Lords EU Committee publishes healthcare report


The UK’s House of Lords EU Committee has published a report on the European Commission's proposal for a Directive on Cross Border healthcare entitled “Healthcare across EU borders: a safe framework”.

The commission's directive aims to clarify EU citizens’ rights to seek medical treatment in member states other than their own, and have the costs reimbursed by their own national healthcare systems. These rights have been confirmed in numerous European Court of Justice Rulings but the proposed directive represents the first efforts by the EU to codify these rights in a single document.

The directive not only covers in- and out-patient treatment, but also extends to dentistry.

The report welcomes the European Commission for a Directive on patients' rights to cross-border healthcare, but calls for improvements and warns that it must be carefully monitored upon implementation, suggesting a three-year review.

The Committee agree with the Commission that, as the right of EU citizens to travel to another Member State to receive healthcare has been confirmed by the European Court of Justice over the last ten years, it is essential to put in place a legal framework to replace the current ad hoc arrangements.

The Committee consider whether patients seeking healthcare in other Member States should pay the costs themselves in advance of treatment and then claim reimbursement later. They raise concerns that this would prevent those without adequate financial means from taking advantage of their right to cross-border healthcare. The report recommends that a patient’s own healthcare provider should pay the fees directly to the provider in the other member state, and suggests that this could be linked with the process of securing authorisation prior to travel, which the committee considers necessary to enable patients to make informed decisions about their treatment.

The report also calls on member states to ensure that patients are aware of their rights under the directive and are informed about the quality of care that they can expect, and any potential language barriers. Member states should finance information for its own citizens about healthcare abroad and should draw up a description of its own health system to guide other member states. It accepts that in practice it will fall to medical practitioners, such as GPs and dentists, to actually provide the information to patients.

The directive distinguishes between “hospital care” and “non-hospital care”. It defines hospital care as any treatment requiring an overnight stay. Non-hospital care is everything else. In the light of ECJ case law, the Directive provides that reimbursement for non-hospital care shall not be subject to prior authorisation, provided that if this care were carried out in the home member state, it would have been paid for by its social security system.

However, the directive permits member states to implement a system of prior authorisation for reimbursement of the cost of hospital care provided in another member state. The directive proposes that patients pay for their cross-border treatment upfront and seek reimbursement at a later date. This would fit in with how several EU health systems already work for domestic care, where the hospital provider and social insurance are separate organisations. In the UK, the care and insurance are both provided by the NHS, so the patient gets free treatment. The House of Lords wants to replace the pay and reclaim system with one where the hospital is paid direct.

Most EU countries favour a pay and reclaim basis. The Commission itself is prepared to consider direct payments, but only after treatment has been completed. This issue illustrates that most UK organisations that gave evidence have little understanding on how health systems work outside the UK.    

The EU plan has an implementation target date of 2011.



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