An EU plan on health tourism is expected to open up competition between member states’ national health services in a major step towards an open market for public healthcare.
Patients will be able to forgo the NHS and instead go abroad to an EU state for treatment there – funded by the European taxpayer.
According to a draft of the EU directive on cross-border healthcare, a national health service will be obliged to fund outpatient treatments in Europe, such as scans and minor operations, if the patient was referred by a medical professional and is suffering delays.
But national services will able to refuse to fund major operations such as joint replacements or serious dental operations if they can argue that domestic services will suffer as a result.
The European Court of Justice had ruled, in a number of landmark cases, on patients with chronic pain for whom waiting time for treatment in another EU country was much longer than in their home country, such as the Yvonne Watts case; and patients who buy refundable medical aids, such as spectacles, in another EU member state where they are cheaper, such as the Nicolas Decker case.
In both cases, the Court ruled in favour of free choice for patients.
The downside is that the national healthcare system may find itself having to pay more cash if patients are reasonably delayed for too long and are given the right to look for alternative healthcare abroad.
The draft directive specifies that if the appropriate care for the patient’s condition cannot be provided in their own country “without undue delay, then they will be authorised to go abroad, and any additional costs of treatment will be covered by public funds.”
For smaller member states the financial impact may be more significant. In Luxembourg, up to 7% of the healthcare budget is spent on cross-border care. It could also be impossible to provide some forms of highly specialised care in member states like Cyprus and Malta, where patients are instead sent abroad in an organised manner to receive these treatments.
The key princples of the directive are that patients should at least receive health care similar to what they would have been entitled to in their home country. Patients’ home countries should carry the cost for health care abroad up to at least the price they would have been charged had the patient been treated at home.
Member states should also provide all the relevant information “to enable informed choices by patients” concerning availability, prices and outcomes of the health care they provide. This concerns in particular the question of liability and procedures to be followed in the event of medical malpractice.
Dr Frank Portelli, chief executive of private hospital St Philip’s claims thousands of patients are kept on state hospital waiting lists for years, some actually dying in the process.
“State health has failed to provide prompt treatment for patients who are in pain, particularly surgical treatment for chronic conditions such as joint replacement. Many patients feel that treatment delayed is treatment denied. And this is what the EU is all about – freedom of movement of goods, services, and in this case medical services.”
He added that if the directive is passed, this could lead to countries with inefficient health services to ‘bulk buy’ treatments with their EU counterparts.