MEP warns of growing threat of patient mobility

Abstract

Several recent European Court rulings state that national health systems must pay for their citizens' health care abroad if appropriate treatment cannot be provided at home within a reasonable time. Will this push more patients to seek medical help abroad? Pelle Neroth reports. Several European Court of Justice (ECJ) rulings could throw European health care into disarray, by allowing Europeans to travel abroad freely for health care, without prior authorisation, and to charge the cost of this treatment back to their own health systems. More and more continental Europeans are taking advantage of the rulings to enjoy health care abroad. It represents an enormous, exciting expansion of patients' rights and consumer choice. For fundholders, however, the prospects are mixed: on the one hand, it represents an opportunity to save money, if patients go abroad to countries where health care is cheaper. On the other, it represents a loss of control, as fundholders cannot monitor the standards of foreign care providers, nor can they control the conditions or frequency under which the care is sought. It is the sort of “Anglo-saxon” freedom that, had the issue been part of the French referendum debate on the constitution, would probably have resulted in an even more emphatic “non”. The French would have realised they face competition not only from “Pawel the Polish plumber”—the mythical hate figure of the no-campaign for the cheap labour competition he represented—but “Pawel the Polish surgeon”. Ironically, for a time in which European politics is consumed by the ramifications of the French and Dutch referendums, this freedom has nothing to do with the proposed EU constitution because ECJ rulings are always binding on all member states. These new health-care freedoms have arisen out of several ECJ cases involving EU nationals seeking care in other EU countries during the past few years. Following refusals from national health-care systems to reimburse care enjoyed abroad, the ECJ determined that national health-care providers who don't pay up are acting as a barrier to free competition to provide services—a basic EU right. However, in order to allow national social-security systems some control over their budgets, any hospital care sought abroad still has to be preauthorised. In the UK, this means patients must still get the green light from a consultant and their primary-care trust to receive treatment abroad, a situation that is very similar to the current E112 scheme for which authorisations to go abroad are rarely granted. That still leaves free dentistry, spectacles, and other possible day-care treatments available abroad without authorisation, for which the cost can be charged back to the NHS up to the level equivalent to UK rates. Crucially, authorisation for hospital care cannot be refused if the national health-care system cannot show that care can be provided domestically within a reasonable waiting time. This provision is sure to provoke dispute. The NHS, for instance, is likely to argue for a reference point of what are reasonable waiting times based on the national average. The ECJ has ruled that the patient's medical condition must be the only factor of consideration. The impact could be revolutionary: it sets out European-wide standards irrespective of national targets for what health-care systems have to achieve, because if national health providers don't meet these standards, they risk being charged for sending the patient abroad for health care. From the point of view of health systems, the spectre of even less control looms on the horizon. There is no European statute legislation on this issue, and rulings are advancing based on ad-hoc decisions of the ECJ. The conservative MEP John Bowis recently wrote a report for the European parliament urging the European Commission—the policy-writing body of the EU—to make a framework proposal on patient mobility to rein in what he describes as the ECJ's “rampantly activist instincts”. In the absence of statute rules on this area of medicine, there are fears that the ECJ may define very narrowly what is unreasonable waiting time, or reduce the definition of what is hospital care to overnight stays, so that daytime visits to foreign hospitals do not require authorisations. Bowis has even suggested the ECJ may abolish all authorisation requirements, even for hospital care. He admits that the Commission's failure to spell out exactly what patients rights are—it cannot reverse ECJ rulings, but can define a limit against further extension of patients' rights—could arise because people don't want to draw attention to the ECJ rulings by enshrining it in legislation. Bowis said: “One or two member states are really trying to hide this, pretending that nothing is happening.” One senses he is being diplomatic, and that one of these states is the UK.