EU edges closer towards cross-border healthcare


The European Parliament has approved plans to give EU (European Union) patients the right to seek healthcare within the bloc more easily and be reimbursed for the costs. MEPs (Members of the European Parliament) also want patients to be properly informed about their rights when they are treated outside their home member state.

The draft directive on cross-border healthcare aims to eliminate obstacles for patients who seek treatment in an EU member state other than their own.

It also clarifies patients’ right to be reimbursed after treatment in another member state – rights that have been confirmed in European Court of Justice judgments but are not yet included in EU legislation.

The directive does not change the right of member states to define the benefits that they choose to provide.

If a member state does not include a particular treatment as part of the entitlement of their citizens at home, this EU cross-border healthcare directive does not create any new entitlement for its citizens to have such treatment abroad and be reimbursed. The new directive will not affect current patient rights, which are already codified under another EU regulation, or the regulations on the coordination of social security systems.

Under the draft directive, European patients will have the right to seek healthcare within the bloc but member states may nonetheless introduce a system requiring prior authorisation for the reimbursement of hospital costs if the financial balance of the member state's social security system could otherwise be seriously undermined. No state can do this unilaterally, it has to get at least majority approval from other states before it can include prior authorisation in national law.

Meanwhile, MEPs want member states – not the EU Commission as originally proposed - to define what hospital care is. They also stress that the prior authorisation requirement must not create an obstacle to patients’ freedom of movement.

On the reimbursement of medical costs incurred, MEPs agree with the general rule that patients are to be reimbursed up to the level they would have received in their home country. They add that member states may decide to cover other related costs, such as therapeutic treatment and accommodation and travel costs.

Since the proposed rules would in practice mean that patients needed to pay in advance and get reimbursed only later, MEPs added a provision that member states may offer their patients a system of voluntary prior notification. In return, reimbursement would be made directly by the member state to the hospital of treatment.  MEPs say member states must ensure that patients who have received prior authorisation will only be required to make direct payments to the extent that this would be required at home.

The Commission is to examine whether a clearinghouse should be established to facilitate the reimbursement of costs.

Parliament has added special rules for patients with rare diseases and disabilities that might need special treatment. Patients affected by rare diseases should have the right to reimbursement, say MEPs, even if the treatment in question is not provided for by the legislation of their member state and this shall not be subject to prior authorisation. Special costs for people with disabilities must also be reimbursed under certain conditions. Furthermore, all information must be published in formats accessible to disabled people. Parliament voted to exclude long-term care and organ transplants from the directive.

To improve patients' confidence in cross-border healthcare, they must receive appropriate information on all major aspects of such care, such as the level of reimbursement or the right of redress in the event of any harm arising from healthcare. MEPs back the idea that national contact points should be established but they also propose establishing a European Patients Ombudsman to deal with patients' complaints regarding prior authorisation, refunds or any harm suffered, after all complaint options within the relevant member state have been explored.

The legislation was prompted by a series of EU court rulings in the 1990s that established the right of patients to be reimbursed for treatment abroad. But the lack of legislation means there is still legal uncertainty for patients about under what conditions they are entitled to have their costs repaid. At the moment, just one percent of healthcare budgets are spent on cross-border healthcare.

The law now goes back to the member states for consideration and will be only be taken up again in the parliament's new legislature, beginning in September. This was the European Parliament's first-reading position. This dossier is expected to require two readings and is unlikely to be concluded until the end of this year or possibly early 2010. Individual country legislation could be two to five years away.

EU member states are still working to iron out a range of practical difficulties before the plan can be formally adopted. EU ambassadors will now discuss the proposal in early May as member states continue to wrangle over the practicalities of enhanced patient mobility. The plan has been discussed several times at meetings of EU governments this year, but Brussels insiders warn there is still much work to do before agreement is reached.

Among the outstanding issues to be resolved are how much power member states will have to control the flow of patients to their health services from outside their jurisdiction. It is believed that the Czech EU presidency is now suggesting that countries should have greater freedom when demanding prior authorisation for treatment, particularly for "specialised and cost-intensive" care. The presidency is hoping for political agreement at a meeting in Luxembourg on June 8.

Cooperation by member states on health issues is a thorny issue as healthcare is a matter for individual countries, and there are significant differences in funding models of health and social insurance systems across the EU.

How this could affect medical tourism is not known. Those expecting a flood of state-paid patients to their hospital are likely to be disappointed. Much EU medical tourism is for cosmetic surgery, wellness, spas and dentistry-where there is limited provision in state healthcare. Some EU countries have an efficient state health system where patients do not feel the need to look overseas. But others suffer long waiting lists or poor provision. Much will depend on whether states are allowed to dilute the effect of the legislation by demanding that patients get advance authorisation, as countries where demand for overseas treatment is most likely are also those where health bureaucracy would make life difficult for those seeking state-paid overseas care.

European medical tourism could benefit now from the proposals as opening people’s eyes to the idea of medical travel and that other countries may have better or cheaper private care than at home, will make more people aware of the benefits of medical tourism.

What must not be forgotten is that the whole point of the legislation is to benefit patients -not states, politicians, hospitals or the medical tourism trade.

UK Liberal Democrat MEP Liz Lynne reminds us that the legislation paves the way for European patients to access healthcare across the EU irrespective of income: “Why should a patient have to lose their sight waiting for a cataract operation, or spend months in agony waiting for a hip replacement when they could get treatment sooner in another member state, sometimes at a lesser cost to the country of origin? If a clinician advises treatment and this cannot be provided at home, then we need a legal framework to ensure that they can seek it elsewhere."



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