The EU framework on patient mobility

Presentation by: Bigyan Ojha

Outline of presentation

• Patient mobility; overview

• EU directive; scenario

1. State of play of transposition

2. Use of prior authorization

3. The level of patient mobility

4. Reimbursement practices

• Importance of EU directive for patient

• Challenges

• References

Patient mobility; overview

• The EU Directive 2011/24/EU on the application of patients’ rights in

cross-border healthcare creates a legal framework for the patient’s right

to seek healthcare in another member state and to benefit from cross-

border healthcare services.

• Cross-border healthcare codifies the main principles of the case law

established by the European Court of Justice (ECJ) related to cross-

border healthcare.

Contd…

• Patients who are entitled to a particular health service, that is among

the benefits provided for under the statutory healthcare system in their

home country (Member State of affiliation), are entitled to be

reimbursed for the same service if they decide to receive it in another

member state.

• However, the level of reimbursement can never exceed the actual costs

of the healthcare received.

EU directive; scenario

o Directive 2011/24/EU1 came into force on 24 April 2011.

o It was due to be transposed by Member States by 25 October 2013.

o European commission prepared and submitted report on operation of

directive to european parliament and to the council by 25 october 2015 and

every three years thereafter.

o The report includes;

1. state of play of transposition,

2. use of prior authorisation,

3. the level of patient mobility,

4. reimbursement practices.

1. State of play of transposition

• Infringement proceedings were launched against 26 member states on

the grounds of late or incomplete notification of such measures.

• As of 1 July 2015, four infringement proceedings remained open, and

all four member states concerned had made firm commitments to

address the outstanding issues.

• The next stage for the commission is to assess whether member

states have transposed the directive correctly.

2. Use of prior authorization

• Member states can require patients to seek prior authorization for

certain treatments as below;

• For healthcare which involves overnight hospital stay of at least one night

• For highly specialized and cost-intensive healthcare

• In serious and specific cases relating to the quality or safety of the care provided by the

particular provider in question

• A prior authorization can be refused e.g. if the patient can be offered the

treatment in the member state of affiliation within a time limit which is

medically justifiable

3. The level of patient mobility

• Patient flows for healthcare abroad under the directive are low.

• Of the 21 Member States who introduced a system of prior

authorization, 17 were able to supply data on numbers of requests

for authorization specifically under the Directive.

• It seems to be due to low numbers of claims rather than large

numbers of refusals: the available data suggests that roughly 85 %

of reimbursement claims are granted.

4. Reimbursement practices

• The reference point for reimbursement for cross-border healthcare

should be the amount borne by the system when that particular

healthcare is provided by a public or contracted healthcare provider in

the member state of affiliation.

• Some states has provision of ‘gatekeeper’ structure, where a referral

from a GP or family doctor is required for a patient to access specialist

healthcare as well as to be reimbursed in another member state.

Offers additional possibilities for patients to obtain healthcare abroad

It provides a minimum set of patients' rights

It requires Member States to provide clear information to patients on their rights and options

Provides a legal basis for European collaboration in the fields of health technology assessment, eHealth, rare diseases, and safety and quality standards

Importance of EU directive for patient

Challenges

• Providing clear rules and reliable information : less than two in 10 EU

citizens are informed about their rights in this area, and only one in ten

knows role and responsibilities of National Contact Points

• Meeting patients' expectations

• Ensuring EU countries work closer together

• Clearing up years of legal uncertainty.

References• Bermejo, D. C. (2014). Cross-border healthcare in the EU: Interaction betweenDirective 2011/24/EU and the Regulations on social security coordination. Paperpresented at the ERA Forum.

• Costigliola, V. (2011). Mobility of medical doctors in cross-border healthcare. EPMAJournal, 2(4), 333.

• Legido-Quigley, H., Glinos, I. A., Baeten, R., McKee, M., & Busse, R. (2012). Analysingarrangements for cross-border mobility of patients in the European Union: a proposalfor a framework. Health Policy, 108(1), 27-36.

• Quinn, P., & De Hert, P. (2011). The Patients’ Rights Directive (2011/24/EU)–Providing(some) rights to EU residents seeking healthcare in other Member States. ComputerLaw & Security Review, 27(5), 497-502.

• Rosenmöller, M., McKee, M., & Baeten, R. (2006). Patient mobility in the EuropeanUnion. Learning from experience.

• Strban, G. (2013). Patient mobility in the European Union: between social securitycoordination and free movement of services. Paper presented at the ERA Forum.

Thank you for your attention !Any Questions ?