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Plans to lay down clearer rights for patients to seek healthcare in another Member State - and be properly reimbursed - were beefed up by Parliament's Public Health Committee on Wednesday. These rights have been confirmed by European court rulings but are not yet enshrined in EU law. MEPs also want patients to be properly informed about their rights when being treated in another Member State.

If a form of treatment is covered under their national healthcare system, patients will as a rule be allowed to receive that treatment in another EU country, stresses the committee. They will also be reimbursed without prior authorisation up to the level they would have received in their home country. If a Member State refuses to reimburse a treatment, a medical justification for that decision has to be given.

The legislation is about patients and their mobility within the EU. "The challenge is to enable access to and reimbursement of cross-border healthcare for all European patients. It is very important that Europe gives a clear reply to the patient who wonders if his care is reimbursed when he needs to cross the border. Today, the European Parliament wished to avoid the risk of legal uncertainty for the patient, stating clearly the cases where a Member State may refuse a reimbursement or the right to seek treatment abroad", said Françoise Grossetête (EPP, FR), whose second-reading draft report was adopted by 47 votes to 2 with 1 abstention by the EP Environment and Public Health Committee.

Home state to pay bills directly if notified in advance

Since the proposed rules would in practice mean that patients need to pay in advance and get reimbursed only later, MEPs added a provision that Member States may offer their patients a voluntary system of prior notification, whereby, in return for such notification, the reimbursement would be made directly by the Member State to the hospital providing the treatment.

The directive does not, however, change the right of Member States to define the benefits that they choose to provide and if a Member State does not include a particular treatment as part of the entitlement of their citizens at home, no new entitlements for patients are created.

Prior authorisation for hospital treatments

The committee agrees with the principle that for hospital and certain forms of highly specialised care Member States may introduce a system requiring prior authorisation if the financial balance of the Member State's social security system or the viability of the health system could otherwise be seriously undermined. MEPs also agree with the Council that the Member States, not the Commission, must decide which treatments should require prior authorisation. They say that the prior authorisation requirement must not create an obstacle to the freedom of movement of patients.  The committee also narrowed down the list of reasons for which a patient can be refused authorisation for cross-border treatment.

Extra attention to people with rare diseases

MEPs added special rules for patients with rare diseases, saying that "patients affected or suspected to be affected by rare diseases have the right to access healthcare in another Member State and to receive reimbursement even if the diagnosis and/or treatment in question is not provided for by the legislation" of the home Member State. Such treatment shall, however, be subject to prior authorisation.

National contact points to provide information to patient

The Public Health Committee backs the idea that in all Member States national contact points should be established to give patients relevant information upon request, such as treatment options, information about a specific healthcare provider, the level of reimbursement or the possibility of redress in the event of any harm caused by the treatment. Such information must also be accessible electronically. Furthermore, MEPs say national contact points should cooperate closely with each other and with the Commission and that citizens should be made aware of the existence of such contact points.

Long-term care and organ transplantation excluded

MEPs supported the Council's view that long-term care, organ transplants and vaccination campaigns should be excluded from the directive. They also want sales of medicinal products and medical devices via internet to be added to this list.

€10 billion per year spent on cross-border healthcare

On average 1% of public healthcare budgets or about €10 billion per year is spent on cross-border healthcare. According to a Eurobarometer study, 4% of Europeans received medical treatment in another EU Member State in 2006-2007. Cross-border healthcare is more frequent for the treatment of rare diseases and in border regions, smaller Member States and areas with large numbers of tourists.

Plenary vote scheduled for 18 January 2011

Jana JALVI-ROBERTSON

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