Draft bill on cross-border healthcare circulated for comments
The Ministry of Social Affairs and Health is requesting comments on a draft proposal to amend the Act on Cross-Border Health Care. The most central amendments deal with renewing the right to reimbursement under the Directive on the Application of Patients’ Rights in Cross-border Healthcare.
Under the current Act, patients have the right to receive reimbursement for medical costs related to treatment, medication and travel as provided in the Health Insurance Act if they seek elective care in another EU Member State, in Switzerland or in a country belonging to the European Economic Area. Patients who receive treatment for a sudden illness or who have a prior authorisation have the right to reimbursement based on the costs of corresponding treatment and client charges in the patients’ municipality of residence.
The Ministry proposes that in the future the right to reimbursement would be almost the same in the three cases, i.e., elective care, sudden illness and prior authorisation.
Medical costs would be reimbursed up the amount of the cost for the same or corresponding care in the patients’ wellbeing services county, the City of Helsinki or the joint county authority for the Hospital District of Helsinki and Uusimaa. However, the reimbursement may not exceed the costs the patients actually pay for the health services they receive. They would still have to pay themselves the client fee charged from patients receiving the same or corresponding care in Finland. Costs for travel and medication would be reimbursed as before as provided in the Health Insurance Act.
Only treatment that is deemed necessary on medical or dental grounds or on the basis of health science would entitle patients to reimbursement. Another condition for reimbursement would be that the service received abroad could be deemed part of the range of public healthcare services in Finland. To receive reimbursement for elective care, patients would also need a referral if they would need a referral for similar treatment in the Finnish public healthcare.
As a rule, the reimbursement under the Directive would only apply to cases and services where by law patients would be entitled to receive services from a wellbeing services county, the City of Helsinki or the joint county authority for the Hospital District of Helsinki and Uusimaa.
The right to reimbursement would exist for treatment received in EU and EEA countries, Switzerland and the United Kingdom of Great Britain and Northern Ireland.
The aim of the amendments is to ensure that the right to reimbursement for cross-border healthcare would correspond to the new legislation enacted as part of the health and social services reform. Another goal is to take into account the European Commission’s comments to Finland regarding the relationship between the current reimbursement scheme and the objectives of the Directive.
Comments on the draft bill are invited by 28 July 2022. The Government proposal is due to be submitted to Parliament in autumn 2022. The amendments are due to enter into force on 1 January 2023.
Marika Lahtivirta, Legal Adviser, [email protected]
Sirkku Pikkujämsä, Senior Ministerial Adviser (from 30 June to 15 July)