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Kathi Apostolidis on Cross Border Healthcare Directive
- 1. The challenges of Cross-Border Healthcare Law An opportunity or a fallacy? Kathi Apostolidis – Vice President ECPC Annual General Meeting 2014 Bucharest-Romania
- 2. Patient Rights • Right to decide where to be treated • Right to obtain copy of medical records • Right to privacy • Non discrimination for cost & treatments on the basis of nationality • Right to complaint and to seek redress • Right of appeal on authorisation and reimbursement decisions
- 3. Who knows IT? Two pieces of EU legislation in validity • Regulation 883/2004 on the coordination of social security systems • Directive 2011/24/EE on the application of patient rights to cross border healthcare
- 4. Differences between the Regulation & the Directive • Regulation> Only public healthcare providers covered Directive> covers both public & private healthcare providers for both planned & unplanned care • Regulation foresees prior authorisation, which may be required under the Directive • Regulation> covers all healthcare costs incurred in another MS, • Directive> only at the cost the same services would have in the country of the patient • Directive> more support to patients National Contact Points, European Reference Networks
- 5. From declaration to reality Article 6: National Contact Points for Cross-Border Healthcare ...Member States shall ensure that the national contact points consult with patient organizations...... ... In order to enable patients to make use of their rights in relation to cross-border healthcare, national contact points in the member state of treatment shall provide them with information concerning healthcare providers,.....as well as information on patients’rights, complaint procedures & mechanisms for seeking remedies.....
- 6. Does it answer All the Questions of European patients seeking treatment abroad?
- 7. Οbligations of the member states • rules concerning the reimbursement of costs of cross-border healthcare • responsibilities of the Member States with regard to cross-border healthcare • cooperation between healthcare systems. Prior authorization What & how much is re-imbursed National Contact Points European Reference Networks Interoperability of healthcare systems for the exchange of documents
- 8. Rules on the reimbursement of costs of cross-border healthcare MS have two instruments to reduce access & re-imbursement Prior authorization Eligible cost and level of re-imbursement
- 9. Responsibilities of MS with regard to cross-border healthcare • National Contact Points • European Reference Networks
- 10. Cooperation between healthcare systems • Interoperability of European healthcare systems • ehealth • Quality and safety guidelines • Cross border care in border regions • Health technology assessment. • Need for culture of trasparency & collaboration
- 11. European citizens remarks on the Directive • Slow and non transparent transposition procedure • Non involvement of citizens’organizations • Lack of information to patients & citizens on their rights • Need for multi-language Information about the Directive and health care providers • Need for user friendly, high quality, effective & in lay language information on NCP websites
- 12. Patient organizations remarks on the Directive
- 13. How patient organisations can help improve the implementation • Get well informed • Start a dialogue with membership & other patient and citizens’ organizations • Set an appointment with the Head of the NCPs • Requested to be consulted by the NCP on issues relevant to your expertise • Propose concrete measures for improving and accelerating patient safety, quality of care, access & reimbursement
- 14. How patient organisations can help improve the implementation • Keep a record of reported issues by patients who have had cross-border care • Ask other organizations for similar records • Send your findings to the Commission • Commission welcomes feedback from patients to assess effectiveness of implementation
- 15. Thank for your attention email : kathi.apostolidis@ecpc.org @cancereu European Cancer Patient Coalition ECPCtv CHAMPIONING THE INTERESTS OF EUROPEAN CANCER PATIENTS
Notas del editor
- Good morning ladies and gentlemen, Patients and patient organizations across Europe welcomed last year the decision to make the Directive on the application of patient rights to cross border healthcare a European law . They expected that after October 25, 2013 it would be much easier for European patients to seek treatment in another Member State. The Directive on patients’ rights in cross-border healthcare is an important achievement of the ‘patient empowerment’ policy of the EU and an essential requirement enabling European citizens to benefit from cross-border healthcare services. It is a natural extension of the fundamental freedoms enshrined into the EU Treaties. Τhe Directive on the application of patients’ rights in cross-border healthcare aims to establish clear rules to facilitate access to safe and high quality health services in the European Union, guaranteeing mobility of individuals/patients seeking health services in another Member State from that of their origin.
