An older German diabetic will take his medical prescriptions on a trip to Italy, but it is uncertain whether the pharmacist will honor them. A Polish woman would like to have hip surgery in the country where her grandchildren live and work, but how can she arrange it from Poland? A Portuguese patient would like to undergo cataract surgery by a specialist in Spain, but will it be reimbursed? Only a few such cases have been mentioned, where from the patient’s perspective, rights and rules regarding cross-border healthcare need to be explained more clearly.
In the EU legal act that has just been adopted, it is clarified that patients have the right to safe and quality treatment, both within EU borders and to corresponding reimbursement of costs. Patients who travel to another EU member state to receive medical care will be treated in the same way as citizens of the country in which they are being treated. This new legal act will benefit EU patients in several other areas as well. It will facilitate closer cooperation between national healthcare authorities and the exchange of information on quality and safety standards in healthcare. It will help people needing specialized treatment, for example patients requiring diagnosis of rare diseases or treatment of such diseases. It supports the development of so-called European reference networks, within which specialized expert centers already recognized in Europe are linked on a voluntary basis. Healthcare experts throughout Europe will be able to exchange best practices related to healthcare and thereby provide standards of excellence at the highest level.
What scope is this about? Patients would prefer healthcare to be provided in their own country. Demand for cross-border healthcare therefore represents only about 1% of public healthcare spending, currently roughly 10 billion EUR. This estimate includes cross-border healthcare that patients did not plan in advance, such as emergency care. This means that for planned cross-border healthcare, for example hip and knee replacement surgery or cataract surgery, less than 1% of spending and patient movement is involved.
What happens to the legal acts already existing in this field (the social security regulations)? For citizens requiring care (including emergency care), existing regulations will continue to apply during a temporary stay abroad, and care that they need will continue to be provided. For planned care, the patient may request prior authorization in advance. It cannot be refused where treatment cannot be provided within a medically justifiable timeframe.
Why do we need this new legal act then? This directive does not affect rights of citizens already enshrined in the existing social security regulations. Although current rules, which focus on social security agreements rather than patient rights, have existed since 1971, it remains necessary to clarify that EU citizens have a right to healthcare in another member state.
One of the main achievements of this new directive in hospital care is the right of patients to choose their own healthcare provider.
For outpatient care, patients will be able to seek healthcare abroad without prior authorization or formalities, and after returning home they will be able to claim reimbursement of costs. This directive applies not only to public but also to private providers.
For both hospital and outpatient care, patients will have access to information on the quality and safety of the care they will receive.
This directive is also intended to answer practical questions, for example where information can be found on quality standards applied by a hospital, or at what level costs will be reimbursed. The Court of Justice of the European Union has confirmed (1) that the right to seek cross-border healthcare is already contained in the treaties. However, with the directive that has just been adopted, this right is clearly set out in EU legislation and provides a single, coherent framework for all citizens across Europe.
Do I need permission from my country's national authority before traveling abroad for treatment? National authorities may introduce a system of so-called prior authorization in three cases:
1) for healthcare requiring at least one overnight hospital stay; 2) for highly specialized and high-cost healthcare; 3) in serious and specific situations concerning the quality or safety of care provided abroad. In these three cases, patients may be required to request consent in advance from the competent national healthcare authority in their country responsible for paying costs.
Can such permission be refused? National healthcare authorities may refuse an authorization request if the treatment or the relevant provider could represent a risk to the patient. If appropriate care can be provided domestically within an acceptable time, the authorization request may still be refused, but Member States will have to explain why such a decision is necessary.
What should I do if my application for authorization is refused? Patients have the right to request a review of any administrative decision on cross-border healthcare that concerns them.
How much will my costs be reimbursed after treatment abroad? Patients will be reimbursed the same amount they would receive in their own country for the same type of healthcare. Member states with free care will have to inform patients of the reimbursement rates.
