The EU Directive on Cross Border Healthcare: Update

Some had high hopes that the EU Directive on Cross Border Healthcare would transform the European medical tourism market and provide a much needed boost to patient flows.

Some had high hopes that the EU Directive on Cross Border Healthcare would transform the European medical tourism market and provide a much needed boost to patient flows. The vision was that EU citizens would be banging on the doors of hospital elsewhere in the EU. – See more at: http://internationalmedicaltraveljournal.build.eibs.co.uk/blog/the-eu-directive-slow-patient-engagement-40193/#sthash.7w7FN9mk.dpufSome had high hopes that the EU Directive on Cross Border Healthcare would transform the European medical tourism market and provide a much needed boost to patient flows. The vision was that EU citizens would be banging on the doors of hospital elsewhere in the EU. – See more at: http://internationalmedicaltraveljournal.build.eibs.co.uk/blog/the-eu-directive-slow-patient-engagement-40193/#sthash.7w7FN9mk.dpuf

The vision was that EU citizens would be banging on the doors of hospital elsewhere in the EU.

An incredible amount of time and effort has been invested within government departments and healthcare services across the European Union in the implementation of the Directive. In the UK, the European Union (EU) Directive on patients’ rights in cross-border healthcare became law on 25 October 2013. NHS England is now responsible for administering and determining applications made under the S2 route and the EU Directive route. A central team (the ‘European team’) operates within NHS England’s Leicestershire and Lincolnshire Area Team, to manage the process on behalf of the whole of England. Local Clinical Commissioning Groups (CCGs) who commission healthcare services for their local population are often involved in supporting the decision making process. So, there’s a system in place to support patients who wish to exploit their right to travel.

Other EU states are making slow progress with the implementation, and there’s a variety of approaches. According to EU Health Commissioner, Vytenis Andriukaitis, “Some countries have very elaborate systems of prior authorization; others seem to use a lower level of reimbursements than they should and others have different administrative requirements.”

Informing patients

Extensive information has been provided for patients within the NHS Choices web site on seeking treatment under the Directive. At Intuition, we published ” A UK patient’s guide to the European Directive on Cross Border Healthcare”, and distributed it online and in print to relevant organisations around the UK.

We have also featured the EU Directive heavily in our print publication – The Patients’ Guide to Treatment Abroad – that is distributed in GP practice and clinic waiting areas across the UK.

However, there has been little active communication of these new rights to the public as a while. The government and the NHS isn’t inclined to say to people:

“Hey, did you know you can go and get your hip done in Brussels, and we’ll pay for it!”

…because it wouldn’t go down well with the politicians or the public. You can argue that sending patients abroad may reduce some of the pressure on the NHS but it will not have a significant effect on the NHS budget, and that’s what counts.

The hospitals and clinics overseas and the medical travel facilitators targeting UK patients just don’t have the marketing budgets (or just won’t spend the money) to get the message across to the UK healthcare consumer. On the one hand, they’re saying, “Why aren’t people coming to us from the UK, we’re much cheaper… Why isn’t the NHS sending us patients, we’re much cheaper.” On the other hand, many are not prepared to invest in getting their message across in an effective way.

A trickle… not a flood

The reality is that few people across Europe know their rights to cross border care. And perhaps those people who are aware of them wish to access healthcare at home. Some industry proponents were hoping that the EU Directive would result in patients flooding across borders to exercise their rights. It’s been more of a trickle. Here are some of the numbers:

In the UK:

  • In 2014, S2 forms issued by the UK for healthcare in another Member State: 1,350 (Around 80% of these are for maternity/birth in another country).
  • In 2014, EU Directive reimbursements: 727 (of which 48 were subject to prior authorisation). There were 46 refusals to pay under the EU Directive refusals.

In Croatia:

  • 250 requests for reimbursement under the Directive received in the 18 months since the Directive became law.

According to a report in Politico, “Croatians are not generally using the directive because the health care provided by the older EU members, and even some newer ones, like Slovenia, is more expensive than in Croatia…. But the cheaper medical services in Croatia attract Slovenians and Italians, who go there mostly for dental treatment”.

In Poland:

According to the Polish National Health Fund:

  • 2,000 applications for reimbursement received since November 2014, of which 1,200 were reimbursed

An EU report on the implementation of the Directive is due to be published in September.

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As Editor in Chief of International Medical Travel Journal (IMTJ) and a Healthcare Consultant for LaingBuisson, Keith Pollard is one of Europe’s leading experts on private healthcare, medical tourism and cross border healthcare, providing consultancy and research services, and attending and contributing to major conferences across the world on the subject. He has been involved in private healthcare, medical travel and cross border healthcare since the 1990s. His career has embraced the management of private hospitals in the UK, research and feasibility studies for healthcare ventures, the marketing and business development aspects of healthcare and medical travel and publishing, research and consultancy on cross border healthcare.