| Author (Person) | Chapman, Peter |
|---|---|
| Series Title | European Voice |
| Series Details | Vol.10, No.27, 22.7.04 |
| Publication Date | 22/07/2004 |
| Content Type | News |
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By Peter Chapman Date: 22/07/04 EU CITIZENS should not be able to "make a profit" or stay in hotels at taxpayers' expense when they travel abroad for health care, the European Commission pledged this week. The promise is part of Commission internal market chief Frits Bolkestein's bid to persuade sceptical member states to accept the inclusion of health care in a new directive aimed at cutting barriers to the EU's multi-billion euro market for services. European Voice understands that Bolkestein has tabled a raft of amendments designed to make it clear that citizens will not have a blank cheque when they exercise their rights to travel abroad more freely to have surgery or health check-ups in another country. In a paper sent to diplomats who will discuss the proposals tomorrow (23 July) Bolkestein suggests changes to Article 23 of the law that would strictly limit the amount of money that national health systems or insurance schemes would have to pay out. "It could be made clearer that a patient cannot make a profit when receiving treatment abroad and that his right to assumption of costs is always limited by the actual costs incurred," said the paper, drawn up by aides to the commissioner. "It could be specified," Bolkestein's team admits, "that Article 23 does not require member states to reimburse travel and accommodation costs and that this issue is dealt with at national level." The Dutchman has a difficult task winning member states over: a majority of governments currently oppose the plan, arguing that health care is too closely entwined with public policy to be treated in the same way as other sectors - from hairdressing to massage. The biggest opponents include France, Belgium, Denmark, Hungary, Spain, Sweden, the Czech Republic and the UK. Other states with major problems are Ireland, Portugal, Italy, Poland, Finland and the Netherlands. A British source said: "We support the directive more generally. We think it would get rid of red tape and make the internal market for services a reality. "But what we are going to argue is that the scope of the directive should not include health. This is because you can have health provided privately or by member states' governments - and it is that distinction between private and public that causes the problems," she said. Bolkestein, who has already faced flak from trade unions across the EU for other parts of his proposals, argues that the inclusion of health care is mainly codifying rights set out by the European Court of Justice (ECJ) in a series of cases concerning patients travelling abroad for treatment. He points out that it would also complement a 33-year-old regulation that deals with the paperwork in cross-border health cases. Inserting health care in the directive clarifies the rights of citizens and the obligations of governments and the industry. Crucially, he believes it increases the chance that member states will abide by the ECJ's rulings and lessens the need for expensive court cases. The EU executive points out that relatively few countries have responded to court cases by changing national laws. Under the proposed directive, governments are obliged to issue a formal authorization to patients awaiting hospital treatment to travel abroad under certain, urgent, circumstances. To qualify, the treatment, such as a hip replacement operation, would be available normally in the home country but unavailable to the patient "within a time frame which is medically acceptable in the light of the patient's current state of health and probable course of the illness". If these criteria are met, the citizens' own health system would reimburse the travelling patient to the same level as a patient in the country where the hospital is situated. If the health system in the country is less generous, the patient would be entitled to a top-up to make sure he or she does not lose out by travelling abroad. The same benefits extend to 'non-hospital' treatment where the patient has been granted specific authorization by his or her health system to seek care in another country. This could be for a consultation with a specialist or a consultant doctor, where an overnight stay in hospital is not deemed necessary. The directive also states that citizens are free to travel to another country for non-hospital care without prior authorization from their national authorities. But in this case, the patient's national health system would only have to reimburse the same amount towards the cost of care as it would to a patient receiving treatment at home, which could be less generous. In his list of suggested amendments, however, Bolkestein suggests making it clear that the authorities in the patient's own member state have the right to decide whether or not a particular treatment is deemed as hospital care or not. Moreover, Bolkestein suggests tweaking the law to take into account countries that offer 'benefits in kind' health care and do not operate reimbursement systems. These states, such as the UK, would be able to set reimbursement levels for treatments normally provided in kind. The European Commission is trying to convince Member States that healthcare should be included in a proposed directive aimed at cutting barriers in the EU's services sector. |
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