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The issue at stake in Case C-243/19 A v. Vesel��bas ministrija is whether a personal choice on the part of a patient, based on religious beliefs, must be considered when assessing the need for cross-border healthcare. The Court of Justice of the European Union holds that the Charter of Fundamental Rights of the European Union is applicable and the right to freedom of religion can be invoked, in addition to medical criteria. However, the sustainability of the healthcare system can be an objective justification for refusal to grant authorisation for cross-border healthcare. Furthermore, the case clarifies ��� to a certain extent ��� the parallel tracks for claiming cross-border healthcare., Maastricht Journal of European and Comparative Law, vol. 28, no. 6, p. 900

Cross-border healthcare use among elderly Turkish migrants living in Denmark has been of concern in regards to their compliance with Danish healthcare provisions. A qualitative study of 30 elderly Turkish migrants was conducted, and the analysis led to the construction of two types of users: acute and intentional. The acute users respected the authority of the Danish healthcare system and only sought the use of healthcare services in acute situations whilst in Turkey. In contrast, the intentional users planned to consult and buy healthcare services whilst in Turkey. It was concluded that national health authorities should acknowledge and appreciate the benefits of transnational health practices represented by those groups of migrants who, in cooperation with their doctors, are competent users of cross-border healthcare services. The results of this study call attention to scholars of health and migration to be aware of our own ‘concerns’, which may represent spots of blindness hindering important and surprising insights.

This paper discusses the future of migrants with acute heart problems and without permanent permission to remain in the country where they are seeking asylum. What does the country they have traveled to owe them? Specifically, what healthcare services are they entitled to? This may seem a niche problem, but numbers of migrants with acute heart problems could increase in the future. Besides, similar problems could be raised by, for instance, traumatized migrants with acute needs for healthcare services for other serious conditions. The paper identifies the issues and some positions on them. Arguments for and against these positions are explored. This particular set of problems in healthcare ethics creates several challenges, at both national and international levels, concerning access to transplantation, public willingness to donate organs, optimal use of organs, justice and fairness, and potential conflicts of law, politics and ethics, as well as issues revolving around interaction and communication (or lack of it) between agencies and professions.

The perspectives that have been brought out until now, indicate that the extensive humanitarian challenges facing the region and particularly the study area, was compounded by the gradual exit of externally based organizations and the closure of relief camps. As the wave of conflicts receded after 2015, communities that were displaced temporarily or dislocated permanently, sought to rebuild their homes and livelihoods. The story of recovery is complex and chapter unfolds through two parallel narratives. The Indo-Bhutan border, although unfenced in most locations, is still well demarcated. From the Indian side, the boundary can be deciphered visually through Border Pillars, Border Out Posts (BOPs) and Border Gates. The existing open border regime has over time resulted in complex web of socio-economic relationships across the main border gate. From the perspective of the book, the breakdown of health systems that was experienced in Milon and its surrounding villages, was in contrast, mirrored by the gradual strengthening of Bhutan’s health system in its southern districts (especially in Sarpang District and Gelephu Thromde area) that are contiguous to Kokrajhar and Chirang, respectively. Located a few kilometres from Milon, the border gate after Dadgiri marks the edge of Indian territory. Paradoxically, both sides of the border experienced intense episodes of civil strife, but had completely different outcomes in health. For Bhutan, the ingress of the armed organizations (between 1992 and 2003) onto its territory and establishment of camps by the militants (who numbered between 3,000 and 4,000) was a major foreign policy challenge. This culminated in a brief but intense armed conflict (Operation All Clear) in 2003, between the Bhutanese armed forces and the major Indian militant groups (ULFA, NDFB and KLO) based in Bhutan. The Dzongkhag of Sarpang was severely impacted as a consequence. Utilizing a cross-border perspective, which links together the community histories on both sides of the border gate, the chapter examines the problem of Conflict and Border Malaria and traces out the manner in which Bhutan’s health system transformed despite the occurrence of large-scale violence on the Indian side. It also provides some insight into the importance of the open border in rebuilding lives and livelihoods for communities living near Milon. The chapter presents key learnings from Bhutan’s experience and the possibilities emerging from local-level health cooperation.

