Directive on patients’ rights in cross-border healthcare

DG SANCOUnit D2 Healthcare systems

EU law on healthcare since early 1970s: social security Regulations

• - Primarily co-ordination between systems• - Unplanned healthcare (EHIC)• - Possibility of referral to other EU Member State

(MS) (E112 / S2)• - Prior authorisation system; authorisation of E112 /

S2 can't be refused where "undue delay" applies• - Payment dealt with between health systems

European Court of Justice jurisprudence 1997 - 2006

• - Healthcare is a service within the meaning of the EU Treaty

• - If a patient is entitled to a treatment at home he or she is entitled to reimbursement for that treatment abroad

• - Reimbursement is up to cost of that treatment in home system

• - For some treatments (“hospital” care), health systems may require patient to seek “prior authorisation”

Provisions of Directive 1: patient entitlements

• - Patients have right of reimbursement when they receive healthcare in another EU MS

• - Level of reimbursement up to cost of treatment athome

• - Quality and safety standards / legislation of MS of treatment applies

Provisions of Directive 2: prior authorisation

• - Prior authorisation possible for a) overnight stay; b) highly specialised healthcare ("hospital care")

• - Authorisation may be refused if no "undue delay"• - Authorisation processes must be reasonable,

"properly reasoned"

Provisions of Directive 3: National Contact Points

• - Each MS must set up a National Contact Point (NCP)

• - NCPs tell outgoing patients about: rights; entitlements; reimbursement; appeal processes

• - NCPs tell incoming patients about: quality and safety standards and systems; complaints and redress

procedure

Provisions of Directive 4: prices, access, information, prescriptions

• - Healthcare providers must provide information on: treatment options; quality and safety; prices;

authorisation status; insurance / liability cover• - Patients should have access to care on basis of

non- discrimination; providers must apply same scale of fees as for domestic patients

• - Directive introduces cross-border prescriptions to help patients moving across borders

Summary of rules post 25 Oct 2013

• - "Non-hospital care" in domestic basket of benefits: Directive without prior authorisation or apply for authorisation under Regulations

• - "Hospital care" in basket of benefits: authorisation under Directive or Regulations (may be refused if no "undue delay")

• - Care not in basket of benefits: referral under Regulations

Provisions of Directive: rare diseases

• - Prior authorisation: may seek specialist view• - Awareness-raising of EU-level diagnostic tools;

possibilities for E112 / S2 referrals• - Political encouragement rather than legal obligation

Co-operation between health systems

• - Recognition of prescriptions• - European Reference Networks• - Health Technology Assessment• - eHealth

Thank you!Thank you!

Further information:Further information:http://ec.europa.eu/health/cross_border_care/policy/index_en.htm