Your right to treatment abroad

Anthony Debono writes:

I heard about some new proposals from the EU on the right to seek medical treatment abroad. What has changed? Can you tell us more?

Last July, the European Commission published new proposals on the rights of EU citizens with respect to medical treatment abroad.

But let me first clarify one point which often creates confusion. Many people think that if a particular treatment is not available in Malta, then the EU gives them the right to seek such treatment abroad. This is not the case.

There is no EU right to obtain medical treatment abroad (at the expense of your national health insurance) if this treatment is not available in one's own public health system. This is because it is up to national authorities, not the EU, to determine what treatment should be available in national public health services, taking into account the financial resources available.

Before coming to the new proposals, let me recall existing rights as they stand in EU law.

Firstly, you are entitled to treatment abroad whenever you are in another EU country on a temporary basis (such as on holiday) and require medical treatment which becomes necessary during your stay. Normally, this applies to urgent or emergency cases.

The costs of your treatment is covered by Malta provided that you present your European Health Insurance Card (formerly known as E111) which proves that you are covered by the national health insurance here. This card is free of charge and if you are travelling to the EU (plus EEA countries and Switzerland) you should make sure that you have one.

Secondly, according to existing EU law, you are entitled to medical treatment abroad only if you are authorised to do so by the national health authorities. The authorisation means that the cost of your treatment will be covered.

Under EU law, authorisation may not be refused if the treatment in question is provided in Malta but cannot be given to you within the time normally necessary, taking into account your current state of health and the probable course of the disease. In such cases, your treatment abroad will be at the cost of the national health system.

Over time, the European Court of Justice extended these rights and this is where the new Commission proposals come in. The new proposals seek to codify the new rights established by the European Court thereby making them more clear and generally accessible to all.

In essence, the new rights being proposed in relation to medical treatment abroad are two-fold. But the same precondition remains, namely, that the new proposals do not change the right of EU countries to define the benefits that they choose to provide in their health system. This means that if a particular treatment is not part of our entitlement in Malta, then the new proposals will not create any new right for patients to obtain such treatment abroad and be reimbursed.

In the first place, the proposals state that you should have the right to seek non-hospital care abroad provided that this is already available here. In such cases, you would be entitled not to full reimbursement of costs, but to a reimbursement limited to the level of costs that would have been incurred in Malta had you obtained the care here.

Secondly, the new proposals state that you should also have the right to seek hospital care abroad, again for treatment available under Malta's national health system. The proposals seek to generalise this right and to do away with the need for prior authorisation. Treatment would again be reimbursed up to the level that such treatment would have cost had it been given in Malta.

Prior authorisation may only be retained if the member state in question shows that this new right could imply serious consequences on the financial balance of its social security system or on its public health care system. This means that prior authorisation would be limited to what is necessary and proportionate and it does not constitute a means of arbitrary discrimination.

The Commission is also making other proposals relating to the right of patients to be adequately informed on medical treatment abroad through national information offices and to new ways of promoting further co-operation among health service providers in the EU and to ensure high standards of quality in this sensitive sector.

Since these proposals touch upon the sensitive and costly national health systems, one should not expect their approval to be plain-sailing and it might take a while until the law enters into force. Even so, they must certainly be good news for patients' rights.

Readers who would like to ask questions to be answered in this column can send an e-mail, identifying themselves, to contact@simonbusuttil.eu or through www.simonbusuttil.eu.

Dr Busuttil is a Nationalist member of the European Parliament.