About medical care and prescription drugs abroad
Imagine the situation that you have gone on a trip to another European country, but while you are there you discover that your medicine is running out or you completely forgot it at home. For example, I recently had a situation where I thought I was going on a business trip for just one day, but in reality I returned home three days later due to a snowstorm and cancelled flights.
Data exchange service manager for cross-border ePrescription and Patient Summary (TEHIK)
Cross-border exchange of health data is especially helpful in unexpected situations. In Estonia, we are so used to using ePrescriptions that we hardly even remember the existence of the nostalgic green paper prescriptions.
At the end of January, four years has passed since it was possible to buy medicines from Estonian pharmacies for the first time with an ePrescription issued in Finland. And it has almost been the same time since it has been possible to buy medications with Estonian ePrescriptions in Finnish pharmacies. Estonia and Finland then became the first two countries in Europe (in fact, in the world) to exchange prescription data.
In addition to Finland, people with an Estonian personal identification number currently have the opportunity to buy medicines in Croatia, Poland and some Portuguese pharmacies based on an ePrescription issued in Estonia. In the near future, Spain and then the rest of Europe will be added to the list. When buying a prescription medicine in a foreign country, you must take into account the fact that the same medicines may not be available in all countries or the same medicines may have different names. It is not possible to buy restricted prescription drugs abroad, e.g. narcotic and psychotropic drugs, anabolic steroids and extemporaneous drugs, i.e. drugs prepared locally in a pharmacy. Also, the discounts of the Estonian Health Insurance Fund do not apply immediately when buying medicine abroad - reimbursement can be applied later.
In 2017, together with the cross-border exchange of prescription data, another very important project was initiated - the impementation of the Patient Summary service. The purpose of this service is to ensure better quality medical care for people abroad thanks to electronically transmitted health data. For example, if we go skiing on Kuutsemäe and accidentally break a leg there, the Tartu ambulance will know the primary necessary information about our health using the National Health Information System. But what if I need medical care in another country?
It will soon be a daily reality that a healthcare professional from another European country can receive our most important health information (diagnoses, allergy data, medications used, etc.) in their native language. The summary of Estonian citizens' health data can already be seen by foreign doctors in Luxembourg, Portugal and France, and the Netherlands, Spain, Croatia, Malta and the Czech Republic will be added to this service in the near future.
The exchange of health data takes place via a secure data exchange platform managed by the European Commission. Data is not collected or stored centrally, the platform is only used for real-time transmission of data from one country to another. An important value of this service is that during the data exchange, both the ePrescription and the Patient Summary data are automatically translated into the language of the destination country.
In Estonia, the Health and Welfare Information Systems Center (TEHIK) manages and develops the cross-border health data exchange service, and the service is owned by the Ministry of Social Affairs. The most up-to-date information on which countries have joined the service and what is important in the Patient Summary service can be read on TEHIK's website https://tehik.ee/en/cross-border-data-exchange and https://health.ec.europa.eu/ehealth-digital-health-and-care /electronic-cross-border-health-services_en
Riin Rehemaa: without a doubt, this kind of sharing of health information between countries is very necessary
Riin characterizes her family of four as an average Estonian family that loves to travel more than average. Their adventure-filled Instagram account @thekinkstagram with over eight thousand followers indeed has reports from nearby countries as well as far away exotic places. Many adventures are accompanied by major and minor accidents that require visiting a foreign hospital or clinic. What are her experiences with access to medical care while traveling?
Have you gotten into any situations during your travels that required medical attention?
Since we travel very often, about 10-12 times a year, and mostly with children, we have experienced many possible situations while abroad, including countless health problems. We have broken bones and caught stomach viruses, we have also experienced strange outbreaks that have required repeated visits to the emergency room and made local doctors scratch their heads. Fortunately, we have always received solutions to our health concerns.
Have there been situations where the language barrier has been an obstacle when communicating with a healthcare worker abroad?
Yes, unfortunately. We ourselves do not speak all languages, and we cannot expect this from doctors either. For example, when I broke my finger bone in the middle of the Central American jungle, I drove 10 hours to the nearest hospital, where, looking around the waiting rooms, I discovered that my little finger was clearly the smallest injury. Although I can speak a little Spanish, the local doctor was clearly disturbed by my (in his opinion) unnecessary hospital visit and self-forgettingly yelled at me not to waste his time with my finger swollen to the size of a sausage. I have to admit, half of this conversation was lost for me, but I doubt that he gave me very constructive suggestions there.
Fortunately, in the end, body language has always helped to reach a result, and a pharmacist helped fix the finger until I arrived in Estonia and also recommended suitable painkillers.
In your opinion, is this kind of sharing of health information between countries an important/necessary service and did you know that Estonia has joined such a service?
No doubt. My little daughter was recently quite seriously ill, and as a result her immune system was clearly weakened. When we went on a trip about a month after her illness and she started coughing again and the fever rose quickly, I would definitely have liked the local doctor to have her recent health history in front of him. This would give an opportunity to approach the treatment plan accordingly. In the case of chronic diseases or the need for prescription drugs, such background information is certainly useful.
Due to my personal need, I am completely familiar with it and I can confirm that a prescription issued in Estonia can indeed be redeemed abroad. In this case, for example, in the case of a repeat prescription, it is much easier to get the necessary prescription extended online from your doctor, so you don't have to chase the local clinic while traveling and prove the seriousness of your concern there.
What have you missed in terms of healthcare or medical care while traveling abroad, what could be better?
Availability of medical care. First of all, the problem is that you are simply in a strange place. Getting sick is always unpleasant. Add to that an unfamiliar environment and stress can easily arise - we don't know the local hospitals or doctors, whom and where to turn to. A language barrier, high costs and long waiting times are also possible obstacles. Of course, it would be unrealistic to feel comfortable in these aspects in every new place. I personally believe that digital medical care and the use of my health data by doctors across borders could be a good solution here.
What advice would you share with others regarding travel and medical care?
First of all, you should carry a basic first aid/medicine supply to deal with the unexpected a little better, secondly, never go on a trip without a valid travel insurance, because none of us can predict what might happen and it's an unnecessary risk. Thirdly, if you get sick, but the concern is not so urgent that you would need to go to the actual emergency room, you should probably also contact your doctor in Estonia, who will guide you regarding the necessary activities/medications. After all, we have modern means of communication and digital platforms for that, and it is not always necessary to go to the local clinic - perhaps it will relieve some anxiety.
The article was published in February 2023 in GO Travel Magazine (Estonian).