Health care across EU borders

From the beginning of 2014 at the latest EU citizens will be entitled to receive health care from any EU country. This is in line with a EU directive on the application of patient rights in cross-border health care. In Finland the reform has been the subject of much debate in anticipation of its likely impacts, according to MSAH Ministerial Adviser Pasi Mustonen and Senior Officer Noora Heinonen.

"The directive has been a challenge for us because it has been made largely in line with the thinking of Central European institutions," says Mustonen.

Under the directive, patients coming to one EU country from other EU countries must be attended to in the health care system in the same way as the citizens of that country. Patients are entitled to seek treatment in another EU country without any special permission or referral.

In addition, patients should be able to receive reimbursements for treatment on the same basis as if they were receiving treatment in their own country. And it is precisely this that is posing such a procedural headache in Finland.

"The insurance based social security system of Central Europe differs significantly from the residence-based social security we have in the Nordic countries," explains Mustonen. "Furthermore, the dual channel financing system of health care services is difficult to reconcile with the new requirements."

Under the dual financing system, public and private services are funded in different ways. The same patients pay different amounts for them, and can consequently use two different reimbursement mechanisms. But which one will apply when Finns receive treatment abroad?

With public health services, municipalities cover the majority of the costs, of which patients pay a small client fee.

With private health services, on the other hand, patients pay more and are then reimbursed through the Social Insurance Institution of Finland, known as Kela. Kela's level of reimbursements is fairly low, however, meaning that patients pay a greater portion of the costs.

Mustonen explains that in other EU countries there is no such clear distinction between private and public health services.

"We're now having to consider whether we equate the treatment one receives abroad with private or public health care in Finland. The model we choose has a notable impact on the amount patients would pay."

Other countries face less of a quandary as they usually use only a single reimbursement mechanism.

The compensation model that will be used has yet to be decided. The steering group in charge of drafting the new legislation will decide on the matter this spring. But despite the challenges, Finland regards the directive favourably.

The directive accords with the government's aims of widening the options for people seeking health care, for instance by allowing people to choose ,within fairly broad parameters, which health centre or hospital they attend

"The directive strengthens patients' rights, increases their options and clarifies the rather confusing legal situation," says Mustonen.

He refers to confusion is due to the fact that there has not been any legislation at EU level concerning health services. Because of this the European Court of Justice has had to solve cases on an individual basis.

Much about the implementation of the directive remains to be seen. To what extent, for example, will Finns make use of services abroad?

Mustonen estimates that people living in the Helsinki metropolitan area and young people will be more inclined to do so, whereas this may not apply so much to people living in more remote areas and older people.

Conversely, the MSAH does not anticipate an exodus of patients from abroad in search of health services in Finland.

"We don't foresee massive flows of patients travelling to Finland, neither do we foresee large patient flows from Finland," says Senior Officer Noora Heinonen. "It is sure, though, that particular Finnish health services will attract patients from other EU countries."

There is a definite demand for the sorts of highly specialised medical care available from Finland's public health care system.

"They include neurosurgery, paediatrics, cardiology and possibly oncology," says Heinonen. "The treatment and care in these areas  are centralized within the Finnish public health care sector, and the capacity to receive patients from abroad is limited."

Heinonen points out that Finns resident in other EU countries may also make use of the new law to seek medical treatment back home, instead of using the services in the country where they live.

She says that the Finnish private health care system, which provides high quality a treatment across a wide range of medical conditions, and at a reasonable cost, is also likely to be a magnet for some people elsewhere in the EU.

Under the directive EU states will set up National Contact Points NCPs to provide information on all key features of cross-border healthcare. This is to enable patients to exercise their rights on cross-border healthcare in practice.

The NCP in Finland will most likely be located with Kela.

 "The NCP will provide information for patients, health care professionals, sickness insurance institutions and media about where to seek medical care abroad and what the reimbursements will amount to," explains Heinonen.

"They will also give information on where to seek treatment and care when coming to Finland. The NCP will start operating from the beginning of 2014." 

Maija Luotonen and Mark Waller