Patient mobility

G. Muscat asks:
What are my rights with respect to medical treatment abroad? Can I seek treatment abroad if this is not available in good time in Malta?

Patient mobility has increased substantially over the past years and so have the rights of EU patients who seek treatment in a hospital in another EU country.

There are different aspects of this issue that need to be tackled. For instance, it is one thing talking about treatment abroad that you may need during a visit or a stay in another EU country. But it is another thing talking about treatment abroad when you are in Malta and simply want to go abroad for treatment because you feel that the Maltese health service is not providing you with the necessary treatment in good time.

Let us take these different scenarios separately.

In the first case you may be on holiday in another EU country for a short while and may have an accident or otherwise need urgent medical treatment, such as hospitalisation. In this case, you are entitled to treatment on the same basis as citizens of the EU country you happen to be in. If you are requested to pay for this service then you should be reimbursed by your home country (Malta) on the basis of the tariffs and fees that you paid in the country where you received the treatment.

For this purpose, it is advisable to make sure, prior to travelling, that you take with you the applicable forms that will help you with the necessary administrative procedures. For those who go abroad for a short stay, such as a holiday, a form known as €111 is required. For others, such as students or workers who travel for longer stays, different forms are necessary. Forms may be obtained from our national health authorities and, thankfully, they will soon be phased out in favour of a single European health insurance card that will make things easier for everyone.

The situation is different when it comes to going to another EU country specifically for medical treatment and then expecting your national health insurance in Malta to foot the bill.

Let us say that you require medical treatment which is normally available in Malta but which you are not getting because of long queues or other delays. Can you seek this treatment abroad at the expense of the Maltese health insurance system to which you have contributed?

The answer is not an automatic yes. But nor is it a no.

To be sure, you can well seek a hospital abroad provided that you are given prior authorisation to do so by the local public health authorities. That is to say if the national health authorities confirm to you in advance that the Maltese national health insurance will foot the bill of your treatment abroad.

But what happens if you are not given authorisation?

Well, on this score, in recent years the European Court of Justice has issued a series of interesting rulings and a number of principles have been established.

In particular, it has now been established that prior authorisation cannot be refused by the national health authorities if you have not been given your care in your home country (in our case, Malta) within a medically acceptable time limit considering your condition. In such cases, you would be entitled to seek treatment abroad and to receive reimbursement under your (Maltese) national health insurance scheme up to the level of reimbursement that would normally apply in your country.

This applies in cases where treatment would normally be available in Malta but which was not given to you because of an unduly excessive delay, taking into account your medical condition and your medical history. It does not apply in cases where treatment is not available in Malta or to which you are not entitled in Malta.

The European court has also made it clear that a proper system of authorisation must be in place allowing you to apply for authorisation and to be given a reply based on objective and transparent criteria and not on the discretion of any particular individual. If an authorisation is refused then you must be given a reason and you are entitled to challenge a negative decision.

With respect to any non-hospital treatment to which you may be already entitled in Malta, the court established that you should be able to obtain such treatment in another EU country and get reimbursed in your country even without any prior notification.

However, patient mobility rights in the EU are still evolving and are not applied in the same way in all EU countries. So to avoid disappointment you should check about your rights and entitlements before incurring expenses. After all, although national governments are required to respect EU law with regard to your mobility rights as a patient, national health systems still remain in the hands of national authorities and not the EU. Unsurprisingly, therefore, national governments have been reluctant to give in to requests made by their own nationals to travel abroad for medical treatment at the expense of their own national insurance system. National governments have also been reluctant to apply the judgments of the European court in this area because of the possible financial implications.

Yet, despite this resistance and despite the restrictions that continue to apply, the European court too has made significant inroads. In its most recent case on this subject, it went as far as allowing a claim for reimbursement of travelling and accommodation expenses incurred in connection with travelling abroad for medical treatment.

The European Commission too appears determined to push for increased mobility rights of patients and to put pressure on recalcitrant governments. The Commission wants this issue clarified in its controversial proposal for a new law on services in the internal market.

Hopefully, in the coming years, national borders will also be completely removed for patients.

Readers who would like to raise issues or ask Dr Busuttil a question are invited to send an e-mail, making reference to this column, to contact@simonbusuttil.com