A new EPHA report examines the progress of the implementation of the 2011 Directive on the application of patients’ rights in cross-border healthcare (2011/24/EU). Following the European Commission’s own first review of the operation of the Directive, EPHA’s report calls for actions to ensure that the Directive does not exacerbate health inequalities by only working in favour of well-to-do patients and Member States. Among other measures this will entail tailored and transparent information provision for patients regarding their reimbursement rights, improvements in the administrative processes around cross-border care, standardised indicators and working modes, and better data collection.
The Commission report on the operation of the Directive, released on 4 September 2015, reveals that some Member States appear to be deliberately complicating cross-border healthcare processes for patients. Among the often unnecessary hurdles erected by countries feature the requirement to demonstrate why it is medically necessary for a medical intervention to be received abroad, the obligation to receive specialist referral in the patient’s country of affiliation, and requests to provide sworn translations of invoices.
The Commission also found that overall, patient flows under the Directive have been quite low so far, whether for planned care (including treatments subject to prior authorisation by the affiliate Member State) or unplanned treatments. The criteria as to whether or not prior authorisation is required vary significantly between Member States, and in 14 countries it was found to be ’unclear’ what kinds of treatments are subject to it. 21 countries have prior authorisation systems in place, yet others do not use it at all at this point.
In 2014, there were roughly 40,000 requests for cross-border reimbursements among the 20 countries that reported data. Denmark topped the list with about 30,000 claims, followed by France, and Luxembourg. Clearly, these are all wealthy countries with large segments of society who can afford to go abroad and cover their own travel and accommodation costs.
As noted in the new EPHA report on the implementation of the Directive, from a health equity perspective it is worrying - albeit not surprising - that richer Member States tend to cover treatment abroad more readily than their poorer neighbours. In addition, the Commission noted that three countries are calculating reimbursements based on costs borne by private or non-contracted providers, which reduces the payments to patients as the rates are not as high as for public or contracted providers.
In terms of transparency, the incomplete data and ’inability to produce data’ detected by the Commission raises question marks about how seriously some Member States are taking the transposition of the Directive and its data collection requirements.
Regarding information about patients’ rights, one of the key points of the EPHA report on Cross-border Healthcare is that patients themselves have yet to feel or even be aware of the benefits the Directive could offer them. Fewer than 20% of patients feel sufficiently informed about their cross-border healthcare rights, and the National Contact Points (NCPs) meant to provide information on the Directive are only known to about 10%. In addition, health professionals are also not sufficiently aware of the Directive. More worryingly, there are large divergences when it comes to the performance of the NCPs and their provision of information on health and safety systems in other Member States.
Overall, EPHA agrees with the recent Opinion by the Expert Group on Investing in Health (August 2015) which argues that currently there is no ’proper home’ for European cross-border collaboration and recommends further research and better data collection, greater efforts at awareness raising and improvements in the administrative processes around cross-border care. Moreover, current coverage gaps should be closed to make cross-border care less burdensome, e.g. for parents accompanying their children.
Crucially in the context of austerity policies affecting the EU health sector, EPHA would like to see the EU explore how cross-border healthcare provision could be deployed as a solidarity tool to decrease health inequalities.