1. Cross-border healthcare in the
European Union – prospects and
challenges to the Health Tourism
Product Offer of NORDA
Stella Tsartsara
Gerontologist, Integrated Long Term
Care, Cross Border Healthcare - Senior
Tourism expert

2. NOU NORDA Sustainable Development
Strategy 2020
• Tourism and leisure is
the 1st choice for
territorial development
• Production, services
and port logistics

3. Assets for Health Tourism around the
year in NORDA region
• The longest beaches in Europe,
• Varying proportions of area covered by forests –
0.2 in Puck, up to 74.4% on the Hel Peninsula
• Moderately warm summers, with the mean
atmpospheric temperature of ca. 17-17.5o C.
• Mild winters – ca. 0-0,5o C, 1 650 sunny hours

4. Natural trails : Across the ravines and cliffs of Rozewie:
- the Łebskie Błota nature and ornithology path
- the educational trail in Rąbka Protection District

5. NOU NORDA – an appealing offer for
sports and leisure
• The total planned length of bicycle routes is 450 km
• 28 surfing schools
• 4 golf courses
5

6. Proximity of Gdynia with Urban
Centres of Poland

7. 38% of Polish tourists visited the region of Pomerania
24% of foreign tourists visited the region of Pomerania – Poland’s
second most frequently visited region
7

8. NOU NORDA Main Health
Tourism Product Offer
1. Integrated Long Term Care
for Active and Healthy Ageing
(AHA) and
2. Wellness, Rehab, Spa

9. Wellness & Spa Centres in NOU
NORDA
11
30 centres

10. Integrated Long Term Care
as a Destination Asset to
Senior Tourism
Development

11. “Hans and Gretel are on vacation”
Profile of elderly travellers
• John 75, post-stroke frailty,
he is insecure with slow gait
• Mary 65, suffers from post
cancer CHF and slight frailty
…but they have not lost
appetite for life!
“Where to this year Gretel?”

12. Cost benefit in the 2 Senior Tourism
destinations A & B – for customer
Destination A
• No elderly support upon
arrival (care plan, health
monitoring etc.)
• Expensive MTF
• Extra paid one off access to
nurse or GP, or medical
devices (wheel chair)
• Extra paid travel agents for
tour packages
What is behind…
• Segregated, expensive lines of
businesses, coordinated by an
MTF
• And yet more is not provided out
of cost (dietary info, internet
cards, etc.)
But, Hans and Gretel are only middle
income retirees just as other 71
million other baby boomers…
William J. Schroer: the Social Librarian

13. Cost benefit in the 2 Senior Tourism
destinations A & B – for provider
Destination B
• Patient Advocacy
Community centre offers:
– Welcoming and AFE Housing
What is behind…
• Senior Tourism Centralized
information, administration,
management, and coordination
of
– local businesses, AFE housing etc.
– Senior Tourism Packages from
trained community professionals
– Home care monitoring & support
to John and Mary just as they
provide to local elderly people
An Integrated Senior Tourism
Service Proposal

14. Cost benefit in the 2 Senior Tourism
destinations A & B – for provider
Destination B
• Patient Advocacy
Community centre offers:
– Care Plan e-Monitoring
– Trained social workers paying
visits to John and Mary, aligned
nurse and GP (if needed)
– Medical devices provision
What is behind…
• Senior Tourism Centralized
information, administration,
management, and coordination
of
– E- health monitoring system for
occasional visits of elderly
population
– GP, nurse, social worker aligned
just in case
– Alert system linked with the elderly
(alarm watches from AAL trials,
etc.)
An Integrated Senior Tourism
Service Proposal

15. Cost benefit in the 2 Senior Tourism
destinations A & B – for Local Authorities
and business
Destination B
• Patient Advocacy
Community centre offers:
– Aligned tourism packages
designed for elderly with local
community businesses
– Assures FIT vacationing
What is behind…
• Senior Tourism Centralized
information, administration,
management, and
coordination of
– Senior Tourism Packages from
trained professionals, as part of
the Local Development Plan
and Territorial Branding
activities
– Capacity built and business
development programs.
An Integrated Senior
Tourism Service Proposal

16. Expensive infrastructure for
LRAs , unless it is service
driven…
By coordinating
housing,
transportation,
outdoor activities,
social events,
community based
care and senior
tourism sector
organization and
delivery
…that Integrated Care can
provide to augment Local
Senior Tourism Destination
Value & Branding

