In a recent speech on patient safety, John Dalli of the European Commission, responsible for Health and Consumer Policy, said, “Access to safe and good quality healthcare is critical for patients, not only in their own country, but also across borders. The differences in access to healthcare between member states are alarming. The European Union has already made some progress towards securing equal access to safe and good quality healthcare across its borders. You will, no doubt, be aware of the European Court of Justice rulings confirming that patients have the right to be reimbursed for healthcare received in another EU Member State. Yet only a few patients are aware of this and only a few can afford to exercise this right. I hope that member states will soon give their green light to the European Commission's proposal on patients' rights in cross-border healthcare, which will enable patients all over Europe to access safe and good quality treatment across borders and be reimbursed for it. “
Spain’s Minister for Health, Trinidad Jimenez, together with John Dalli presided over an informal meeting of EU health ministers in Madrid in April. A debate took place on the guidelines on the rights of patients to cross-border healthcare and the work of the Spanish Presidency in order to try and harmonise the different points of view of the member states to offer sufficient legal security and guarantees of quality to patients. Although not on the agenda, and as an informal meeting not subject to the usual EU rules on reporting who said what or even which countries attended, those ministers not prevented from attending by volcanic ash clouds, also discussed cross-border healthcare.
Spain has led the resistance to the directive on cross-border health care, and at the meeting it tried to broker a draft compromise to take the discussions forward, that just happens to benefit countries such as Spain whose climate attracts large numbers of EU expatriates as a permanent or winter home. Most of these expatriates are retired, with one in four adults in the EU now over 65.
The deal engineered by Spain seeks to overcome the main problems that led the Council to reject the Swedish EU Presidency’s compromise, in December 2009, on the legal basis, the underwriting of costs and prior authorisation. Spanish Health Minister Trinidad Jimenez was at pains to argue, “This is just a working document, not an official text. It was not presented in detail to the ministers, but their reaction was positive and we hope to reach agreement in June.”
The deal engineered by Spain seeks to overcome the main problems that led the Council to reject the Swedish EU Presidency’s compromise, in December 2009, on the legal basis, the underwriting of costs and prior authorisation. Spanish Health Minister Trinidad Jimenez was at pains to argue, “This is just a working document, not an official text. It was not presented in detail to the ministers, but their reaction was positive and we hope to reach agreement in June.”
One of the provisions on which the 2009 discussions faltered was the definition of the member state of affiliation:
For the Spanish, the directive has to resolve this question in detail, covering all potential cases.
In the case, for example :
"...of a Dutch national living in Spain and wishing to receive treatment in the Netherlands, the Dutch state would have to bear the costs.
However, if this Dutch national decided to seek treatment in Italy, then the cost could be taken on by the country of residence, namely Spain, but under certain conditions.
The costs would only be paid if the patient is not hospitalised, is not treated using sophisticated technologies, and the cost of the treatment must not be greater than equivalent treatment in his country and if the treatment is not experimental. The patient must also have received quality services.
Soif a citizen from one country who lives in another, wants to be treated in a third country, they would have to obtain an authorisation from his or her doctor for the transfer and only at a hospital where the quality is guaranteed by the country it is in, but even if these conditions are met, there would be a ban on the patient actually being admitted overnight, or from taking part in any experimental treatments. The idea of such restrictions is to make the person either return to his or her country of origin, or to remain in their country of residence for treatment.
- who has to pay for retired people who live in a state other than their state of origin?
- For instance, who would pay for a retired British national who lives in Spain and receives health care in France?
For the Spanish, the directive has to resolve this question in detail, covering all potential cases.
"...of a Dutch national living in Spain and wishing to receive treatment in the Netherlands, the Dutch state would have to bear the costs.
However, if this Dutch national decided to seek treatment in Italy, then the cost could be taken on by the country of residence, namely Spain, but under certain conditions.
The costs would only be paid if the patient is not hospitalised, is not treated using sophisticated technologies, and the cost of the treatment must not be greater than equivalent treatment in his country and if the treatment is not experimental. The patient must also have received quality services.
So
This sounds more complicated than the original plan; you may be confused as to who pays for what and wonder how the average consumer would ever understand it, let alone the health bureaucracies of some EU countries.
Some countries have free state healthcare, in others you pay and try to get it back from a mixture of state and private insurance, and in others health plans are compulsory but available from hundreds of private providers; so trying to work out payment from what may be three different types of systems is an administrative nightmare.
But that is the Spanish plan, to comply with the principle of the directive, but in practice to make it so complicated and difficult for any consumer to get healthcare paid for by complex mixtures of state bodies and insurers, that it may effectively kill the concept.
Part two of the plan is that the 27 health ministers gets so tangled up in details, and with several countries facing pressure on health expenditure due to economic problem wanting to avoid anything that adds to costs, that the proposal fails due to inaction and neglect.
Some countries have free state healthcare, in others you pay and try to get it back from a mixture of state and private insurance, and in others health plans are compulsory but available from hundreds of private providers; so trying to work out payment from what may be three different types of systems is an administrative nightmare.
But that is the Spanish plan, to comply with the principle of the directive, but in practice to make it so complicated and difficult for any consumer to get healthcare paid for by complex mixtures of state bodies and insurers, that it may effectively kill the concept.
Part two of the plan is that the 27 health ministers gets so tangled up in details, and with several countries facing pressure on health expenditure due to economic problem wanting to avoid anything that adds to costs, that the proposal fails due to inaction and neglect.
Most countries are staying quiet on whether they are for or against the original directive, and /or for or against the Spanish plan. This is complicated by changes in the ruling party in some countries, even since last year. The UK’s Labour administration was firmly behind both Spain’s antagonism to the proposal and the concept of complexity making it unworkable, but the attitude of the new Conservative-LibDem coalition is as yet unknown.
Portugal, Poland, Greece and Romania are known to have supported Spain last December in opposing the original proposals to legislate along the lines laid down by the court as tabled by the European Commission in 2008.
Health authorities and politicians in other EU countries are known to support Spain simply because they feel that their patients should use their own domestic system, and there are reports that as many as 15 EU health ministers agree with the latest Spanish suggestion.
Portugal, Poland, Greece and Romania are known to have supported Spain last December in opposing the original proposals to legislate along the lines laid down by the court as tabled by the European Commission in 2008.
Health authorities and politicians in other EU countries are known to support Spain simply because they feel that their patients should use their own domestic system, and there are reports that as many as 15 EU health ministers agree with the latest Spanish suggestion.
The main problem with the original proposal is that it attempts to reconcile vastly different healthcare systems. Britain mostly relies on its state-run National Health Service to deliver procedures, while the Netherlands relies on a network of private insurers, and in Spain their health system is administered by the regions, which have trouble dealing with each other, let alone foreign providers. In theory, the cross-border healthcare directive is on the agenda for approval in June, but in practice, the process looks like running for months, if not years, before any conclusion.
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