In October 29th, 2020, the Court of Justice of the European Union delivered a judgment in case A. vs Ministry of Health, No C-243/19. The Court in the judgment analysed significant legal issues relevant to Latvia. Therefore, the aim of the article is to analyse the main proceedings about the patient’s right to cross-border healthcare when effective hospital treatment is available in the patient’s Member State but the method of treatment used is against the patient’s religious beliefs. The article also aims to analyse whether the principle of objective investigation and prohibition of legal obstruction by institutions and courts in accordance with Administrative Procedure Law have been obeyed. In the article, European Union and national legal framework and scientific literature in the field of patient’s right to receive cross-border healthcare have been analysed. Facts of main proceedings in national court cases and request to Court of Justice of the European Union for preliminary ruling from the Senate of the Supreme Court of the Republic of Latvia have been studied as well. Next, the Advocate General Gerard Hogan’s opinion and judgment of the Court of Justice of the European Union has been analysed. Further, the judgement of the Senate of the Supreme Court of the Republic of Latvia has been investigated. Upon concluding the article, the author draws attention to certain issues of national court’s legal analysis, which could be incompatible with the principle of objective investigation and prohibition of legal obstruction by institutions and courts.

The aim of the article is to assess the access to health services in light of European Union regulatory changes, with particular emphasis on cataract procedures implemented in Poland during the years 2015–2017. Statistical data from the National Health Fund for the years 2015–2017 was analyzed by means of statistical description, graphical and table presentation. For parametric queues, a Student's t-test (α = 0.05) was used. For the number of submitted and paid applications under the directive, the linear trend model and the significance of the directional coefficient (α = 0.05) were used. The waiting queue for cataract surgery from the second quarter of 2015 to the fourth quarter of 2016 had an upward trend. In 2017, a drop in the number of waiting patients was observed, with a simultaneous increase in the number of applications submitted under the directive. At the same time, contract growth was observed, which translated into a decrease in the number of patients waiting for surgery in Poland. Nevertheless, no decreasing trend in the number of patients treated under the cross-border directive was observed.

While policy attention is understandably diverted to COVID-19, the end of the UK's post-Brexit ‘transition period’ remains 31 December 2020. All forms of future EU−UK relationship are worse for health than EU membership, but analysis of the negotiating texts shows some forms are better than others. The likely outcomes involve major negative effects for NHS staffing, funding for health and social care, and capital financing for the NHS; and for UK global leadership and influence. We expect minor negative effects for cross border healthcare (except in Northern Ireland); research collaboration; and data sharing, such as the Early Warning and Response System for health threats. Despite political narratives, the legal texts show that the UK seeks de facto continuity in selected key areas for pharmaceuticals, medical devices, and equipment [including personal protective equipment (PPE)], especially clinical trials, pharmacovigilance, and batch-testing. The UK will be excluded from economies of scale of EU membership, e.g. joint procurement programmes as used recently for PPE. Above all, there is a major risk of reaching an agreement with significant adverse effects for health, without meaningful oversight by or input from the UK Parliament, or other health policy stakeholders.

espanolResumen El presente estudio analiza el impacto de la normativa de desplazamiento de pacientes sobre la dinamica sanitaria intraeuropea a partir de un enfoque mixto. Basado en una perspectiva cualitativa, interpretativa e inferencial de datos secundarios disponibles, se determina la viabilidad del crecimiento del mercado sanitario tanto para paises miembros de la Union Europea como los no miembros. Se encuentra que la normativa vigente no abarca todas las garantias tacitas demandadas por pacientes en cuanto al aseguramiento y cobertura de servicios, medicos generando espacios para la presencia de captadores de pacientes que operan en un entorno de incertidumbre parcial. EnglishAbstract The present study analyzes the impact of the regulation of patient's mobility on intra-European health dynamics from a mixed approach. Based on a qualitative, interpretive and inferential perspective of available secondary data, the growth viability of the health market is determined for both European Union and non-EU countries. It was found that current legislation does not cover all the tacit guarantees demanded by patients in terms of insurance and coverage of medical services generating spaces for the presence of agents that operate in an environment of partial uncertainty.

