Topic:
Cross bording health care
Course: FALK1 Pharmacy Practice
Syllabus of Lecture 1. 11. 2019
Lector: PharmDr. Bc. Dana Mazankova, Ph.D.
mazankovad@vfu.cz
Directive 2011/24/EU
on patients´rights in cross-border healthcare
The proposal of directive is:
– to ensure free movement of health services and a high level of health protection
– to clarifiy the rules on access to healthcare in another EU country, including
reimbursement
Aims of directive:
1. Ensure rights to reimbursement for healthcare
2. Provide assurance about safety and quality
3. Establish cooperation between health systems
1. aim: Helping patients
National Contact Points (NCP)
 Information to patients
Patients have access to all relevant information via National Contact Points (NCP)
• at national level, at least one National Contact Point
 Safeguards for health systems - conditions of reimbursement:
National health authorities - pay out ONLY for healthcare that correspond to the
benefits provided in its territory
Patients - pay NO MORE for treatments they would pay for at home
2. aim: Quality and Safety
 Transparency and accountability of system
 Member States responsibility of health care provided
 Cooperation of Member States
3. aim: Cooperation between health systems
 Recognition of prescriptions
 eHealth system
 Health Technology Assessment (HTA)
TERMINOLOGY
Healthcare
– means health services provided by health professionals to patients to assess, maintain or
restore their state of health, including the prescription, dispensation and provision of
medicinal products and medical devices
Cross-border healthcare
– means healthcare provided or prescribed in a Member State of EU other than the
Member State of affiliation
Member State of affiliation
– means the Member State that is competent to grant to the insured person a prior
authorisation to receive appropriate treatment outside the Member State of resident
What is the EU Directive on Cross Border Healthcare all about?
• assumption:
• citizen of the EU has the right to travel, live and work in any Member State of EU
Basic right to healthcare can be summed up as:
 if you are entitled to healthcare in your own country (the Member State of affiliation),
you can choose to get treated in another EU country, whether your healthcare is
provided by state or by private insurer
What scale in Cross Border Healthcare are we talking about?
• patients prefer to receive healthcare in their own country
• this estimate includes cross-border healthcare which patients had not planned
in advance
Limitation of Cross Border Healthcare
Cross Border Healthcare should not apply to health services:
– long- term care services provided by:
• home care services
• in assisted living facilities
• in residential homes or housing
– organ transplantations
– public vaccination programmes against infectious diseases
– sale of medicinal products and medical devices over Internet
1. It is necessary to plan this treatment („planned care“)
2. Treatment present a risk for patient or population
3. Healthcare is provided by healthcare provider that give serious concerns relating to quality
or safety of provided care
 the Member State of affiliation may refuse to grant healthcare to patient prior its
authorisation
Healthcare may be subject to prior authorisation by the Member State of affiliation:
Cross Border Healthcare should apply to health services:
- medical treatments
- dental and orthodontic treatments
- cosmetic and plastic surgery
3 categories of treatments
that are reimbursed in the frame of healthcare provided in a Member State
of EU other than the Member State of affiliation:
Cross Border Healthcare should apply to dispenzed / sold:
- drugs (medicinal products)
- medicinal devices
Prescription, dispensation and provision of medicinal products (and medical devices) where
these are provided in context of health service
• patient purchases medicinal products (and medical devices) in a Member State of
EU other than the Member State of affiliation
• patient purchases medicinal products (and medical devices) in another Member
State of EU than that in which the prescription was issued
Cross bording health care in Czech Republic
System of drug dispenzation in a pharmacy
to incomer patient from other Member State of EU
• Patient has right to receive immediate health care
– receive endorsement (bill) from physician, pharmacist
= payment for cross-border treatment upfront
a) Patient is in Czech on short stay
– business trip, trip, holiday,…
1. Step: Patient choose health insurance company
• Ask insurance company for insurance validation for the stopping time (residence) in Czech
– This validation is available only for immediate health care
b) Patient is in Czech on long stay
– students, migrant workers, pensioners, …
2. Step: On the basis of this validation pharmacist dispense drug to patient
– with the same fees as for domestic patients
3. Step: Pharmacist bill this drug to insurance company
Document:
• “Your rights to treatment in Europe - a UK patient’s guide to the EU Directive”
www.treatmentabroad.com/eu
Also health care providers need to understand what’s going on…
Benefits of Cross Border Healthcare system for patient
• in the case of hospital care
- patients are able to choose their healthcare provider
• in the case of non-hospital care
- patients are able to seek healthcare abroad without prior authorisation or
formalities, and claim reimbursement upon their return home
• (for planned care - a patient must apply for prior authorisation)
• patients will be reimbursed the same amount as they would receive in their own country for
the same type of healthcare