OPENING THE DOOR TO BETTER HEALTHCARE ACROSS EUROPE

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• OPENING THE DOOR TO BETTER HEALTHCARE ACROSS
  EUROPE
• Proposal for a Directive on
• Patients rights
• in cross-border healthcare
• Royal College of Physicians
• London
• 16 October 2008
• B. Merkel, Head of Unit
• DG SANCO C5

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Aims of Initiative

• Help patients to exercise their right to
  reimbursement for health treatment in any EU
  country (cross-border healthcare)
• Provide assurance about safety and quality of
  cross-border healthcare
• 3. Foster cooperation between health systems to
  improve healthcare for all

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Why cross borders for healthcare?

• Patients prefer to be treated as close to home as
  possible
• Sometimes healthcare patients need is better
  provided abroad
• closer to home
• (in border regions)
• lack of capacity
• specialised care, rare diseases

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Size of Cross border mobility

• Patient mobility is limited (currently 1 of
  public health spending)
• but larger in certain frontier regions

• This doesnt count the situations when the
  citizen decides to pay for healthcare himself
  many people do not know they have a right to be
  reimbursed

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Background

• ECJ rulings on patient mobility (since 1998)
  under free movement
• Removal of healthcare from Services Directive
  (2006)
• EP and Council called for a specific health legal
  instrument
• Council conclusions on Common values and
  principles in EU health systems (2006)
• Public consultation (2006-2007) Impact
  Assessment (2007)

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Key Starting points for EU action

• Values
• Common values and principles of EU health
  systems universality, solidarity, access to
  good quality care and equity
• Patients
• Free movement rights for patients established by
  the ECJ
• Subsidiarity
• Respect for Member States responsibilities for
  organisation and delivery of healthcare
• No harmonisation
• Social Security Regulation (1971)
• Urgent care in another MS with European Health
  Insurance Card
• Planned care prior authorisation granted where
  there is undue delay

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1. Helping patients to access cross-border
healthcare

• For non hospital care right to seek healthcare
  in another MS without prior authorisation and be
  reimbursed ( eg dental care, medical
  consultations)
• For hospital care MS may choose to introduce a
  system of prior authorisation if system faces
  risks
• Clear rules on reimbursement up front payment
  with reimbursement at home up to the level for
  the same or similar treatment in the home system
• Procedural guarantees, i.e. fair and quick
  procedures and right to ask for a review of any
  administrative decision,
• Information available to patients to make
  informed decisions - national contact points.

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2. Ensuring Safer and Better Quality Cross-border
care by clarifying responsibilities

• MS where treatment takes place is responsible for
  assuring
• quality and safety of care
• information and assistance to patients
• redress and compensation for harm
• protection of privacy and personal data
• equitable treatment of patients from home country
  and from other Member States including protection
  against discrimination.
• Arrangements should be transparent monitoring
  systems in place

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SAFEGUARDS TO ENSURE A FAIR AND EQUITABLE SYSTEM

• For Patients
• All patients will have
• Clarity about what they can get reimbursed and
  how
• Information about healthcare in other countries
• Assurances about quality and safety of care
• Assurances about getting help and compensation,
  if needed

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SAFEGUARDS TO ENSURE A FAIR AND EQUITABLE SYSTEM

• For Health Authorities
• They pay out no more than they would have for
  treatment at home
• They pay out only for treatment they would pay
  for an home
• The rules of the home system apply for people
  going abroad eg gp gatekeeper
• They set the rules for care in their country
• If there is a risk to their system they can
  introduce prior authorisation for hospital care

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3. Fostering cooperation between healthcare
systems to improve healthcare for all

• Efficient use of resources
• strengthening eHealth and improving
  interoperability
• European Reference networks (to share expertise
  and innovation on specialised care)
• Sharing efforts on Health
• Technology Assessment

• Easier recognition of prescriptions issued in
  other MS
• Information on cross-border flows for planning

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So What will be the impact?

• SO WHAT WILL THE IMPACT BE?
• Patient-mobility remains limited but impact for
  individual patients is high
• No significant impact on national budgets

• Quality and safety of cross-border care improves
• More clarity for all about rules for
  reimbursement of care
• Patients have new options to access the care they
  need

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Next steps

• Proposal adopted by the Commission on 2 July 2008
  as part of a  Renewed Social Agenda Package  -
  available in all languages - in co-decision
  procedure.
• Implementing measures to be adopted by a new
  comitology committee

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• Thank you!