Questo lavoro analizza il decreto legislativo del 4 marzo 2014, n. 38 sulle cure transfrontaliere. Le norme del decreto sembrano garantire il diritto alla salute, perché stabiliscono che non esiste l’obbligo di ottenere una autorizzazione da parte dell’amministrazione, prima di poter espatriare al fine di ottenere le cure all’estero. Esse, però, al contempo, svantaggiano i meno abbienti, perché approntano un sistema di assistenza indiretta e precisano che gli amministrati possono ottenere il rimborso delle spese sostenute solo nei limiti dei costi che la prestazione avrebbe avuto se fosse stata eseguita nel territorio di provenienza. Inoltre, quando introducono la eccezionale necessità di una previa autorizzazione, attribuiscono alla p.A. un potere fortemente discrezionale. Infine, non chiariscono alcuni aspetti relativi ai procedimenti amministrativi da attivare per ottenere il rimborso e non regolano in modo adeguato i rapporti con il regolamento CE n. 883/2004. Esiste davvero un diritto alle cure oltre lo Stato? ---------- This work analyzes the Italian Legislative Decree of 4 March 2014, n. 38, about the cross-border healthcare. The provisions seem to guarantee the right to health, because they state that the patients have not to obtain an authorization from the administration, before being able to get treatment abroad. At the same time, they disadvantage the poor, because they establish a system of indirect assistance and they specify that individuals may obtain only the reimbursement of the costs that the service would have incurred if it had been performed in the territory of origin. In addition, when introducing the exceptional need for prior authorization, they confer to the public Administration a highly discretionary power. Finally, they aren’t clear when they regulate the aspects of the administrative procedures. Is there really a right to health care over the state?

This article aims to discuss issues of "Medical tourism" within the European Union countries. The author in his publication presented the trends of medical tourism and considered the cause of this phenomenon. The article makes reference to the history of migration in medical purposes. The role of freedom of movement and freedom to provide services as the base of the economic system of the European Union for the development of medical tourism. The publication presents the basic regulations on this subject in terms of Polish law and European law. The author based on reports and scientific publications tried to in this article to assess after the presentation of both positive and negative effects of this phenomenon, and also provide potential opportunities and threats flowing from it.

Objective Even though medical travel is expanding, limited research has identified pitfalls along the full process of medical travel. This study explores the experiences of medical travellers, with a focus on potential issues that may threaten safe and effective medical travel. Methods The experiences of medical travellers were assessed using a cross-sectional questionnaire in the Netherlands in 2014. The questionnaire ( n =101) contained 52 items measuring the transfer of records, quality of care abroad, follow-up care, and reimbursement. Additionally, experts provided feedback on the pitfalls identified. Results 63.1% of medical records were not transferred in advance to the clinic abroad, and for 10.7% of cases these remained unknown during treatment. Although quality of care abroad was rated higher than in the home country, follow-up care was initially refused to 22.2% of patients. Additionally, patients reported problems related to reimbursement. Conclusion More effort is needed to facilitate safe medical travel. Medical professionals should be informed on procedures for medical travellers, especially concerning follow-up care and record transfers. Yet, medical travellers themselves are ultimately responsible for this transfer. Clear information on the necessity of this personal transfer, and clarification on reimbursement options and the authorisation procedure, should be provided by national contact points and third-party payers. Additionally, payment structures to care providers may need adjustments to cover costs of follow-up care.

