New report suggests Brexit could impact UK access to EU reciprocal healthcare


What happens to access to EU healthcare when Britain finally leaves the EU at the end of the official transition period in December 2020? The British government is reportedly hopeful of striking a deal with the EU to continue as things are now, meaning Brits can still be part of the European Health Insurance Card (EHIC) scheme after Brexit. But this has not been negotiated yet and a new report from the House of Lords EU select committee says it is unconvinced the government will get what it wants.

In the absence of an agreement on reciprocal healthcare, the rights of UK citizens to hold an EHIC card for treatment in the EU will cease after Brexit, says the EU Home Affairs Sub-Committee in a new report.

These arrangements support the free movement of people by eliminating the financial or bureaucratic barriers that millions of citizens, whether UK nationals resident in the EU or those from the EU resident in Britain, would otherwise face in accessing treatment. Reciprocal healthcare arrangements also play a vital role in allowing people with disabilities or long-term health conditions, the elderly, and children with healthcare needs, to travel abroad and avoid prohibitively expensive insurance costs.

The UK government's ambition post-Brexit is to continue the access provided by the current arrangements. In this new report, the committee examines the draft Brexit agreements drawn up by the UK and the EU and assesses the extent to which they address the concerns raised by witnesses.

In the absence of an agreement on future relations that covers reciprocal healthcare, the rights currently enjoyed by 27 million UK citizens, thanks to the EHIC, will cease after Brexit. Other rights, provided for by the S2 scheme and Patients’ Rights Directive, will also come to an end.

Reciprocal healthcare arrangements post-Brexit will only be achieved by agreement between the UK and the EU. The government has not yet set out its objectives for the future UK-EU relationship. The report urges the government to confirm how it will seek to protect reciprocal rights to healthcare of all UK and EU citizens post-Brexit, as part of any agreement on future relations.

Lord Jay states: "One of the primary aims of the EU's reciprocal healthcare arrangements is to support free movement by eliminating the financial or bureaucratic barriers that individuals would otherwise face in accessing healthcare. These arrangements have brought the greatest benefit to some of the most vulnerable members of our society. The committee heard evidence on the vital role that reciprocal healthcare plays in improving the lives of people with disabilities, the elderly, and children. We do not wish to see this progress reversed in the future. While we applaud the spirit underlying the government’s ambition to maintain reciprocal healthcare arrangements, including the European Health Insurance Card, post-Brexit, it is difficult to square this with ending freedom of movement of people from the EU. We therefore urge the government to clarify whether it will seek UK participation in the EHIC, S1 and S2 schemes as a non-EU Member State; set up a separate scheme with the EU27; or explore the possibility of reaching bilateral arrangements with individual countries. Clarity will enable UK and EU citizens, the NHS, and insurance providers, to plan for the post-Brexit future."

The S2 system under Regulation 883/2004 gives patients authorisation to receive healthcare or maternity care on the same terms as the local population, with the cost of that treatment met by their country of residence. Individuals need to apply for S2 funding ahead of their treatment, providing evidence that they meet the eligibility criteria and a clinician’s statement regarding their case. S2 only covers treatments that are provided by a state-run or contracted service. Patients must pay any contribution to the costs that a local citizen in the other state would normally pay. In some countries this can amount to up to 25% of costs.

On the continent of Europe, UK citizens and their dependents may live in one country, work in a second and receive medical treatment under S2 arrangements in a third. The S2 scheme and Patients’ Rights Directive works very well for UK or EU citizens who needed planned treatment in another EU country, and is especially valuable for patients with rare diseases or in border situations, where the nearest suitable facilities might be in a different country.

In 2015 1,186 individuals from the UK were reimbursed for treatment in accordance with the Patients’ Right Directive. Poland, Latvia and France were among the most popular destinations for treatment. 40 NHS hospitals are involved in the European Reference Networks that were established under the directive.

In 2016 1,342 S2 portable documents were issued by the UK to its citizens, and 1,100 were granted to EU, EEA and Swiss nationals for treatment in the UK.

The IMTJ Medical Tourism: Facts and Figures 2018 report contains a detailed analysis of European cross boarder healthcare and use of the EHIC card.



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