European Electronic Personal Health Records initiatives and vulnerable migrants: A need for greater ethical, legal and social safeguards.

The effective collection and management of personal data of rapidly migrating populations is important for ensuring adequate healthcare and monitoring of a displaced peoples' health status. With developments in ICT data sharing capabilities, electronic personal health records (ePHRs) are increasingly replacing less transportable paper records. ePHRs offer further advantages of improving accuracy and completeness of information and seem tailored for rapidly displaced and mobile populations. Various emerging initiatives in Europe are seeking to develop migrant-centric ePHR responses. This paper highlights their importance and benefits, but also identifies a number of significant ethical, legal and social issues (ELSI) and challenges to their design and implementation, regarding (1) the kind of information that should be stored, (2) who should have access to information, and (3) potential misuse of information. These challenges need to be urgently addressed to make possible the beneficial use of ePHRs for vulnerable migrants in Europe.

With a little help from my (neighbouring) friends. 'Border region patient mobility' in the European Union: A policy analysis.

Increased disparities in income and health care expenditure across EU countries may lead to an increase in patient mobility, which may, in turn, call for more action by the EU and its Member States. At present, patient mobility (or cross-border healthcare) is still a marginal phenomenon but is deemed to increase in the future. In this paper we examine border region patient mobility, defined as patients receiving care in a neighbouring country within a certain proximity. We examine, with the use of a spatial competition model, the options used to regulate such a patient flow and their welfare implications, both for patients and Governments. We show that marginal price costing would lead to an increase in patient welfare, whilst reducing the risk of increasing cost for the exporting country. At present there seems to be an East/West difference in the way these flows are regulated. In order to increase equity, we suggest that a 'joint implementation' of EU Directives by neighbouring Member States, especially in the field of cross-border healthcare, would allow Member States to define target populations (in terms of type of care and distance travelled) that could allow more freedom in terms of border care, without increasing health care expenditure. A future combination of the two existing legal frameworks in this field would also be more user- or patient-friendly.

Patient Mobility in Times of Austerity: A Legal and Policy Analysis of the Petru Case.

The case-law of the Court of Justice (ECJ) on patient mobility was recently challenged by a ruling that a patient could go to Germany for treatment when facilities in Romanian hospitals were inadequate. Given the reported impact of austerity measures in the field of health care this raises the question; what is the impact of the ECJ's ruling on how Member States can manage expenditure and limit outflows of patients and how should such measures be legally evaluated? The objective of this article is to analyse potential impact on health systems in the context of increasing pressure on public financing for health. While the ECJ mainly referred to the requirement of treatment in due time, we also analyse possible austerity reductions of the basket of care against the background of EU law (i.e., EGJ case-law, patient mobility directive, Charter of Fundamental rights and social security regulation).

Patient mobility in the context of austerity and an enlarged EU: The European Court of Justice's ruling in the Petru Case.

Since 1998, the European Court of Justice (EUCJ) has established a set of principles concerning patient mobility across Member States. At present, these principles are challenged against a new background, i.e., an enlarged EU and austerity-driven measures in the field of healthcare. This is even more relevant in view of the significant differences between countries and between services on healthcare access. In the Petru case, a Romanian woman sought healthcare in Germany due to an alleged lack of basic infrastructure in her local Romanian hospital. A crucial question arises in this context of whether the patient's interests (i.e., right to cross-border healthcare) or the Member State's interests (i.e., financial stability of the healthcare system) prevail. We analyse this case and its implications for future patient mobility. From the point of view of patients, the EUCJ's decision implies that also a lack of medication and basic medical supplies can be claimed as "undue delay", however for Member States it is sufficient to provide quality treatments in at least one hospital. Although the Court has provided a solution for the Petru case, we argue that major challenges remain, such as the definition of the international state-of-the-art or other limitations to reductions of the health basket.