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LONG TERM STRATEGY for EUROPEAN SPAS and HEALTH RESORTS Janka Zálešáková, Belek, TURKEY, May 26th, 2011

New Directive 2011/24/EU of the European Parliament and of the Council

on patients rights in cross-border healthcare • Establish rules for facilitating access to safe high-quality cross-border healthcare in the EU • Ensure patient mobility in accordance with the principles established by the Court of Justice. • Should be apply to individual patients who decide to seek healthcare in a member state other than state of affilation

It is clear that the obligation to reimburse costs of cross- border healthcare should be limited to healthcare to which the insured person is entitled according to the legislation of the Member State of affiliation (14)

EU Directive regarding the application of patients´rights on cross-border healthcare


Rehaclinics No ESPA members

Specialized hospital departments

– Patients should enjoy a guarantee of assumption of the costs of that healthcare at least at the level as would be provided for the same healthcare, had it been provided in the Member State of affiliation. This should fully respect the responsibility of the Member States to determine the extent of the sickness cover available to their citizens and prevent any significant effect on the financing of the national healthcare systems.

– Directive should not apply to those long- term care services deemed necessary in order to enable the person in need of care to live as full and self- determined a life as possible. Thus, this Directive should not apply, for example, to long-term care services provided by home care services, in assisted living facilities and in residential homes or housing (‘nursing homes’).

CHAPTER III REIMBURSEMENT OF COSTS OF CROSSBORDER HEALTHCARE Article 7 General principles for reimbursement of costs 1. Without prejudice to Regulation (EC) No 883/2004 and subject to the provisions of Articles 8 and 9, the Member State of affiliation shall ensure the costs incurred by an insured person who receives cross-border healthcare are reimbursed, if the healthcare in question is among the benefits to which the insured person is entitled in the Member State of affiliation. 4. The costs of cross-border healthcare shall be reimbursed or paid directly by the Member State of affiliation up to the level of costs that would have been assumed by the Member State of affiliation, had this healthcare been provided in its territory without exceeding the actual costs of healthcare received.

Spas with strong medical background is especially European fenomenon, only partly in Asia (e.g. Japan, China...)

Spas and spa facilities are in the most European countries the part of a health system and spa treatment/healthcare is paid by social/health insurence. Cross-border healthcare for traditional spa treatment is good known many years, mainly by selfpaid patients/clients in some countries full/partly reimburse (e.g.Germany)

What products of spas can be as cross-board healthcare paid in other member states


MEDICAL SPAS in EU ● License of the state authority providing spa treatment as part of healthcare ● Natural healing sources/ all treatments recognised by state authority ● Strong medical background (high qualified personel, e.g. physicians, physioterapists, masseurs etc.) ● Implementation of new treatments based on scientific results and specialized services (e.g. diagnostics, laboratory tests, health consulting) ● Medical and preventive packages ● Length of stay (more than two weeks)

European spas Spas and spa facilities are in the most European countries the part of a health system Inseparable part of a health system and the health tourism Conditions necessary for creation and existence of a Spa in Europe

Thermal spas Mineral spas

Local natural healing source (healing water, healing peloids, healing gases, natural healing sources of sea, climatic conditions suitable for healing, acknowledged natural system of cure – Kneipp.

Peloid spas Climatic spas

High quality environment Specific and protected spa place

Kniepp spas

Medical background for rehabilitation and cure, primary and secondary prevention

Priesnitz spas

Radon spas

Tallasso spas ...

Main products of European Spas

Relax Wellness Weekend Breaks > Relaxation Stays Prevention - primary Recuperation > Regeneration Spa

HEALTHCARE Postacute rehabilitation Chronic diseases- secondary prevention

> Medical Spa Stays


Groups of diseases treated in European spas

• diseases of the locomotor apparatus – 70 % • diseases of cardiovascular system – 12 % • diseases of the respiratory tract • skin diseases • disorders of nourishment and metabolism • neurological diseases • psychological problems • gynecological diseases • urogenital diseases • recovery after oncological treatment

indications according natural healing source

– Systematic and continuous efforts should be made to ensure that quality and safety standards are improved in line with the Council Conclusions and taking into account advances in international medical science and generally recognised good medical practices as well as taking into account new health technologies.


- indication spectrum according local healing sources - all medical treatments must be recognised - qualification of staff - safety for clients and staff in all places -etc. ......



On 12th – health tourism Mr. Andrzej Rys, Director for health system and products EC – need cooperation of MS on standards and guidelines on quality and safety ofcross-border healthcare Mr. Helmut Heckenstaller, chief advisor of the CEO Techniker Krankenkasse – EUROPESpa med Mr. Teofilo Leite, president of UEHP Guarantee of quality: European standards as base for european accreditation

Mr. Alfred Hackl, gen. Director of Spa Sarvar – goodbye pampering – hello prevention and healthcare

• very low equity

• door for quackery is widely open • different standards and regulations witin EU • lack of well trained therapist NEEDS • International comparability – EU standards

Products in common european market in spa-healthcare SPA rehabilitation (Anschlussheilbehandlung) more and more after high-tech. operations, direct conections with specialised clinics Products of secondary prevention for chronicaly ill patients Products of primary prevention for risk groups of population with specific program Primary prevention with education in healthy lifestyle – young people

Quality in medical spas... QUALITY - different things for different people another requirements for quality in different products


Target of prevention in Spas Healthy nutrition → prevention of cancer, cardiovascular diseases, DM, obesity Physical activity → prevention of cancer, cardiovascular diseases, osteoporosis, OA, obesity No smoking →prevention of certain types of cancer, cardiovascular diseases No drugs → prevention mental and physical disorders Lack of stress → prevention of depression Positive thinking → stimulation of all body systems



Changes in Lifestyle Smoking ∟ Cardiovascular diseases ∟ Cancer ∟ Respiratory diseases Nutrition (lack of fruits and vegetables, excess of fat and sugar in fast food) ∟ Overweight and obesity (risk for cancer, DM, CDV) ∟ Cancer Lack of physical activity ∟ OA, OP, CVD ∟ Obesity ∟ Cancer Stress psyco-social determinants Alcohol harmful abusus, and other drugs


Future of European Spas linked with health needs Preventive programmes directed at changing of life style and as a prevention of common diseases – aim for Europe and Spas Old age of Europeans (increased number of seniors) – programmes directed at keeping the quality of life in old age Classic spa treatment mainly for diseases of locomotory apparatus, psychiatric diseases depresive stage, cardiovascular diseases

Research and investigation in spa treatments and services/evidence based spa medicine Balneological Research Institute Universities and High schools with pregradual and postgradual education in field balneology Insurance companies – studies on economical benefits of spa treatment Spa facilities – objectification of own health products and own natural healing sources Professional associations (Kneippverband, ESPA ?) Tourist research institutions (ETI in Trier) In comparison with other medical fields less money (no interest of pharmaceutical companies) In future existence of spa health resorts without research and investigation is endanger


JANKA ZALESAKOVA - Long term strategy for European Spas  

Janka Zálešáková, Belek, TURKEY, May 26 th , 2011 SPA IS MORE… •Establish rules for facilitating access to safe high-quality cross-border he...

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