Cross-border telemedicine

Health care systems in the EU are facing different challenges in the coming decades, such as an increasing demand for health care due to an ageing population and an increase in persons with (multiple) chronic diseases. Telemedicine can be a solution for these challenges. The definition of telemedicine is health care delivered to the individual patient and consultations between health care providers for the purpose of the patients’ treatment with the use of ICT solutions. A distinction between doctor to doctor (D2D) and doctor to patient (D2P) telemedicine is made. This thesis analyses barriers and opportunities in cross-border telemedicine from an economic and legal perspective. The right to health care is a central theme in linking these perspectives. The health care system in the Netherlands is the topic in the economic perspective and the crossborder provision of services, data protection and privacy and liability are the topics of the legal perspective. The health care system provides incentives for financing of telemedicine. The Dutch health care system is based on the regulated competition where access to health care and efficient allocation of resources is balanced. Opportunities within the health care system are competition, available subsidies for innovation and increasing demand for telemedicine services. Barriers are the hybrid financing system and no long term financing solutions. The legal framework of cross-border telemedicine consists of international law, EU law and national law. Three parts of the legal framework are examined further: the cross-border provision of services, data protection and privacy and liability. The conclusion is that investigated parts of the legal framework do not provide considerable barriers to cross-border telemedicine. However, some legal uncertainty exists on the application of EU legislation in practice, in particular on data protection and liability. In conclusion, the economic perspective contains more barriers to the development of cross-border telemedicine than the legal perspective. Subsidies and long term financing are solutions to existing barriers to telemedicine. Moreover, evidence on the cost effectiveness is needed in order to make decisions on the wide use of telemedicine services.