Directive on patients’ rights in cross-border healthcare

1. Directive on patients’ rights in cross-border healthcare DG SANCO Unit D2 Healthcare systems

2. EU law on healthcare since early 1970s: social security Regulations • - Primarily co-ordination between systems • - Unplanned healthcare (EHIC) • - Possibility of referral to other EU Member State (MS) (E112 / S2) • - Prior authorisation system; authorisation of E112 / S2 can't be refused where "undue delay" applies • - Payment dealt with between health systems

3. European Court of Justice jurisprudence 1997 - 2006 • - Healthcare is a service within the meaning of the EU Treaty • - If a patient is entitled to a treatment at home he or she is entitled to reimbursement for that treatment abroad • - Reimbursement is up to cost of that treatment in home system • - For some treatments (“hospital” care), health systems may require patient to seek “prior authorisation”

4. Provisions of Directive 1: patient entitlements • - Patients have right of reimbursement when they receive healthcare in another EU MS • - Level of reimbursement up to cost of treatment at home • - Quality and safety standards / legislation of MS of treatment applies

5. Provisions of Directive 2: prior authorisation • - Prior authorisation possible for a) overnight stay; b) highly specialised healthcare ("hospital care") • - Authorisation may be refused if no "undue delay" • - Authorisation processes must be reasonable, "properly reasoned"

6. Provisions of Directive 3: National Contact Points • - Each MS must set up a National Contact Point (NCP) • - NCPs tell outgoing patients about: rights; entitlements; reimbursement; appeal processes • - NCPs tell incoming patients about: quality and safety standards and systems; complaints and redress procedure

7. Provisions of Directive 4: prices, access, information, prescriptions • - Healthcare providers must provide information on: treatment options; quality and safety; prices; authorisation status; insurance / liability cover • - Patients should have access to care on basis of non- discrimination; providers must apply same scale of fees as for domestic patients • - Directive introduces cross-border prescriptions to help patients moving across borders

8. Summary of rules post 25 Oct 2013 • - "Non-hospital care" in domestic basket of benefits: Directive without prior authorisation or apply for authorisation under Regulations • - "Hospital care" in basket of benefits: authorisation under Directive or Regulations (may be refused if no "undue delay") • - Care not in basket of benefits: referral under Regulations

9. Provisions of Directive: rare diseases • - Prior authorisation: may seek specialist view • - Awareness-raising of EU-level diagnostic tools; possibilities for E112 / S2 referrals • - Political encouragement rather than legal obligation

10. Co-operation between health systems • - Recognition of prescriptions • - European Reference Networks • - Health Technology Assessment • - eHealth

11. Thank you! Further information: http://ec.europa.eu/health/cross_border_care/policy/index_en.htm