Crossboundary medical care: The example of Type 2 Diabetics in Germany and France, in need of treatment in the neighboring country

Abdelhaq Bahjaj, Heinrich Krayl, Thomas Wetter


Introduction and problem: In times of European integration and aging societies it becomes more important that citizens with medical conditions receive continuity or care when treated abroad. We use the old time European allies Germany and France and the complex and highly prevalent condition Diabetes Mellitus to investigate the smoothness of the transition when patients cross borders.

Material and methods: We reviewed the recommendations of WHO and legal documents in the European Union and the two countries regarding what rights citizens have. We selected one well renowned hospital each. There we followed quasi random samples of 33 resp 34 local patients. Of these patients we studied in full and compared the documents used for the visit. This included percentage of pertinent parameters noted or not noted, units and normal ranges applied and several more. We also assembled a list of available standards for documentation and to what extent they were used and addressed the basic question of trustworthy translation between the two speciality languages.

Results: While legislation gives the patient a far ranging right to treatment abroad, practice shows notable and partially alarming differences. Different professional groups perform different tasks; outpatient and inpatient treatment are differently organized giving patients different roles than at home; completeness of documentation varies by a factor of more than two for core parameters; differences in physical unions and the absence of units in French records bearsevere risks; some standards are used differently and standards in general are used much less than appropriate.

Discussion: Although limited in scope the study demonstrates that Sunday speeches about open borders in the EU have a blind eye on health practice. Inertia hampers the potential of standards to be used for all structured data and we are barely touching upon the multiple languages problem for necessarily narrative parts.


Type 2 diabetes mellitus; medical records; inpatient and outpatient discharge letters; national and European laws; international standards in medicine; medical informatics; linguistics; translation science; France; Germany

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