Bulgarian Abstract: Докладът изследва особеностите на контрола при възстановяване на разходи от трансгранично здравно обслужване в светлината на нормативната уредба и съответстващата й система за контрол и отчетост. Анализират се някои особености в същността, упражняването и режима на трансграничното здравно обслужване. На нивото на общия и специален контрол на Изпълнителна агенция "Медицински надзор" и делегираните й контролни правомощия се изясняват особеностите на прилагания механизъм за контролно въздействие и свързаните с него субекти и правомощия. English Abstract: The report examines the peculiarities of the control in case of reimbursement of expenses for cross-border healthcare in the light of the normative regulation and its corresponding system for control and accountability. Analyzed are some peculiarities in the essence, exercise and regime of the cross-border healthcare. On the level of the general and special control of the Medical Supervision Executive Agency and the control powers delegated to it are clarified the peculiarities of the applied mechanism for control impact and the subjects and powers related to it.

Despite the legal authority to confirm, override or modify healthcare insurance decisions made by physicians and government officials, health tribunal decisions have not been empirically analyzed. Using a novel quantitative methodology, all 387 Health Services Appeal and Review Board written and publicly available electronic decisions released over a five-year time period were statistically analyzed with respect to Ontario public health insurance requests for global cross-border healthcare. The statistical results found that patients knew their diagnosis prior to requesting cross-border healthcare, and 84% of patients requested specific northern US facilities for specific treatment. Two specific healthcare facilities in the US were requested for either surgery or assessments. A significant number of patients were seeking cross-border healthcare for pain treatment. This research challenges the assumption that cross-border treatment requests result only from domestic delay when instead patients are seeking specific treatments at specific facilities. This novel quantitative research methodology and data source of written and publicly available electronic Health Services Appeal and Review Board decisions should be used to inform policy decision regarding the utilization and evaluation of Canada's healthcare system and publicly funded healthcare insurance.

The Cross-Border Patients’ Rights Directive represents an attempt to resolve the unclear situation that had developed due to ‘negative integration’ within the field of healthcare. While the adoption of the directive ends the EU-level decision process, it represents the start of the implementation process, where national institutional structures and interests play a key role. This article investigates the role of resources as a key factor shaping transposition within the member states, with a focus on Poland and Bulgaria. The article shows that a multidimensional perspective of resources is important for understanding transposition of EU directives in member states. While previous research has tended to consider resources at the aggregate, national level, the present study shows that specific concerns about the ‘adjustment costs’ at the sector system level are of key importance.

Patient flows across the regions of the Italian National Health Service can shed light on patient mobility, including cross-border flows within the European Union. We used 2009 data on 11,531 NHS admissions for aortic valve replacement operations to measure the extent of inter-regional patient mobility and to determine whether resident and non-resident patients differ. We also investigated whether public and private hospitals behave differently in terms of attracting patients. For this major cardio-surgical intervention, patient mobility in Italy is substantial (13.6% of total admissions). Such mobility mainly involves patients moving from southern to northern regions, which often requires several hundred kilometers of travel and a transfer of financial resources from poorer to richer regions. Patients admitted in the regions where they reside are older than those admitted outside their regions (69.2 versus 65.6, p

Patientenmobilitat und grenzuberschreitende Gesundheitsversorgung sind alltagliche Phanomene in der Europaischen Union (EU). Im Jahr 2011 hat die EU eine Richtlinie erlassen, um in diesem Kontext Rechtssicherheit herzustellen. Bisher gibt es keine umfassenden systematischen Studien uber ethische Aspekte grenzubergreifender Gesundheitsversorgung. In dieser Arbeit werden die rechtlichen Entwicklungen der grenzubergreifenden Gesundheitsversorgung dargestellt und die in der Literatur vereinzelt erwahnten ethisch relevanten Aspekte heuristisch und auf Patiententypologien aufbauend systematisch inventarisiert und diskutiert. Es zeigt sich, dass die Moglichkeit der Patientenmobilitat und die damit vor allem verbundenen Finanzierungsregelungen die Autonomie einiger Patienten sicherlich verbessern kann. Allerdings konnen wohl nicht alle Patienten Versorgungsverbesserungen erwarten. Im Gegenteil konnen sogar negative Konsequenzen fur einige Patienten folgen, was vor allem aus gerechtigkeitstheoretischen Uberlegungen kritisch zu sehen ist.

