ACCESS TO HEALTH CARE ACROSS THE EU Lessons learnt from the Judgements of the EU Court of Justice EURORDIS 2005 Membership Meeting VENICE Francesco Ronfini.

Slides:



Advertisements
Similar presentations
Health Insurance and Europe Hungary’s example
Advertisements

Association Internationale de la Mutualité Europe in health: the impact of ECJ decisions on healthcare systems Willy Palm AIM Director Palma de Mallorca,
Bernard v. Bosman Michele Colucci
Directive on patients rights in cross-border healthcare DG SANCO Unit D2 Healthcare systems.
THE POSITION OF JOBSEEKERS Paul Minderhoud Centre for Migration Law Coordinator Network on Free Movement of Workers.
EU Cross-Border Care Directive from the Primary Care perspective Results of a simulation Rita Baeten Gothenburg, 3 September 2012.
Current legal situation of pharmacies in the EU Brussels, 15 April 2009 Dr. Edurne Navarro Varona.
CJEU CASE C-338/11 – Santander Asset Management SGIIC and Others Judgment of the Court (Third Chamber) of 10 May European Tax Law 32E22000 Mikko.
C-342/10 Commission v. Finland Failure of a Member State to fulfil obligations – Free movement of capital – Article 63 TFEU – EEA Agreement – Article 40.
Irish Centre for European Law Conference The Law of the Lisbon Treaty.
INTRODUCTION INTO PRIVATE INTERNATIONAL LAW OF THE EUROPEAN UNION Marko Jovanovic, LL.M. MASTER IN EUROPEAN INTEGRATION Private International Law in the.
INTRODUCTION: In recent years integration has been achieved through tax harmonisation and through European Court of Justice (ECJ) case law This integration.
EU: Bilateral Agreements of Member States
Massimo Serpieri EU Commission – DG Research
Case C-446/03 Marks & Spencer
Definition and Types of Banks
DIRECTIVE OF THE EUROPEAN PARLIAMENT AND THE COUNCIL on the application of patients' rights in CROSS-BORDER HEALTHCARE voted Karleen De Rijcke.
EUROPEAN TAX LAW (32E22000) JAKI TAALAS & JOEL KERÄNEN SGI, C-311/08 TRANSFER PRICING.
CJEU Case C-231/05, AA Oy Finnish Corporate Contribution System Antti Lehtola
Coheur Alain : Mutualités Socialistes de Belgique Coheur Alain : Mutualités Socialistes de Belgique Common Challenges for Health and Care A Europe of patients.
SFB International Tax Coordination 10/21/2005, Timo Fischer Europeanization of Long-Term Care – An economic approach to European Social Security Law –
European Health Policy, Enlargement and Health Systems Bernard Merkel European Commission Public Health Directorate Bad Hofgastein, September 2002.
1 SIM Directive (Services in the Internal Market) & European Code of Conducts 12 September 2007.
1 INTERREG IIIB “ATLANTIC AREA” Main points of community regulation 438/2001 financial management and control systems EUROPEAN COMMISSION SPAIN.
Introduction to EU Civil Judicial Cooperation Dr. Francesco Pesce Assistant Professor in International Law Università degli Studi di Genova (IT)
Employment policy, labour market and free movement of workers European Social Policy Faculty of Social Sciences, Charles University in Prague.
ILGA Europe AGM, 17 October 2003 Is the EU good for your health?  What can it do?  What does it do?  What should it do?  What will it do?
Ministerie van Volksgezondheid, Welzijn en Sport The Dutch Healthcare Reform: Towards Private Healthcare for All Visit Dr. Hlavacka and delegation Slovak.
Meeting with the Romanian Motor Insurers’ Bureau Bucharest 19 th August 2004 Ulf Lemor.
The Eighth Asian Bioethics Conference Biotechnology, Culture, and Human Values in Asia and Beyond Confidentiality and Genetic data: Ethical and Legal Rights.
Business Law Lesson 3 Dr. Gabriella Gimigliano
Reform of Annex X 2013 The active attempt to make the external service of the European Union unattractive Ferdinand Kopp, SFE
A major step towards a Europe for Health Directive on patients’ rights in cross-border healthcare DG SANCO Unit D2 Healthcare systems.
Proposal for a Directive on services in the Internal Market adopted on 13 January 2004 Com (2004) 2 final.
