Cross-border medical treatment
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The European Court of Justice has recently ruled that urgent medical decisions made while a patient is in another EU country do not have to be approved by the national health authorities in the patient's country of residence.
Simon Taylor, head of Alexander Harris's International Travel Litigation Team, talks to LexisNexis about the possible implications of the decision...
The ECJ's latest ruling on cross-border medical cost reimbursement confirms that urgent medical decisions in the patient's country of stay do not have to be approved by the national health authorities of the patient's country of residence.
"I don't think the UK social security system has anything to fear from this judgement; because it arises from emergency circumstances there is no chance of abuse by patients who might premeditate seeking off-shore treatment, " says Simon Taylor, head of Alexander Harris's International Travel Litigation Team.
The case -Heirs of Annette Keller v Instituto Nacional de la Seguridad Social (INSS) et al, C-145/03 - concerned Annette Keller, a German national resident in Spain who obtained a E111 form from the Spanish health service (Insalud) to cover any emergency medical treatment arising from a one-month trip to Germany. While she was in Germany, she became sick and was diagnosed with a life-threatening brain tumour. She asked Insalud to issue a form E112 so as to be able to continue receiving treatment in Germany (form E 112 authorises an insured person to go to another Member State in order to receive appropriate medical treatment). The validity of that form was extended several times.
Her doctor in Germany decided to transfer her to the Zurich University Clinic (Switzerland) because he felt that was the only place the she could be operated on with any chance of success. After the treatment, Insalud refused to reimburse Keller for costs incurred at the Zurich clinic saying she should have first sought permission. A Spanish court referred her subsequent claim against Insalud to the ECJ with a query on reimbursement based on EU Regulation 1408/71, which deals with the application of social security schemes to workers employed in other member states.
The ECJ said firstly, that one of the objectives of the 1971 regulation is to facilitate the free movement of insured EU citizens who need or who have been authorised to have treatment during a stay in another member state. Secondly, that the doctors in the member state of stay are best-placed to assess the treatment needed by the patient, the resident member state institutions having placed confidence in those doctors for the validity of the E111/E112 forms. This assessment can include transferring the patient to another member - or non-member - state, the court said. Further, the patient's national health authorities cannot force the patient to have a medical examination or subject medical findings and decisions to its approval.
"The judgement very much arises from unusual emergency circumstances," Taylor comments. "The ECJ is making medical considerations paramount, and we would always support that principle."
In less drastic situations, patients generally have emergency treatment and then are likely to be required to return to their country of residence - that is, they would not have an E112 approved or extended where treatment is available at home. "We have always found that treatment for UK nationals is reimbursed by the UK authorities under E111. At the earliest possible time, as soon as the person is stabilised, they can be repatriated to the UK and treatment continued there."
"I am not aware of any similar claim to the Keller case arising in the UK and that may be because the NHS and the UK paying bodies takes a different approach than the Spanish health authorities," he says. "But now that the matter has come up in this case, it is a settled point as far as we are concerned."
Author Greg Bousfield - published by LexisNexis
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