EUROPE : Was 25 October the day that Europe forgot?

Ever since IMTJ began, there has been a discussion on whether or not EU rules on cross-border healthcare would have a major or minor effect on medical tourism.

When the cross-border healthcare directive was originally agreed, most of Europe seemed prosperous, but since then we have seen economic bailouts for Cyprus, Greece, Ireland, Portugal, Spain and others. We have seen political turmoil in several countries, with dramatic cuts to public healthcare spending in several. The European Union has expanded to 28 countries.

28 countries are full members — Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the UK.

Potential candidates for EU membership are Albania, Bosnia and Herzegovina, Iceland, Kosovo, Macedonia, Montenegro, Serbia and Turkey.

Over the last decade, the EU Court of Justice has issued rulings confirming the right for patients to be treated outside their home country and reimbursed under certain conditions, but the applicable rules were still not entirely clear.

Directive 2011/24/EU on patients’ rights in cross-border healthcare clarifies these rules.

In addition:
•It creates a network of national contact points to provide clear, accurate information on cross-border healthcare.
•It helps EU countries share experiences on how to provide patients with the best possible care, for example using new health technologies.

Directive 2011/24/EU on patients’ rights in cross-border healthcare clarifies the rules on access to healthcare in another EU country, including reimbursement.

All the new rules and laws refer to planned treatment only; separate arrangements exist to deal with emergency and unplanned accidents and illnesses.

Under EU law, any EU resident can seek medical treatment in another EU country if:
•The specific treatment they need is not available in their home country, but is covered by statutory health insurance/ free national health system.
•Or the medical circumstances of their case mean they might not receive the treatment in time. Medical circumstances include degree of pain, the nature of any disability (which might for example make it impossible or extremely difficult to work), the probable course of the disease, and medical history.
•If people want their home health insurer to cover the cost of hospital treatment abroad, they must ask for prior authorisation.
•Once authorised to seek medical treatment in another EU country, they should be treated there on the same terms – and charged the same costs – as a person insured in that country.

EU countries have until 25 October 2013 to pass their own laws implementing the Directive.

Even countries supportive of the changes such as the UK, Netherlands and Germany have been very late in bringing in regulation, a supporting network and new rules for their citizens on when and how they can get planned healthcare in other countries.

Those strongly opposing the directive have delayed and dithered so much that several could take years to implement legislation. The country leading the opposition to the whole concept was Spain, and in recent months it has shown that it has little interest in complying, with flagrant disregard for existing regulations on unplanned and emergency healthcare for foreign nationals. Many reports have said that the European Commission is taking legal action against Spain, but these are not correct. At present all the European Commission can do is investigate problems; trying to prosecute a country that no longer has enough money to provide healthcare for its own people would be a long, tedious and probably pointless exercise.

The vast majority of countries seem to be in agreement with the principle of the new laws, but are not hurrying to do much about it. A few small countries that see great potential to send citizens overseas are changing their laws. One problem is that there is no central database recording where each member country is with legislation and setting up systems.

Meanwhile, the current and expected effect on medical tourism in Europe seems negligible.

Medical tourism news
21 October 2013
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