- Patients under the Directive have a number of rights, but are patients informed about these rights? Are all other health care stakeholders informed about these patient rights and their obligation to respect them? the issue is how easily patients can exercise those rights. When they do exercise their rights under the Directive is there adequate information and support to guide them?
- Deciding on the appropriate coverage for cross border healthcare is not easy for the European patient. All the more since two different instruments are in validity: the regulation and the directive. How patients will make sense of legal documents? The European legislation and rules are not transparent to European citizens and the existence of two pieces of legislation governing cross border healthcare with different rules i.e. only adds to lack of clarity for patients. Will the National Contact Points explain to interested patients that there are two systems and that they may choose under which piece legislation they might seek treatment in another EU member state? How patients and families will be helped to understand which of the two possibilities is better for their particular circumstances?
- The differences among the two systems of cross border care are not easy to evaluate in financial or other terms for the average patient, since many factors are
- Article 6 provides for the detailed and specific information of patients by a new structure the NATIONAL CONTACT POINTS. Are they all in place seven months after the expiry date for transposition? The reality is that many questions remain unanswered for those needing treatment in another EU member state. When in October 2013 the transposition into national legislation of he member states expired, few of t he 28 member states had transposed the directive, 30 months after the EU had agreed to the rule, and even those were not ready to face all the details its implementation encompasses. Few National Contact Points are equipped to answer all questions of patients. How the continuity of care will be assured when they returned to their country of origin?
- Does the brochure offer answers to all patients’ questions? One could hardly support this. Two many issues remain open or are patient’s responsibility. Are patients really able to go to another EU member state for treatment? How they will make a decision? Will they be re-imbursed for the cost of care abroad? How they will know that the specialist they will visit in another country is really a specialist?
- Nothing is made easy for the patients seeking treatment abroad. Patients will bear the responsibility for many of the elements involved in accessing planned treatment across borders: The responsibility to find information on potential treatments The responsibility to find the HCP who delivers the chosen treatment The burden to obtain prior authorization the burden of proof in demonstrating to insurers that the treatment has been carried out and the responsibility to submit the correct documentation the financial burden to cover cross border care costs not covered under the direc
- Member states have used the prior authorization, the eligible costs and the level of re-imbursement as measures for reducing the flow of patients from countries with low level of health care services to those with modern high technology ones, or from countries with long waiting lists to countries with adequate admission times. Both the regulation and the directive provide for measures aiming to reduce the burden on healthcare systems from patients using cross border health care. Art 4 of the Dir. Stipulates that Member States shall ensure that the national contact points consult with patient organisations, healthcare providers and healthcare insurers. However very few of the 28MS have consulted with patient organizations during the transposition period, and the overwhelming majority of the patient organizations did not know that their health authority had the obligation to consult with them.
- The Directive clearly states that the “Member States shall ensure that the national contact points consult with patient organisations, healthcare providers and healthcare insurers”. The NCPs are conceived as information focal points for health care services in other EU members states covering a wide array of information services They inform citizens about their rights and obligations in regard to cross border healthcare • They refer citizens to other pertinent authorities for more information. • Patients will be able to complain and seek redress if not satisfied • All treatment must be covered by liability insurance or similar guarantee • Prescriptions issued in one member state, will be recognized in another Art 4 of the Dir. Stipulates that Member States shall ensure that the national contact points consult with patient organisations, healthcare providers and healthcare insurers. However very few of the 28MS have consulted with patient organizations during the transposition period, and the overwhelming majority of the patient organizations did not know that their health authority had the obligation to consult with them. Currently it is clear what European Reference Networks mean since there are no agreed terminologies nor agreed standards to define highly specialized centers. Art. 12 of the Dir. Foresees that the Commission will define the criteria that the ref. networks and health centers members of the networks should fulfill. The primary aim of the ERN will be to benefit European citizens, allowing them to be referred to qualified centers of expertise within EU.
- The implementation and clarification of the many details of the Directive requires the close and genuine collaboration of MS at all levels and among all stakeholders of every MS. Issues like electronic transfer of documents, uniform quality and safety guidelines, are not yet here.
- Patient self-guidance in the choice is a possible critical issue