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Lack of uniform regulations for advertising medical services leads to unfair competition in Europe
In countries where self-promotion is not allowed, practices cannot withstand the competition of neighboring countries addressing the foreign market.
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Results of a recent survey administered by the European Union of Medical Specialists show that advertising medical services is currently allowed in more than half of EU countries. New policies are developing in response to current needs, moving away from old ethical concerns about commercializing health care.
While this is a new trend, according to Marko Hawlina, MD, PhD, member of ophthalmology section of the European Union of Medical Specialists (UEMS), who led the survey, the lack of uniform regulations and guidelines across Europe creates legal inconsistencies and leads to unfair competition.
Medical practices that offer services not covered by national insurance or medical insurance companies, such as refractive surgery, premium IOLs, oculoplastic surgery and esthetic surgery, can hardly survive without some form of self-promotion, he said. Access to all advertising channels, including Internet-based resources such as websites and social media, and more traditional channels such as printed materials, the press, radio and television, is vital to their success in reaching patients.
“That’s why we asked our delegates what forms of advertising are allowed, if any, in the respective countries and, if advertising is allowed, who can advertise: companies managed by doctors, companies managed by managers employing doctors, doctors themselves or some other legal entity. The third question investigated what subspecialties are allowed advertising, typically cataract, refractive and esthetic surgery,” Hawlina explained.
Differences in advertising
Hawlina said he was surprised to find out that 17 out of 28 countries allow advertising.
“Traditionally there has been resistance towards advertising medical services,” he said. “It is a sign that things are moving forwards and barriers are being removed.”
Advertising is still not allowed in Belgium, Croatia, France, Luxembourg, Greece, Cyprus, Estonia and Slovenia, while in Bulgaria and Slovakia there is no legislation covering this specific matter, and one country did not respond.
Regarding who can advertise, no differentiation is made in most countries among individuals, corporations, medical doctors or managers employing doctors. In countries where advertising it is not allowed, no exception is made.
“Interestingly, in most countries where advertising is allowed, no differentiation is made also between subspecialties or types of services. One exception is Switzerland, where doctors can do self-promotion for refractive surgery, esthetic surgery and IOLs, but not for regular cataract surgery per se,” Hawlina said.
Most countries that allow advertising submit it to specific central regulations. It must comply with ethical standards, and the information provided must be truthful, accurate and not create false expectations.
“In Germany, Italy, Switzerland and the UK, for instance, advertising is regulated and controlled by state agencies peer reviewed by national associations. In Austria, regulations are issued by the Austrian Medical Chamber and entail restrictions on advertising channels: No advertising is allowed on television or other broad media,” Hawlina said.
Issues at stake
There are issues created by the non-uniform approach to advertising medical services in Europe, Hawlina said. Physicians working in countries where advertising is not allowed suffer from the competition of neighboring countries where it is allowed.
“There is quite an outflow of patients going abroad for treatment, not because the same treatment it is not offered at home or is not equally good at home, but simply because they are attracted abroad by commercials. Since their own doctors cannot promote themselves, patients may not even know that they offer the same services for the same or even better price,” Hawlina said.
To exacerbate the situation, limitations to self-promotion in some countries may not apply to physicians advertising from abroad.
“Even in cases where restrictions are extended to advertising coming from abroad, it is very unlikely that foreign doctors can be charged. We have such an example here in Slovenia, where we are flooded with adverts coming from Croatia in our media. A lot of our patients go to Croatia, attracted by special offers, reduced prices, discount medical tourism packages. Croatia also has restrictions on advertising, but when it comes to advertising abroad, the Croatian Medical Chamber declines any responsibility and says that it is our problem. So there is nothing we can do but lose a lot of potential patients,” Hawlina said.
In addition, the new marketing landscape offers plenty of opportunities for engaging consumers through social media, which are an unregulated gray zone. According to Hawlina, aggressive advertisers use social media a lot to reach patients abroad.
“We need European regulations to prevent unfair competition. Cross-border health care is a right regulated by EU directives, but in absence of uniform policies on advertising, patients who seek treatment abroad are often attracted by gimmicks rather than superior quality,” he said. “Socially responsible advertising to provide objective information on medical services should be allowed in every country, but current inequalities create problems.” – by Michela Cimberle
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- Marko Hawlina, MD, PhD, can be reached at Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; email: marko.hawlina@gmail.com.
Disclosure: Hawlina reports no relevant financial disclosures.