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Q&A: EU healthcare proposals

2 July 08 19:02 GMT

Patients in the EU may in future choose to shop around Europe for the best and quickest medical treatment, under proposals presented by the European Commission.

The proposals will be subject to lengthy discussion and probably changes before becoming law.

Why has the Commission unveiled this package now?

The Commission says there has been too much uncertainty about cross-border healthcare rights in the EU. The European Parliament and EU governments wanted clarity on this issue, the Commission says.

The new draft directive follows European Court of Justice rulings confirming the right of EU citizens to seek healthcare in other EU member states and get reimbursed at home. The first such ruling dates back to 1998. The Commission's package was originally meant to be announced in December 2007, but Commission President Jose Manuel Barroso decided more work was needed, and now it is part of a wide-ranging social rights initiative called the "renewed social agenda".

Doesn't this package encourage "health tourism"?

The Commission insists that patients will be reimbursed only up to the cost of equivalent treatment that could be provided at home. So if their treatment abroad costs more, they will have to pay the difference themselves. Moreover, treatments not covered by their home health insurance scheme will not normally be reimbursed.

The exception is when they require specialist treatment that is only available in another country. So UK citizens will not be able to claim for expensive spa therapy they received in Germany, for example. In most cases, cosmetic surgery will not be covered either.

According to the Commission's surveys, only about 1% of healthcare budgets is spent on cross-border healthcare annually and the vast majority of patients prefer to get treatment in their own country. For all these reasons, the Commission argues, there is unlikely to be a boom in "health tourism" in the EU.

Who is most likely to benefit from healthcare abroad?

People who live in border regions, where a specialist clinic may be in a neighbouring country, will benefit. In small EU countries like Malta, patients are sometimes referred for specialist treatment in bigger countries. In some countries, providing treatment for rare diseases or conditions is difficult.

Increasing numbers of EU citizens are now opting to retire in another EU country - Britons in Spain and France, for example. That trend is expected to continue because Europe's population is ageing and life expectancy is improving. So the proposals are aimed at giving them easier access to healthcare abroad.

Might these proposals encourage travel abroad for abortions or fertility treatment?

It is true that laws on abortion and fertility treatment vary greatly across the EU. But patients will not be able to claim for medical interventions that are not covered by their home health authority. The Commission believes its proposals will not trigger excessive demand for a particular treatment in a particular state.

But member states will still be able to apply an "emergency brake" if an unexpected surge in cross-border healthcare poses a serious problem: in such cases they will be able to require patients to get prior authorisation for hospital treatment abroad.

Who sets the standard for safety and quality of treatment?

The standards that apply are those of the member state where the treatment is received. So a foreigner should expect the same standard as the locals. The Commission says this has been another area of uncertainty in the past. It hopes its proposals will encourage more pooling of medical expertise across Europe, more co-operation between health systems, more uniformity of standards.

Recognition of prescriptions from country to country should improve. The Commission says that if something goes wrong, "patients will be guaranteed redress and compensation". States will also have to provide more information about healthcare available abroad.

Is there a time limit for reimbursement of costs?

No. The Commission recognises that health service structures and funding vary enormously across the EU. But it says that in cases where states require patients to get prior authorisation for treatment abroad, the wait for that authorisation should be 15 days maximum.

What has been the reaction so far?

The reaction from UK health professionals has been generally cool. The UK Department of Health says the National Health Service must be protected.

"Where UK patients choose to travel abroad for care, the NHS retains the ability to decide what care it will fund. Equally, anyone from other member states travelling to the UK specifically for healthcare will have to pay the full NHS cost of treatment upfront," a department spokesperson said.

The opposition Conservative health spokesman Andrew Lansley said "the reality is that if patients are able to exercise choice amongst a range of health providers within the UK, then EU single market rules mean that we can't treat the Channel as a barrier to competition".

Dr Peter Carter, chief executive of the Royal College of Nursing, said "the EU needs to ensure that equity is central to any further developments in cross-border care". He also called for safeguards to prevent the directive interfering with local health service planning.

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