Patient Mobility

1. The EU framework on patient mobility
Presentation by: Bigyan Ojha

2. Outline of presentation
• Patient mobility; overview
• EU directive; scenario
1. State of play of transposition
2. Use of prior authorization
3. The level of patient mobility
4. Reimbursement practices
• Importance of EU directive for patient
• Challenges
• References

3. Patient mobility; overview
• The EU Directive 2011/24/EU on the application of patients’ rights in
cross-border healthcare creates a legal framework for the patient’s right
to seek healthcare in another member state and to benefit from cross-
border healthcare services.
• Cross-border healthcare codifies the main principles of the case law
established by the European Court of Justice (ECJ) related to cross-
border healthcare.

4. Contd…
• Patients who are entitled to a particular health service, that is among
the benefits provided for under the statutory healthcare system in their
home country (Member State of affiliation), are entitled to be
reimbursed for the same service if they decide to receive it in another
member state.
• However, the level of reimbursement can never exceed the actual costs
of the healthcare received.

5. EU directive; scenario
o Directive 2011/24/EU1 came into force on 24 April 2011.
o It was due to be transposed by Member States by 25 October 2013.
o European commission prepared and submitted report on operation of
directive to european parliament and to the council by 25 october 2015 and
every three years thereafter.
o The report includes;
1. state of play of transposition,
2. use of prior authorisation,
3. the level of patient mobility,
4. reimbursement practices.

6. 1. State of play of transposition
• Infringement proceedings were launched against 26 member states on
the grounds of late or incomplete notification of such measures.
• As of 1 July 2015, four infringement proceedings remained open, and
all four member states concerned had made firm commitments to
address the outstanding issues.
• The next stage for the commission is to assess whether member
states have transposed the directive correctly.

7. 2. Use of prior authorization
• Member states can require patients to seek prior authorization for
certain treatments as below;
• For healthcare which involves overnight hospital stay of at least one night
• For highly specialized and cost-intensive healthcare
• In serious and specific cases relating to the quality or safety of the care provided by the
particular provider in question
• A prior authorization can be refused e.g. if the patient can be offered the
treatment in the member state of affiliation within a time limit which is
medically justifiable

8. 3. The level of patient mobility
• Patient flows for healthcare abroad under the directive are low.
• Of the 21 Member States who introduced a system of prior
authorization, 17 were able to supply data on numbers of requests
for authorization specifically under the Directive.
• It seems to be due to low numbers of claims rather than large
numbers of refusals: the available data suggests that roughly 85 %
of reimbursement claims are granted.

9. 4. Reimbursement practices
• The reference point for reimbursement for cross-border healthcare
should be the amount borne by the system when that particular
healthcare is provided by a public or contracted healthcare provider in
the member state of affiliation.
• Some states has provision of ‘gatekeeper’ structure, where a referral
from a GP or family doctor is required for a patient to access specialist
healthcare as well as to be reimbursed in another member state.

10. Offers additional possibilities
for patients to obtain
healthcare abroad
It provides a minimum set of
patients' rights
It requires Member States to
provide clear information to
patients on their rights and
options
Provides a legal basis for
European collaboration
in the fields of health
technology assessment,
eHealth, rare diseases,
and safety and quality
standards
Importance of EU directive for patient

11. Challenges
• Providing clear rules and reliable information : less than two in 10 EU
citizens are informed about their rights in this area, and only one in ten
knows role and responsibilities of National Contact Points
• Meeting patients' expectations
• Ensuring EU countries work closer together
• Clearing up years of legal uncertainty.

12. References
• Bermejo, D. C. (2014). Cross-border healthcare in the EU: Interaction between
Directive 2011/24/EU and the Regulations on social security coordination. Paper
presented at the ERA Forum.
• Costigliola, V. (2011). Mobility of medical doctors in cross-border healthcare. EPMA
Journal, 2(4), 333.
• Legido-Quigley, H., Glinos, I. A., Baeten, R., McKee, M., & Busse, R. (2012). Analysing
arrangements for cross-border mobility of patients in the European Union: a proposal
for a framework. Health Policy, 108(1), 27-36.
• Quinn, P., & De Hert, P. (2011). The Patients’ Rights Directive (2011/24/EU)–Providing
(some) rights to EU residents seeking healthcare in other Member States. Computer
Law & Security Review, 27(5), 497-502.
• Rosenmöller, M., McKee, M., & Baeten, R. (2006). Patient mobility in the European
Union. Learning from experience.
• Strban, G. (2013). Patient mobility in the European Union: between social security
coordination and free movement of services. Paper presented at the ERA Forum.

13. Thank you for your attention !
Any Questions ?