Medizintourismus (auch Medizinreisen, Internationaler Patientenservice oder cross-border bzw. global health care) ist ein aktuelles Phanomen, das sowohl fur den Medizin- als auch fur den Tourismusbereich immer bedeutender wird. Beide Seiten versprechen sich eine Verbesserung der Reputation und des Images sowie mehr Einnahmen und Arbeitsplatze, aber auch verbesserte Leistungen fur Patienten und fur Touristen: Medizintourismus hilft, Lucken des heimatlichen Gesundheitswesens zu schliesen und ermoglicht qualitativ bessere, gunstigere bzw. schnellere Behandlungen im Ausland, teilweise mit Verfahren, die im Heimatland nicht – legal – angeboten werden. Im Tourismus erweitert er die Angebotspalette des Gastlandes und verbindet medizinische Behandlung und Genesung mit einem attraktiven Aufenthalt fur Pa­tienten und deren Begleiter in einer touristischen Destination. Doch bei aller Popularitat dieser neuen Reise- und Behandlungsformen gibt es Lucken im theoretisch-analytischen Bereich. Es wird der aktuelle Stand der Forschung aus Sicht der beiden Disziplinen Medizin und Tourismus aufgezeigt. Dies erfolgt methodisch in Form einer inter-disziplinaren Betrachtung und basiert vorwiegend auf einem aktuellen Literaturuberblick. Es besteht ein hoher Forschungsbedarf fur das Gebiet des Medizintourismus, wo mithilfe eines inter-disziplinaren Ansatzes die Basis fur theoretische und empirische Analysen zu entwickeln sind: Es fehlen klare theo­retische Abgrenzungen und Statistiken, um das wahre Ausmas und die Nachhaltigkeit von touristischen und medizinischen Leistungen sowohl fur die Gastlander wie fur die Quellgebiete exakt zu erfassen. Im Medizinbereich sind die internen Ablaufe an die Anforderungen Internationaler Patienten anzupassen, wie z. B. Gebuhrenordnung, Rechnungslegung, Sprache, inter-kulturelle Qualifikation des Personals. Zudem sind verstarkt die vor- und nachgelagerten Bereiche der gesamten medizinisch-touristischen Leistungskette zu betrachten, die zumeist im Ausland beginnen bzw. enden. Hier sind einheitliche Qualitats-Standards und Akkreditierungen wichtige aktuelle Themen. Hinzu kommen zahlreiche sozio-kulturelle Auswirkungen, die zu untersuchen sind, wie z. B. Verschiebungen der Versorgungskapazitaten fur einheimische Patienten und/oder moralisch-ethische Fragen bestimmter Behandlungsmethoden. Ferner kann es rechtliche Probleme des Haftungsrisikos bei Fehlbehandlungen geben.