Can I seek healthcare abroad if treatment is not available in my country? Yes, if the treatment is not available in the member state, national healthcare authorities may not refuse a patient who wants to undergo it in another EU country an authorization request. However, reimbursement for such treatment will only be provided if it is included in the national healthcare benefits package.
Public benefit packages are usually defined broadly, but where more precise lists exist (for example, detailed billing codes for treatment costs), they must be used for cross-border reimbursement.
Do I have to pay first for treatment abroad? Yes, the patient usually pays upfront and then the national authority in his or her country reimburses costs as quickly as possible. The regulation also states that Member States may choose whether to require prior written confirmation of reimbursement amount based on an estimate submitted by the patient.
Where can I find more information about my healthcare rights abroad? Under this new regulation, each member state is to establish a contact point to provide information on patient healthcare rights across Europe. These centers will exchange information and be able to provide patients with practical information on reimbursement conditions and rates, available treatments, providers, compensation procedures, and so on. Patients will then have a clearer idea of the quality and safety of healthcare provided abroad, leading to better-informed decisions about cross-border healthcare.
Can health information about me be transferred to the member state where I will receive treatment? The home country will ensure that the healthcare provider in the treatment country can access the patient’s written or electronic medical records in accordance with data protection directives. Strengthened collaboration between member states in electronic healthcare will ensure full readability and comprehensibility of this data. In other words, information technology-based healthcare systems will be able to “communicate with each other,” which can be highly beneficial not only for patient safety but also for the sustainability of healthcare systems.
What should I do if problems occur during treatment abroad? The new legal act establishes the liability of both the treatment country and the paying country regarding complaints and compensation. National contact points will provide patients with the information they need in this regard.
How can I be sure that after treatment abroad, proper care will follow when I return home? To ensure continuity of care, several measures are planned. The treatment country will ensure that patients have access to their written or electronic medical records of the care provided. The home country will ensure that follow-up medical care is equally high-quality regardless of where in the EU the care was provided.
Will my prescription be recognized in another EU member state? A prescription from another EU country will be recognized in the patient’s country of habitual residence and vice versa. This ensures that proper follow-up care can be provided at home after healthcare received in another EU country. The patient is entitled to the prescribed medicine if it is available and authorized for sale in the country where it is to be obtained.
Prescriptions should generally be recognized across the entire territory of the EU. In practice, however, this does not always happen. This new directive gives pharmacists the necessary tools to better understand cross-border prescriptions (for example, improved identification of the prescribed medicine and the corresponding doctors and patients).
What benefit does the Health Technology Assessment (HTA) network provide? A network of national authorities or offices responsible for health technology assessment will lead to a permanent EU structure for cooperation in this area. The added value of health technology assessment is to help decision-makers make the right decisions concerning investments and spending in healthcare. The purpose of cooperation on health technology assessment is to provide objective and reliable information on the effectiveness and efficiency of healthcare technologies. This is a concrete measure that further strengthens evidence-based decision-making by healthcare authorities.
What still needs to be done? At national level, Member States will establish at least one contact point where all relevant information will be provided to patients. They will ensure that their reference centers are linked to the European reference network. They will have to ensure that administrative procedures for using cross-border healthcare and reimbursing costs are in place, including complaint procedures and cost calculation mechanisms. The Commission will establish networks to support cooperation within the EU in the field of healthcare technology assessment and electronic healthcare. It will also help facilitate recognition of cross-border prescriptions.
When will this legal act enter into force? Governments of the Member States have 30 months to transpose these measures into national legislation.
More information: http://ec.europa.eu/health/cross_border_care/policy/index_en.htm
(1) Kohll and Decker (1998); Ferlini (2000); Geraets-Smits and Peerbooms (2001); Vanbraekel (2001); Inizan (2003); Müller Fauré and Van Riet (2003); Leichtle (2004); Watts (2006); Stamatelaki (2007); Elchinov (2010).