title: Purchasing health services abroad: practices of cross-border contracting and patient mobility in six European countries.
abstract: OBJECTIVE
  Contracting health services outside the public, statutory health system entails purchasing capacity from domestic non-public providers or from providers abroad. Over the last decade, these practices have made their way into European health systems, brought about by performance-oriented reforms and EU principles of free movement. The aim of the article is to explain the development, functioning, purposes and possible implications of cross-border contracting.
  
  
  METHODS
  Primary and secondary sources on purchasing from providers abroad have been collected in a systematic way and analysed in a structured frame.
  
  
  RESULTS
  We found practices in six European countries. The findings suggest that purchasers from benefit-in-kind systems contract capacity abroad when this responds to unmet demand; pressures domestic providers; and/or offers financial advantages, especially where statutory purchasers compete. Providers which receive patients tend to be located in countries where treatment costs are lower and/or where providers compete. The modalities of purchasing and delivering care abroad vary considerably depending on contracts being centralised or direct, the involvement of middlemen, funding and pricing mechanisms, cross-border pathways and volumes of patient flows.
  
  
  CONCLUSIONS
  The arrangements and concepts which cross-border contracting relies on suggest that statutory health purchasers, under pressure to deliver value for money and striving for cost-efficiency, experiment with new ways of organising health services for their populations.
authors.affiliation: Dept of Health Organisation, Policy and Economics, Faculty of Health, Medicine and Life Sciences, University of Maastricht, The Netherlands. i.glinos@beoz.unimaas.nl
authors.forename: Irene A
authors.initials: IA
authors.lastname: Glinos
authors.forename: Rita
authors.initials: R
authors.lastname: Baeten
authors.forename: Hans
authors.initials: H
authors.lastname: Maarse
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001530:Belgium; D005060:Europe; D005062:European Union; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D009042:Motivation; D009313:National Health Programs / Q000458:organization & administration*; D020416:Outsourced Services / Q000458:organization & administration*; D018579:Patient Selection; D017149:Private Sector / Q000458:organization & administration; D016730:Program Development; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014187:Transportation of Patients / Q000458:organization & administration*; D014195:Travel