Nueva normativa europea sobre la asistencia sanitaria transfronteriza. Isabel de la Mata Barranco


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XIX Jornadas sobre Derecho y Genoma Humano (18-19 Abril 2012)

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Nueva normativa europea sobre la asistencia sanitaria transfronteriza. Isabel de la Mata Barranco

  1. 1. A major step towards a Europe for HealthDirective on patients’ rights in patients cross-border healthcare DG SANCO
  2. 2. The 3 Aims of this Directive 1. 1 Help patients to exercise their rights to reimbursement for healthcare received in another EU country2. Provide assurance about safety and quality of cross- cross- border healthcare b d h lth3.3 Establish formal cooperation b t E t bli h f l ti between health systems 2
  3. 3. ScopeProvision of all types of healthcare to patients regardlesshow is organized, delivered or financedh i i d d li d fi dExceptions: Long term care (supportive services to everyday tasks) Allocation of and access to organs for the purpose of organ transplants g p Public vaccination programmes
  4. 4. 1. Helping patients (1/2)• Information to patients National Contact Points Patients will have access them to get all relevant information to cross-border healthcare in order to make an informed choice
  5. 5. 1. Helping patients (2/2)Rules of reimbursementClarification of rules - patients will know: know:(1) need for prior authorisation;( )(2) reasons for refusal;(3) level of reimbursement,(4) need for up-front payment up-Procedural guaranteesP d lPatients will benefit from:(1) clarification of responsibilities;(2) clear rules if something goes wrong;(3) right to review of administrative decisions;(4) right to judicial proceedings
  6. 6. 1. Information to patients pConditions of reimbursement- ONLY for treatments included in the national benefits;- Payment up to the same amount as it would pay for at home.Maintaining of national rules- National rules applicable on their territory territory.- Conditions and formalities required in MS can also be imposed fort eat e ts ab oadtreatments abroad.Prior authorisation system- Member States can introduce a system of prior authorisation.General safeguard
  7. 7. 1. The System of Prior Authorisation (1/2) Scope for prior authorisation (PA)Healthcare that: is subject to planning requirements: one overnight stay in a hospital; use of highly specialised or cost-intensive medical infrastructures or cost intensive equipments; involves a particular risk to patients or population; is provided by a healthcare provider who raises concerns over quality and safety of care. care
  8. 8. 1. The System of Prior Authorisation (2/2)Obligation of granting PAIf the healthcare in question cannot be provided within a reasonable time limit(undue delay).Reasons to refuse a PA- Safety risk for patient or for population;- Healthcare is provided by a healthcare provider that raises concerns overquality and safety of care;- Healthcare can be provided within a reasonable time limit.
  9. 9. 2. Q lit and safety (1/3) Quality d f tThe Directive highlights that Quality and safety should bethe cornerstone of the healthcare to be provided to citizensacross EuropeProvides some rules and provisions for facilitating theaccess to safe and high-quality cross-border healthcare andpromotes cooperation on in this respect.Quality is consider an horizontal issue that affects differentchapters and articles (no specific article on this topic)
  10. 10. Responsibilities of Members States on Q & S 2. Quality and safety (2/3) Transparency and accountability• Patients right to information about quality and safety framework and standards • To provide information to patients on national criteria/system related with q y quality and safety y y • Explicit and publicly available national standards / criteria • To provide Information on Health Care Providers with compliance, "
  11. 11. 2. Q lit and safety (3/3) Quality d f t Member States responsibility Refusal of prior authorisation if doubts over q p quality and safety of a y y healthcare provider Continuity of care: same medicall f ll di follow-up as i h lth in healthcare provided locally & access to clinical records Cooperation of Member States Exchange of information on standards and guidelines for quality and safety through national contact points
  12. 12. 3. Cooperation between health systems (1/2)Recognition of prescriptionsA prescription issued in another EU country will bemore effectively recognisedEuropean Reference NetworksThey will bring together specialised centres accross Europehelping citizens to better access highly specialized and complexhealthcare and to disseminate information and expertise
  13. 13. 3. Cooperation between health systems (2/2) The eHealth Network A first step towards "interoperability" of ICT for health at EU level for safety and quality of care continuity of care and health research care, care, - Adoption of the Commission Decision setting up the network: 22 December 2011 - 1st discussion: 8 May 2012 The Network on Health Technology Assessment A permanent EU structure of cooperation to help decision-makers to make the right decisions on health investment and spending
  14. 14. The transposition p p process• Entry into force: 24 April 2011 Transposition period: 30 months (25 October 2013) Bilateral discussions with 27 Member States (MS): • COM questionnaire on the transposition of the measures provided  for in the Directive (May – October 2011) for in the Directive (May October 2011) • COM bilateral visits in all 27 MS (2011 – 2012) to discuss particular  p issues related to transposition Committee on Cross‐Border Healthcare • Formal forum created by the Directive where all 27 MS will meet Formal forum created by the Directive where all 27 MS will meet  regularly to vote on implementing acts (Cooperation chapter).
  15. 15. Thank you! y Further information: