New Directive on Cross-Border Healthcare
The European Parliament has voted in favour of a Directive on patients’ rights in cross-border healthcare. The directive passed a second reading in the European Parliament in Strasbourg on Wednesday 19 January, so the new rules will apply across the EU in about two years' time. The new law will
clarify patients’ rights to access safe treatment across EU borders and to be reimbursed for the costs.
Patients travelling to another EU country for medical care will be entitled to the same treatment as the citizens of the country in which they are treated. The new law will make it easier for national health authorities to exchange information on quality and safety standards in healthcare, and will also help patients who need specialised treatment, such as those who are seeking diagnosis or treatment for a rare disease.
The Directive supports the development of ‘European Reference Networks’, which brings together specialised centres of expertise in Europe on a voluntary basis.
Commissioner for Health and Consumer Policy, Mr John Dalli, said: “In addition to providing a clear and coherent set of rules on cross-border healthcare this Directive will benefit patients in several other ways. It will help patients who need specialised treatment… [and] it will bring about closer and improved health co-operation, including the recognition of prescriptions, between Member States. “Health experts across Europe will be able to exchange best practices and mutually benefit from innovations in health technology assessment and eHealth. I look forward to a swift implementation of this Directive by the Member States,” he added.
He accepted that patients preferred to receive healthcare in their own country, and therefore the demand for cross-border healthcare represented only around 1 per cent of public spending in the area, which is currently around €10 billion.
This estimate includes cross-border healthcare that patients had not planned in advance, such as emergency care. It means that less than 1 per cent of the expenditure and movement of patients is for planned cross-border healthcare, like hip and knee operations or cataract surgery.
In the case of hospital care, one of the main achievements of the new Directive will be that patients will be able to choose their healthcare provider. For non-hospital care, patients will be able to seek healthcare abroad without prior authorisation or formalities, and claim reimbursement upon their return home.
The Directive covers not only public, but also private providers. National governments have 30 months to integrate these measures into national legislation.
Patients’ entitlements – UK patients can only receive healthcare abroad that they would be entitled to receive under the NHS.
Patients with rare disease – The text recognises the importance of cooperation between Member States in the diagnosis and treatment of rare diseases notably through the establishment of European Reference Networks (voluntary networks of healthcare providers and centres of expertise for cooperation in areas where concentration of expertise is required).
Gatekeeping – The Directive now includes the possibility to require patients to be assessed by a health professional – such as a GP – or an NHS commissioner to determine the patient’s entitlement to healthcare. In essence, patients wishing to receive cross-border healthcare may be subject to the same ‘formalities’ as patients seeking healthcare in the NHS. This point takes into account the way in which the NHS operates, and in particular the fact that, unlike many other EU countries, we do not have a list of the healthcare our patients are entitled to receive.
Prior authorisation – The NHS will have the option of introducing a system of prior authorisation for patients seeking cross-border healthcare. Prior authorisation is only possible for healthcare which is subject to planning requirements and which involves at least one night in hospital or requires the use of highly specialised and cost-intensive medical equipment. Authorisation can be refused in specific circumstances, including when that healthcare can be provided by the NHS ”within a time-limit which is medically justifiable taking into account the current state of health and the probable course of the illness of the patient”. For other types of healthcare, a voluntary system of prior notification can be introduced.
System of payment – The NHS will be free to decide on the system of payment to be used to cover the costs of cross-border healthcare. This means that commissioners can decide to reimburse patients who have paid the cost of their cross-border healthcare upfront or, alternatively, they can transfer funds directly to the providers abroad. It was thought that a compulsory system of direct payments could have had the effect of diverting limited national resources from the provision of healthcare to patients in greater need because of the significant resources required to administer such a complex system and the possible risk of fraud.
Cost of cross-border healthcare – Patients will be reimbursed for the cost of cross-border healthcare up the level of cost of that treatment under the NHS. Proposals to oblige healthcare systems to assume additional costs for certain patients have been defeated. Nevertheless, healthcare systems may decide to pay additional related costs such as accommodation and travel costs if they so wish.
Information to patients – National Contact Points will have to be established to provide patients with information related to cross-border healthcare on request. This includes information about the quality and safety standards that apply and which providers will be subject to them.
Incoming patients – Providers will have the right to refuse for planned treatment patients from other EU countries or to prioritise them to the detriment of NHS patients, for example by increasing the waiting time for treatment. This amendment to the text is particularly relevant for NHS organisations providing highly specialised services, for which a possible surge of incoming patients could lead to negative implications in terms of increased waiting times for NHS patients.
Quality and safety – Quality and safety standards of the country of treatment will apply. Member States will remain fully responsible for regulating the quality and safety of healthcare provided in their territory.
E-health – The European Commission shall support and facilitate cooperation across the EU on e-health. This cooperation will take place through the establishment of a network which will consider issues related to the transferability of electronic patients’ records in cases of cross-border healthcare.
The text agreed by the European Parliament on 19 January is expected to be formally approved by the EU Council of European Ministers shortly. It will then become EU law.
The UK and other Member States will have 30 months to enact it.