Although the cross-border provision of health services has existed for a long time, the adoption of Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare has recently revived interest in this topic, because it has opened another legal path to access cross-border healthcare in addition to co-ordination regulations and purely national legal provisions.
In the master’s thesis two possibilities are presented regarding cross-border healthcare. One is the inclusion of mobile EU citizens into the public healthcare systems through social health insurance or national health service. The other is unplanned and planned cross-border healthcare, which maintains coverage in the domestic public health system. I find that the distinction between unplanned and planned cross-border healthcare is not always clear, because the intention of a patient who wishes to receive certain medical services may change while such patient is visiting another EU Member State. Unplanned healthcare under the Regulations is certainly the most common application of cross-border healthcare, but nevertheless, dilemmas may occur as to the notions of temporary stay outside of the competent Member State, as to what can be considered as unforeseen and necessary healthcare, and as to the extent of reimbursement. In addition, in certain cases of unplanned healthcare, Directive 2011/24/EU requires prior authorization by the competent authority, which increases administrative burden for national healthcare systems seeking the best possible solution for the patient. A parallel application of Regulations, the Directive and purely national legislation may also lead to legal and practical problems in planned healthcare, because the administrative procedures for granting prior authorization are too long. Some Member States have established a system of automatic authorization applied if administrative procedures take too long, with procedural deadlines being more stringent than in general administrative procedural rules.
Practical problems may occur for mobile patients if the same cross-border healthcare providers offer both public and private healthcare. At the same time, they can lead to directing patients from public to private healthcare with the same provider. They provide non-waiting lists, but with higher tariffs and direct payments. Therefore, it is "easier" for healthcare providers to treat mobile patients as private patients. Nevertheless, such steering of mobile patients is not allowed. The patient has to decide whether he/she would like to be treated as a public or private patient, and has to be properly informed of the possibility of his/her free choice.
Particular emphasis is laid on the open question of reversed discrimination against national patients compared to mobile ones. Reversed discrimination occurs when an individual has more rights due to movement between EU Member States than he/she would have if he/she remained within a single country. An example of this arrangement is the Slovenian legislation. Two possibilities for elimination of such an arrangement are presented at both national and EU level.
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