17. The Community Based Integrated
Long Term Care model to support
Senior Tourism in NORDA
Patient Care Advocacy
centre
Geriatric assessment &
monitoring provided by
nurses and social
caregivers
Independent Living
Advanced and Instrumental
ADL
i – ADL Community dwelling
organization, welfare
society, "Home Aid" progr.
a - ADL, Community care
givers, welfare society
AssistedLiving
Basic ADL
* Home care programs
* Community care givers

18. The Community Based Integrated Care
model to support Senior Tourism in
NORDA
Patient Care
Advocacy centre
Senior citizens health
monitoring provided
by network of nurses
and social caregivers
Municipal services:
tourism packages,
transport, events,
housing and support
programs for staff
capacity and funding
Local businesses and
professionals, incl.
caregivers trained and
contracted on demand to
boost the local economy
Living Lab in the
Region to test AAL, to
coordinate
longitudinal or cross
sectional studies
Patient Centre acting as
Domestic Management
Organization for Senior
Tourism Services upon
small fee as funding is
secured
Funding Schemes
Investments
Incentives
Clinical trials – AAL

19. Cross Border Healthcare Directive: the
enabling factors of Health Tourism,
Senior Tourism & LTC and Rehab in
NORDA
• Rehab is reimbursed (Germany, Sweden, NL
and private insurances)
• Long Term Care is reimbursed in some
countries (Slovak Republic)
• The Value Proposition for NORDA: good
climate, cheap prices for LTC & nursing
homes, proximity to CE for LMI segment.

20. Division of 'competences' set by Treaty
Health systems are national competence
Single Market: free movement of goods and services
Healthcare not considered part of Single Market, historically
but there is an exception! Rehabilitation and Health Tourism

21. Directive on patients 'rights in cross-
border healthcare 24/2011/EC
• Patients' rights to choose care abroad increased
and clarified
• Increase in information to patients on cross-
border rights and on health systems Minimum set
of patient rights established for all treatment
delivered in the EU, doctor/hospital liability &
obligatory post operative treatment in source –
country.
• Impact / potential demand growing in numbers
in EC (Committee of Regions, Hearing 29/2/16)

22. Report From The Commission To
The European Parliament And The Council
Commission report on the operation of
Directive 2011/24/EU on the application of
patients’ rights in cross-border healthcare
Reimbursement for treatment not subject to prior authorisation
• Of the 26 Member States who responded, only 23 were able to
provide complete data on reimbursements made for treatment not
subject to prior authorisation (Germany and the Netherlands could
not provide data; Belgium could not provide complete data).
Of these 23:
• Finland, France and Luxembourg provided aggregate data for the
Directive and the Social Security Regulations.
– Finland reported 17 142 reimbursement claims,
– France 422 680 reimbursement claims and
– Luxembourg 117 962 reimbursement claims.

23. Cross border healthcare directive 24/11/EC
boosting Medical & Health Travel and
Senior Travel and Long Term mobility in EU
• Shared risk Insurance as in EU with reimbursed medical treatment costs in cross
border healthcare provision and compulsory post-operative aftercare provision at
home will revolutionize the way healthcare is provided
• The leaked "concept paper on health care services within TISA negotiations," in the
Trade in Services Agreement negotiations in Geneva last September (2014), argues
there is "huge untapped potential for the globalization of healthcare services," creating
massive business opportunities from what is a $US6 trillion ($7.7 trillion) per year
industry.
• The proposed regime would involve health professionals authorizing patients to be
treated in other TiSA countries (for reasons including long waiting times in the home
country or inadequate expertise for specific medical problems); and the patient's costs
being reimbursed through their home country's social security system, private insurance
coverage or other healthcare arrangements.“
• 750 million Europeans will be able to travel abroad for cure and care! - Large
multinational , multidisciplinary companies should manage the medical travel
delivery, incl. insurance, MTF, legal, medical, tourism and other sectors’ experts to
maximize efficiency and lobby for reforms.
1) Wikileaks on TiSA for Services - https://wikileaks.org/tisa/
2) http://www.smh.com.au/national/health/medical-tourism-plan-revealed-australia-leads-top-secret-push-for-globalisation-of-healthcare-
20150205-13648w.html

25. Stella I. Tsartsara
Gerontologist, Integrated Care,
Cross Border Healthcare - Senior
Tourism expert
South East Europe Healthcare
LinkedIn :
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tsartsara-456a8322
email: stsartsara@gmail.com
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