New Directive on Cross-Border Health Care clarifies patient’s rights in other EU countries

19.4.2011 6.35

News item N5-57653

The rights of patients of EU member states to receive treatment elsewhere in the Union have received greater clarity under the new EU Directive on Cross-Border Health Care, enabling citizens to enjoy equal treatment with the citizens of the EU country in which they are treated. The new directive also benefits patients in a number of other ways.

"The Directive, which was adopted in February, clarifies the rights of EU citizens to seek treatment in another EU country. The starting point for the Directive on Cross-Border Health Care is that patients are entitled to receive treatment in another EU member state on the same basis that they would receive comparable treatment in their own country," says Kirsi Ruuhonen, Senior Officer, Legal Affairs, at the MSAH

The vast majority of EU citizens receive health care in their own country, but in some cases they may find that better or more suitable or convenient treatment can be found in another EU country. This may concern situations, for example, where there is a need for types of highly specialised care that is not readily available at home, or when people living in border regions find that the nearest appropriate health care facility is in a neighbouring country.

"The most usual reason for seeking treatment abroad is due to the long waiting periods for public health care," says Ruuhonen.

A study conducted a few years ago found, however, that the demand for cross-border health care accounts for only about 1% of public health expenditure. This 1% estimate includes cross-border health care that had not been pre-planned, such as emergency treatment, which means that planned care accounted for less than 1% of expenditure.

Until now the rules for being granted health care in another country and for the reimbursement of costs have not always been clear. This was one reason why the EU Commission developed the Directive on the possibilities of seeking cross-border health care and what it entails. The Directive provides clarity on responsibility for the quality and safety of health care when it is sought in another EU country. It also strengthens cooperation between member states on cross-border health care requirements.

Reimbursement guarantees

Prior to the Directive, patients seeking treatment abroad would generally pay the related costs themselves. Some of them have then applied for reimbursements through the courts and have been granted them. Under the new Directive, patients will pay upfront for the treatment they receive in another EU country and must later be reimbursed for that payment, as long as it concerns treatment that would also be reimbursed in their own country.

"There was a desire with the Directive to include practice based on legal cases into the legislative sphere," says Ruuhonen.

The Directive will not affect existing regulations, such as when EU citizens need health care when in another EU country temporarily or when they seek prior authorisation for planned care. The Directive retains the prior authorisation stipulation for hospital care. The Directive, however, offers greater definition concerning patients' rights.

For example, concerning hospital care, patients will be able to choose their health care provider. For non-hospital care patients will be able to obtain treatment abroad without prior authorisation, and then will be able to claim reimbursement when they return home.

The Directive also contains certain conditions aims at keeping costs in check.

"Patients will have to seek prior authorisation when treatment entails hospital stays or expensive special procedures. Authorisation may be refused if the treatment sought is judged to be detrimental or if the patients' home country pledges to provide treatment within a reasonable timeframe, medically speaking," Ruuhonen explains.

Own country responsibility

Ruuhonen says that the primary responsibility for arranging health care remains with patients' own countries. The cross-border health care Directive offers new opportunities for receiving treatment. The Directive also covers measures designed to ensure that there is continuity of care when a citizen who receives treatment abroad returns home.

This also applies to prescriptions. Those issued in one EU country will be recognised in others. This helps with continuity of treatment. The new Directive will provide pharmacists with ways to prevent the abuse of prescriptions, for example by identifying the doctors and patients recorded on prescriptions.

The condition for receiving reimbursement is that the treatment is the kind that one would receive from public health services in one's own country. People seeking cosmetic surgery or alternative treatments will have to pay for it themselves.

Client fee or KELA reimbursement?

Public health care in Finland carries a small client fee, while fees for private treatment are more, even though the latter can be reimbursed by KELA, the Social Insurance Institution of Finland. In other countries it is not possible to make the same kind of division between public and private health services.

"We now have to decide whether the patient who seeks treatment abroad can receive treatment at the client fee or at the cost of the treatment reimbursed by KELA," says Ruuhonen. The position of the European Court of Justice would possibly be that for the patient the cheaper client fee would be opted for. This would lead to the paradoxical situation where patients would be able to receive treatment abroad that is cheaper than from a domestic private service provider.

"It's an interesting tangle," says Ruuhonen. The MSAH is currently setting up a steering group to consider how the system can be made sensible and fair without bypassing EU obligations.

The new Directive envisages the creation of contact points in member states, which will provide information in patients' rights to treatment both in the country in question and in other EU states. The aim is to allow patients to make informed decisions on the possibilities for and conditions that apply to cross-border health care.

The implementation of the Directive requires that new national legislation is prepared. This is now underway and the necessary regulations are expected to be ready by the end of 2013.

Paula Mannonen and Mark Waller