Cross-Border Health Care Under Construction?

Landmark decisions of the European Court of Justice  Kohll/Decker, C-158/96, C-120/95 ( )  Vanbraekel, C-368/98 ( )  Smits/Peerbooms, C-157/99 ( )  Müller-Fauré/van Riet, C-385/99 ( )  Inizan, C-56/01 ( )

What is today the legal position of a person, insured under a social security scheme, going abroad to receive health care? Aspects:  Benefits  Procedure  Level of reimbursement

National lawRegulation 1408/71

Benefits 1 National law  The social healthcare authority of the country of insurance Regulation 1408/71  The social healthcare authority of the country of treatment

Benefits 2 National law  Social healthcare catalogue of the country of insurance  Content determined by national law (Smits/Peerbooms)  “Normal”: international medical science (Smits/Peerbooms) Regulation 1408/71  Social healthcare catalogue of the country of treatment, but limited to idem country of insurance

Procedure 1 National law  Prior authorisation  Accepted for hospital care (Smits/Peerbooms, Müller- Fauré)  Not accepted for non- hospital care (Kohll-Decker, Müller-Fauré, Van Riet) Regulation 1408/71  Art 22 : Requirement of prior authorisation acceptable for hospital and non-hospital care (Inizan)

Procedure 2 National law  Authorisation may not be refused if similar or equally effective treatment can not be obtained without undue delay in the country of insurance (Smits-Peerbooms / Müller- Fauré) Regulation 1408/71  Art. 22 : Authorisation may not be refused if similar or equally effective treatment can not be obtained without undue delay in the country of insurance (Smits-Peerbooms / Müller- Fauré)

Level of reimbursement 1 National law  Cost actually incurred (consensus) up to the level of the tariffs of the State of insurance (Kohll, Müller- Fauré/van Riet)  Fixed amounts in a system of benefits-in-kind (Müller- Fauré/van Riet) Regulation 1408/71  Care, or reimbursement of the costs of care up to the level of the country of treatment NB Also applicable if authorisation is asked and given for non-hospital care

Level of reimbursement 2 National law  Art. 49 EC: additional reimbursement up to the amount due for hospital care provided in State of insurance if authorisation has been given (Vanbraekel) Regulation 1408/71  The Regulation neither prescribes nor forbids a supplementory payment up to the level of the country of insurance (Kohll, Decker, Inizan, Vanbraekel)

 Full reimbursement if patient asks and gets permission, but not under the Regulation 1408?  Is it necessary to have two procedures? Is integration possible?  Undue delay?  Hospital / non-hospital care?  Level of reimbursement / Co-payments?

Under Construction?