainly interested in the impact of the EU integration and the freedom of movement on healthcare: if and how it affects the behavior of patients but also of providers and hospitals.” Researcher Nora Doering has assisted Glinos in the study of German students and their healthcare seeking behavior since 2010. Between October and December 2010 they collected 235 valid surveys from German students who were living in Maastricht for over one year. This represents about 8% of the total German student population in Maastricht.

According to the researchers, the results were striking: 97% of the respondents went to Germany for healthcare and of these 76% even travelled back and forth to their home city for treatment; 72% received care only in Germany, so not even once in Maastricht. The mean travelled distance was 269 km – for some of them, travelling 800 km was not an obstacle for going home for healthcare. The study concluded that students overwhelmingly go to Germany for medical care. Those who stayed in Maastricht mainly accessed GP services and/or had physiotherapy.

The most mentioned reasons for going home to Germany were knowing the healthcare providers, the system and the language as well as the ease of reimbursement. Nora Doering: “Some students didn’t understand why we asked them where they went for healthcare, “I go home, of course” was a common answer. Initially we thought that maybe these students had had bad experiences with the Dutch healthcare system in the past but that was not the case. It’s a genuine preference.”

Interestingly, the ease of reimbursement isn’t even a real factor in this case: according to EU regulations, EU students who study in another Member State are entitled to receive health care both in their home country and in the country where they study with full cover for the medical expenses. But most just don’t know this and neither do some Dutch health professionals. Doering: “Some students had to pay for a GP appointment here in the Netherlands. That’s simply unawareness of both parties.”

Despite regulations, most people prefer to go to home where they have a familiar doctor and a familiar medical system. Glinos: “Legal entitlements do not change people’s deep-seated preferences. Peer feedback does. We are creatures of habit. We even go to the same supermarket because we know how to find our way there. It’s understandable that for personal matters such as health, people prefer a person or system they know.”

And we shouldn’t forget that there are significant differences between the Dutch and the German healthcare systems. The fact that the Dutch first go to a GP and only then are they referred to a specialist is strange for Germans and the same goes for the idea of giving birth at home instead of in a hospital.

No huge phenomenon
Does this mean there’s no demand for cross-border health care in the EU? In some particular cases there is, says Glinos. “Thousands of people from Vienna cross the border to Hungary for dental care, because they can save up to two thirds of the costs. And if you have a very rare, life threatening illness, you will go anywhere to survive. But I doubt it will become a huge phenomenon. In general, people want the best possible healthcare in an environment they know: if you are ill, you don’t want to travel and leave your friends and family behind. This study on German students confirms this: patients want to be treated at home.”

This phenomenon would need to be examined in other studies. “Of course this is just one population; the study would have to be repeated elsewhere or with a different student population. But the results give us a very strong indication of the preferences of EU citizens, or even of people in general. I would love to look into the movements of Dutch students in Maastricht who come, for instance, from Amsterdam. Do they go there for healthcare as well? I think they do. And how do English or Chinese students handle this?”

In this respect the researchers also have a tip for Maastricht University. Glinos: “Since we have so many international students, why not have a small medical centre on campus with English speaking staff? It would be very useful for international students to have place where they could go to and get some basic information about the Dutch medical system. Most schools have a nurse, so why not have something similar at our university?”

The article ‘Travelling home for treatment and EU patients’ rights to care abroad: Results of a survey among German students at Maastricht University’, by Irene A. Glinos, Nora Doering and Hans Maarse, was published online on 20 January in the scientific journal Health Policy. Irene Glinos hopes to obtain her PhD at Maastricht University in 2013. She also studies health professional mobility in the EU at the European Observatory on Health Systems and Policies in Brussels, where she is working part-time.

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