By Ninian, Alex
Contemporary Review , Vol. 290, No. 1691
AT the beginning of July this year, after at least one earlier promised date had been missed, the EU Commission released its Directive on cross-border health care within the EU. It is intended to promote and clarify the right of patients to get health care treatment in another EU country, as well as providing a basis for increased co-operation between EU health care systems.
It was earlier scheduled to be published around the period of new year 2008 but the date was missed amid a welter of suspicion and conjecture about serious disagreement within the Commission. The UK was rumoured to be one of the least liberal and one of the most restrictive voices. Alan Johnson, the Health Secretary, is fighting for the operation of the Directive in the UK to be subject to NHS permission in advance, for major operations. A Department of Health spokesman has said that the Department is committed to ensuring that the NHS retains the ability to decide what care it will fund.
The proposals will, in principle, give NHS patients the right to free medical treatment in all 27 countries, and will be a new blueprint for medical tourism, but the proposals have to go through the usual European hoops. These require the proposals to be approved by a majority of EU governments and the European Parliament before coming into real force.
Since the consultation process has already been going on for three years and the current version of the Directive is a compromise that has been thrashed out over this period, it could very well become a reality in something like its present form. Certainly, it will give all patients in the EU somewhat greater freedom and will clarify what that freedom is, and it will ease congestion in countries that have long waiting lists for medical procedures.
The Directive has come about from the general desire within the Commission to create commonality across the EU so far as is possible in markets, economic and social rules. It can be said that this is an attempt to create a common European market in health care.
To some extent it has also evolved from a series of European Court judgements which have upheld the right of patients to gain reimbursement for treatment in other countries where they have been subject to undue delay in their home country. There have been some high profile cases where UK citizens have chosen to pay for better or quicker treatment abroad and then had to resort to legal action to get the NHS to reimburse them. In 2006 the European Court of Justice ruled that British patients who face an 'undue delay' for treatment at home can be reimbursed by the NHS if doctors agree that the treatment abroad is justified.
In April 2008, the NHS and the British government brought in a scheme whereby patients in the UK were given the right to choose to have treatment anywhere in the UK. The EU Directive may be said to evolve from this to the extent that it extends patient choice to anywhere in the EU. Some British newspapers and politicians have been saying two things which are at odds with my reading of the actual Directive. One is that the UK will be inundated with Europeans coming here for free health care which the British taxpayer will have to fund. The other is that British residents will be eligible for health care in other Member States only if the cost is less than the NHS cost.
My reading of the actual Directive is that Europeans from other Member States will be eligible to come here for health care if all the criteria are met, and, if so, it will be paid for by their home Member State. Secondly, UK residents will be eligible to go to other Member States for health care, without prior permission, for any treatment offered by the NHS, regardless of whether it is cheaper or dearer than the NHS treatment. If it is less, the NHS will only reimburse the actual cost, and, if it is more, the individual will pay the extra.
The main development to come out of all the disagreements in the Commission during the consultation period is that the earlier proposals were to decree that no prior approval would be required by anyone. …