Patients' rights to treatment abroad will be strengthened under new EU proposals. However, it could take years before they are implemented, writes Carl O'Brien, Social Affairs Correspondent
WHEN RTÉ's Tommie Gorman featured in a documentary on his battle with cancer several years ago, he could never have realised the impact it would have.
There was his moving personal story, a scene where he asks a consultant for his prognosis not knowing what the answer will be; the emotional farewells to staff at a Swedish hospital that probably saved his life. But the biggest impact was his highlighting of the little-known E112 form, an EU measure designed to provide patients with cost-effective, meaningful treatment in the public hospital system of another member state.
For many, it was the first time they realised that hospital treatment was not necessarily confined to Ireland's often patchy and relatively underdeveloped health system. Today, significant numbers are going abroad for specialist treatment and even the national treatment purchase fund pays for certain operations outside the State.
The measure, however, has its limitations. The rules on obtaining healthcare abroad are far from clear, and patients are generally unaware of what they are entitled to. Patients must also have the support of an Irish consultant and their local health board in order to get treatment which is not typically available at home.
Gorman, for example, had to arm himself with wads of uncontradictable information about the need to travel Sweden for specialist treatment before getting the green light to travel.
Under new proposals from the European Commission, however, the process of getting treatment abroad will get a lot easier. Last week it announced that patients in the EU will be able to receive treatment in other member states without needing approval from their own health authorities.
While patients would have to pay for treatment upfront, they would be assured of repayment up to the level of the cost of the treatment under their national health system.
The proposals will only cover treatment that is available in a patient's home country. For example, an Irish woman would not be able to get an abortion abroad and have it paid for by the Health Service Executive (HSE).
The plan follows years of legal cases in which European Court judges have ruled that the freedom to cross EU borders for treatment should be a right for all.
The new measures - expected to come into force by 2010 - may have a significant impact on the health system in Ireland, especially in Border areas and in areas of the health service where there are long waiting lists.
In a health system still struggling to cope with MRSA, and where long waiting lists persist for many procedures, the temptation to go abroad and hit the HSE with the bill will be tempting for many.
It won't, however, allow patients to make a profit by going to cheaper countries to have procedures done and then getting compensated by the HSE. For example, if an Irish patient wants a hip implant done in Spain, he will have to pay for the operation up front. If the cost exceeds the HSE price, the patient will have to pay the difference. If the cost is less, then the operation will have cost the HSE less than if the patient stayed at home - and they will have reduced the queue by one.
Meanwhile, European Commission officials are eager to play down the impact the new measures will have on the health systems of countries such as Ireland.
They point to figures which slow that just 4 per cent of patients in the EU go abroad for treatment at present, due mainly to the hassle of transport.
They also say that the draft directive does not confer any new rights on EU citizens to become health tourists. Nor does it impose any new costs on health systems.
It simply says what is already EU law, though now codified in a far more comprehensive fashion: people have the right to travel and to have treatment abroad. If they do so, they will be reimbursed by the exact amount that their treatment would have cost in their home country (unless the treatment was cheaper in the country in which they chose to have it done).
Also, in a concession to governments such as Ireland which have expressed concern over the move, the proposals include an "emergency brake", giving member states the power to restrict the rights of pa-tients if a major outflow threatens to undermine domestic health systems.
Nevertheless, the new system will be much clearer and will remove much of the doubt that exists at present. And, perhaps most importantly, patients will not need the permission of their health authority.
"This proposal aims to clarify how patients can exercise their rights to cross-border health care and have safe, high-quality care when they do so," said European health commissioner, Androulla Vassiliou. "At the same time, it provides legal certainty for member states and healthcare providers about who is responsible for what, and promotes cooperation between health systems to provide better access to specialised care."
While officials have lauded the measure as an example of how the EU can improve the lives of its citizens, few have been able to say when the new measures will come into force. Negotiations are expected to conclude within 18 months to two years and member states will then have another year to implement the new rules, meaning they should become law sometime in 2011.
How treatment abroad will work
• As long as a treatment is covered under their national healthcare system, patients will be allowed to receive that treatment in another EU country and be reimbursed without prior authorisation.
• For hospital care however, under certain circumstances, a member state may decide to introduce a system in which patients require an administrative prior authorisation beforehand.
• The patient will have to pay the costs abroad upfront, but will receive reimbursement afterwards up to the cost of the same or similar treatment in their national health system.
• Applications, including the reimbursement of costs, will be processed fairly and without delay. Patients will have the right to ask for a review of any administrative decision.
• All relevant information on cross-border healthcare will be available through national contact points.
• It will be made easier for patients to use a prescription they received abroad in their home Member State.
• Patients can be confident about the standards of healthcare abroad, which are guaranteed in the same way as for domestic patients.
• The country where treatment is provided is responsible for clinical oversight.