Trazer uma reflexão sobre a importância e o potencial impacto da migração pendular na busca por serviços de saúde e, em específico, sobre as peculiaridades dessa mobilidade na região de fronteira. O trabalho descreve o contexto em que a mobilidade pendular se insere na modificação do espaço urbano do século XX, apresenta alguns aspectos legais sobre o tema na área da saúde, ilustrando a partir da realidade da tríplice fronteira Brasil-Argentina-Paraguai, enquanto importante local de migração pendular para uso dos serviços de saúde. São apresentadas hipóteses para possíveis impactos da mobilidade pendular, desfechos em saúde, assim como medidas para aferir a mobilidade pendular, tais como o efeito da distância a ser percorrida da residência ao serviço de saúde, o local de residência (país diferente, com condições de desenvolvimento diferentes) e os aspectos organizacionais da atenção à saúde, como a incerteza relativa ao atendimento em função da mobilidade internacional. Conclui-se que essa forma de mobilidade é muito comum na busca por atenção à saúde, e não apenas, como versa a abordagem tradicional, para trabalho e estudo, e que faz-se de grande importância o estudo de seu impacto na saúde das pessoas e a sua inclusão nos debates sobre a atenção à saúde através da fronteira. This article aims to reflect about the importance and the potential impact of pendulum migration in the pursuance for healthcare, and, specifically, about the peculiarity of this kind of mobility in border areas. It describes the context in which the pendulum migration is inserted for the modification of the urban space in the 20th century, makes initial comments about legal aspects of the theme in health sector, and describes the reality of the Brazil-Argentina-Paraguay triple border as an important location of pendulum migration for the pursuance of healthcare as an illustrative fact. In this way, hypotheses are formulated about the causes of the pendulum migration impact on patient’s health like the effect of the distance covered from home to healthcare facilities, and organizational aspects related to healthcare like the uncertainty about having or not health assistance due to international mobility. It concludes that this kind of mobility is very common in the pursuance of healthcare despite the traditional approach to the theme mentioning only work or study. Besides that, it is very important to study its impact on health and to include this theme on the cross border healthcare debate.

The world is increasingly global for corporations and individuals, except healthcare, the market for which seems remains more local. The aim of this chapter is to explore if the availability of big data will lead to a more global healthcare system. Four healthcare transformation scenarios, based on Geddes’s model of local and global thinking and acting are explored. Within each scenario the role of big data is described.

In Swedish law, the notion of ‘science and proven experience’ (in Swedish, vetenskap och beprövad erfarenhet) defines the gold standard for public decision-making and practice, especially in medicine. The notion is notoriously vague but nevertheless plays an important role in the distribution of rights and duties of patients and healthcare workers. For example, failure to provide care in accordance with this standard can lead to penal responsibility. The notion also helps to define Swedish patients’ right to reimbursement for cross-border healthcare. From a legal point of view, the notion is especially intriguing because it appears to import medical standards into the legal conceptual apparatus. The purpose of this article is to explore the mechanisms of this and kindred ‘importing notions’ by investigating the role that the notion of science and proven experience plays in Swedish law and in the transfer of information between the legal and medical fields.

Health cooperation with Balkan Countries in diagnosis and care of congenital heart malformations was developed since 2008 by the Heart Hospital of “Gabriele Monasterio” Tuscany Foundation (FTGM) jointly with the Association “Un Cuore un Mondo” and with the support of the Tuscany Region. A tele-echocardiography network was implemented interconnecting the Heart Hospital in Massa with selected Pediatric and Gynecology centers in Croatia, Bosnia-Herzegovina, Albania, and Romania. Up to 100 patients were transferred to Massa from Balkan countries for specialized care or cardiac surgery. This initiative was recently empowered in the frame of European IPA program by the AdriHealthMob project, aimed at providing cross border healthcare services in the Adriatic area, and since 2015 a telemedicine network for heart malformations has being developed (namely, “Arriviamo al Cuore di Tutti”) in Tuscany with the financial support of Lions Clubs and their International Foundation (LCIF), jointly with regional healthcare authorities.

This chapter aims at providing an insight into some major aspects linked to migration of medical doctors within Europe. The article describes main factors which contribute to doctors’ migration. Further, the current and future mobility trends in Europe are discussed. A major part of this chapter is dedicated to an overview of the EU legal framework impacting healthcare professionals’ mobility, followed by some useful information related to the procedures for recognition of professional qualifications and offices in charge of mobility. Finally, the impacts on healthcare systems and the policy implications of doctor’s mobility are described in context of personalised medicine.

