What is the significance of the Cross Border Healthcare Directive?
Accessing Planned Healthcare in another State What is the significance of the Cross Border Healthcare Directive? On 25th October 2013, the Cross Border Healthcare Directive 2011/24/EU came into force throughout the EU.
The Directive is designed to clarify patients' rights to access safe and good quality treatment across EU borders, and be reimbursed for that treatment. Patients travelling to another EU country for medical care should enjoy equal treatment with the citizens of the country in which they are treated. If patients are entitled to that healthcare at home, then they will be reimbursed by their home country. Their reimbursement will be up to the cost of that treatment, if obtained at home. In some cases, patients may need to seek authorisation before travelling for treatment, in particular if the treatment requires an overnight stay at a hospital or highly specialised and cost-intensive healthcare.
How does the Cross Border Healthcare Directive dovetail with existing provisions on obtaining health or medical care in another Member State under Regulations 883/2004/EC and 987/2009/EC?
If you are travelling temporarily to another Member State of the EEA or to Switzerland, and you require necessary medical care in that State, you can still rely on your European Health Insurance Card to obtain the medical care that you require during that temporary stay.
You can still apply for prior authorisation for planned medical care under Regulation 883/2004/EC. This authorisation cannot be refused if you cannot be treated in your home country within a time limit which is medically justifiable. It is important to note that in Ireland, treatments that qualify for funding under the E112 Treatment Abroad Scheme (under the social security Regulations) are excluded for reimbursement under the CBD. Before applying for authorisation under either scheme, you should satisfy yourself that you are making the application under the correct scheme. To obtain advice, you should contact the Treatment Abroad Scheme office on 056 778 4551 or the Cross Border Directive Office on 01 620 1668 in Ireland.
What is the added benefit of the Cross Border Directive over existing provisions on obtaining healthcare abroad under the social security Regulations?
First the Directive covers all healthcare providers in the EU and is not limited to public providers. Second, prior authorisation will not be required in all cases as is currently the case for planned medical treatment under the social security Regulations. As a patient, you should be able to receive sufficient information to enable you to make an informed choice prior to making a decision to obtain treatment in another State. National contact points have been established to assist and advise patients on their options under the Directive. The HSE has established a National Contact Point (NCP) office for the administration of the Cross Border Healthcare Directive in Ireland.
The contact details for this NCP are: National Contact Point, Cross-Border Healthcare Directive Department, HSE Overseas Section, Stewarts Hospital, Mill Lane, Palmerstown, Dublin 20 Tel: 01 620 1668 Email: firstname.lastname@example.org
When is prior authorisation from my national authority required under the Directive to receive treatment in another State?
National authorities are permitted to introduce a system of "prior authorisation" for going to another Member State for treatment in 3 cases:
- For healthcare which involves overnight hospital stay of at least one night
- For highly specialised and cost-intensive healthcare
- In serious and specific cases relating to the quality or safety of the care provided by the particular provider in question
If you are subject to Irish legislation, you will require prior authorisation from the HSE in all the above cases.
Can this authorisation be refused?
National health authorities can refuse authorisation if the treatment in question, or the healthcare provider in question, could present a risk for the patient. If the healthcare can be provided at home within a medically justifiable time limit, then authorisation can also be refused. However, Member States will need to explain why such a decision is necessary, and will need to base their assessment of what is "medically justifiable" on your individual case.
What if I am refused authorisation?
Patients have the right to request a review of any administrative decision on cross-border healthcare for their individual case.
How much will I be reimbursed after receiving a treatment abroad?
Patients will be reimbursed the same amount as they would receive in their own country for the same type of healthcare. Member States where care is free at the point of delivery will need to inform patients about their reimbursement tariffs. If the treatment abroad is cheaper than in the home country, the reimbursement will reflect the real price of the treatment.
Can I seek healthcare abroad if the treatment is not available in my country?
Yes, but you will only be entitled to reimbursement if it falls within the "basket of benefits" you are entitled to according to the legislation or rules of your home country.
In Ireland, any service which is provided by the public health services in Ireland can be availed of under the Cross Border Directive (CBD), for example
- acute/psychiatric hospital services – day, inpatient, outpatient care,
- community based outpatient care e.g:
- dental/orthodontics services (some exceptions i.e. dental screening services in schools)
- speech & language services o occupational therapy services (some exceptions i.e. assessment for aids at home)
- psychology services o physiotherapy services o disability services
- methadone programme o ophthalmic (eye tests etc) services
- mental health services
Do I need to pay for cross-border treatment upfront?
Yes, generally the patient pays upfront and is then reimbursed by their national authority as quickly as possible.
What should I do if something goes wrong whilst receiving treatment abroad?
The National Contact Point will be able to explain your rights and give information on the regime applicable in the country of treatment. Your home country is obliged to provide you with the same follow-up treatment it would have provided had the treatment taken place on its territory.
How can I be sure that the treatment I received abroad will be followed up properly on my return home?
Your home country has an obligation to ensure that the medical follow-up is of the same quality regardless of where in the EU the treatment took place.
Will my prescription be recognised in another EU Member State?
A prescription issued in another EU country should be recognised in a patient's country of residence and vice versa. This ensures that the healthcare provided in another EU country is properly followed-up on the patient's return home. The patient is entitled to obtain the prescribed medicine provided that the medicine in question is authorised for sale and available in the country where he or she wishes to have the product dispensed. Although these principles are not new, in practice getting prescriptions recognised can be difficult. Although it will not solve the problem overnight, the provisions of the Directive should greatly increase the ability of pharmacists to understand and dispense prescriptions issues in another Member State.
What information must be included in a prescription to ensure that the medication referred to can be obtained outside the Member State which issued it?
To be eligible for cross border use, the prescription must comply with the Annex to Directive 2012/52/EU. The name and surname of the prescribing professional must be set out together with their professional qualifications; their direct contact details; their work address and signature. The prescription should also include the date of issue; the patient’s name and surname; date of birth and information on the product prescribed. In relation to information on the product prescribed, the common name of the product should be provided (Directive 2001/83/EC); the brand name; the pharmaceutical formulation (tablet, solution, etc), quantity; strength and dosage regime.
Where can I find further information on my rights in Ireland to obtain healthcare abroad?
You can obtain further information on obtaining healthcare abroad through the following website of the HSE - http://hse.ie/eng/services/list/1/schemes/cbd/acchealthcareabroad/