Background The EU Directive on the application of patients’ rights in cross-border healthcare provides rules for facilitating access to cross-border healthcare and promotes cooperation on healthcare between member states, which brings many changes both in the organization and financing of health care. The aim of this paper is to assess whether providers in Poland are prepared to function within the single European market and what may be the impact on the …

European Union (EU) Member States were required to direct their health practices to ensure implementation of ‘Directive on patients’ rights in cross-border healthcare’ which provides the right for EU citizens to seek treatment abroad. This study recruited Maltese patients, consequently it identified and quantified domains constituting willingness to access cross-border healthcare. Via this analytical approach, the results and recommendations were presented to assist cross-border healthcare policy., peer-reviewed

In this commentary, we establish a relationship between medical sociology and the study of medical tourism and cross-border healthcare by introducing Ronald Andersens behavioral model of healthcare use, and linking this model to the recent empirical study of Kovacs et al. on patients travelling to Hungary for orthopedic treatment. Finally, we plead for more measurement in the field of patient mobility.

Abstract Implementation of the Directive on the Application on Patient’s Rights in Cross-border Healthcare (2011/24/eu) has proved to be quite challenging in Finland.

The 21st century started with some significant efforts globally in the e-health sector. This was mainly pushed as a generic strategy from many nations and international organizations in order to cope with issues such as ageing population, demographic shift, social security limitations, and financial instability. A second reason was the introduction of new technologies such as cloud computing, Web interoperability standards, mobile health, and social media that are steadily changing the way healthcare has been seen in the last decades. In addition to that, globalization, commuting, immigration, and increased mobility raised the issue of cross-border healthcare and the right to access normalized healthcare services anywhere, anytime. In that context, the authors analyze the technological offerings and result of the epSOS (European Patient Smart Open Services) framework and how it has affected strategic decisions in electronic prescription in Greece, thus creating a new useful e-health national application. They prove that by rethinking healthcare, reusing established standards such as HL7 CDA (Health Level Seven Clinical Document Architecture) and IHE (Integrating the Healthcare Enterprise) profiles, it is possible to propose a new innovative system that is in fact based upon new technological propositions such as REST (Representational State Transfer) architecture and cloud computing.

Mobility of medical doctors has both positive and negative effects to be carefully considered in healthcare systems. Medical doctors decide to move from one country to another not only because of higher incomes, but in search of better working environments, career opportunities and social recognition. Thus, mobility of medical doctors is seen as a symptom of more fundamental health systems problems. Migration of health professionals in generally and of medical doctors in particular has its roots in current problems of healthcare systems. These need to be addressed by policy makers in an integrated manner because health professional mobility cannot be considered in isolation. While some European countries have to deal with major shortages of medical doctors, other are confronted with increasing pressures to manage maldistribution, both geographically and in terms of specialities needed.

This supplement is focused on the methods, results and recommendations from the research project “Methods of Assessing Response to Quality Improvement Strategies” (MARQuIS). MARQuIS was funded by the Scientific Support to Policies component of the European Union Sixth Framework Research Programme (Contract SP21-CT-2004-513712), and it lasted from January 2004 to June 2008. MARQuIS was coordinated by R Sunol, assisted by P Vallejo, from the Avedis Donabedian University Institute (Autonomous University of Barcelona) in Spain. Some of the European leading organisations in the healthcare quality field participated in this study, with two different roles

A critical problem in providing appropriate compensation for medical accidents in the context of cross-border healthcare is designing and supervising the factfinding processes. Numerous compensation systems in multiple jurisdictions, handling a high volume of cases, must be able to achieve outcome efficiency (neither under-compensating nor over-compensating victims), while also achieving administrative efficiency (low transaction costs). It is impossible to achieve these goals without consistent, accurate, evidence-based factfinding, particularly in an area as factually complex as medical-accident compensation. This paper discusses a framework for producing such factfinding without creating a centralized factfinding institution, and provides examples of general principles, institutional structures, and specific types of legal rules for evidence assessment. It illustrates aspects of this framework using the National Vaccine Injury Compensation Program in the United States. Both the structure of that Program and the cases decided under it provide insights on how factfinding can be transparent, evidence-based, and coordinated, as well as (presumably) accurate, so that all potentially affected parties can be confident that the compensation system is achieving its goals.