EU co-ordination of sickness benefits An overview of the main rules in Regulations n° 883/2004 (BR) & 987/2009 (IR) Prof. dr. Herwig VERSCHUEREN University.
Tension between the Competence of the Member States to Organize and Finance Health Care and Liberalization Efforts of the European Union Filip Křepelka.
Community action on cross-border healthcare Royal College of Physicians 17 January 2008 Robert Madelin Director General for health and consumer protection.
Integrating Health across Policies Health and the Single European Market Coheur Alain : Association Internationale de la Mutualité.
R.Greaves Cross-border provision of services Art 49 EC Treaty within the context of the provisions on Establishment.
Basic economic freedoms. 1. Free movement of goods The Community shall be based upon a customs union which shall cover all trade in goods and which shall.
Directive on Services in the Internal Market Issues related to health services.
Access to healthcare : a view from the European Court of Justice Piet Van Nuffel EPPOSI workshop Berlin November 2004.
Tension between the Competence of the Member States to Organize and Finance Health Care and Liberalization Efforts of the European Union Filip Křepelka.
TAIEX Workshop on the Cross- Border Healthcare Directive Ankara, Turkey, April 2015 Topic 3: Reimbursement of Costs of Cross-Border Healthcare Professor.
Evaluation of restrictions: art. 15 and art TAIEX Seminar on the EU Service Directive, 3 May 2007 Carlos Almaraz.
Self employed persons (SEP) Slovak Republic Budapest
M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Working Group for Chapter 2– Freedom Movement for Workers Bilateral.
Cross-Border Health Care Under Construction?. Landmark decisions of the European Court of Justice  Kohll/Decker, C-158/96, C-120/95 ( )  Vanbraekel,
Modernizing Health Care Inez Bartels.  Strong focus on the provision of health care  Institutions governing health care consumption control patients.
Week 12. Lecture 2. Health Law & the EU Cross-border healthcare: patients’ rights.
An internal market perspective on medical services Jarek Pytko E2 - Public Interest Services DG for Internal Market, Industry, Entrepreneurship & SMEs.
DG Employment, Social Affairs and Equal Opportunities Modernised Social Security Coordination Zagreb, June 2010 Coordination in the field of sickness,
KHO:2008:23 Finnish Dividend Taxation of EU Individuals.
Commission Staff Working Document Free Movement of Workers in the Public Sector 18 January 2011 Ursula Scheuer European Commission DG Employment, Social.
M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Working Group for Chapter 2– Freedom Movement for Workers Bilateral.
© S. Henneron, 2005 M.Sc. in European Business and International Business Law Sandrine HENNERON European Labour Law Presentation.
Version 3 (2. February 2012) European Citizens´Initiative (TEU: Art. 11, Para 4; TFEU: Art. 24, Para 1) Title of the proposed ECI Unconditional Basic Income.
The Protection of Confidential Commercial or Industrial Information in Environmental Law: Analysis and Call for a Graded Concept of Protection Prof. Dr.
Case C-174/14 JUDGMENT OF THE COURT (Fourth Chamber) 29 October 2015
Cross-border healthcare and the EU Directive 24/2011
Bernard v. Bosman Michele Colucci.
European and international tax law
The Mutual Recognition Regulation
INTRODUCTION INTO PRIVATE INTERNATIONAL LAW OF THE EUROPEAN UNION
Valentina Calderai, University of Pisa
Investor protection and MIFID
EUROPEAN UNION AND HOSPITALS
Cross-border provision of services
Outline Background: development of the Commission’s position
Freedom of movement of workers in the EU
Presentation transcript:

ACCESS TO HEALTH CARE ACROSS THE EU Lessons learnt from the Judgements of the EU Court of Justice EURORDIS 2005 Membership Meeting VENICE Francesco Ronfini

1.More and more people are crossing borders for medical treatment; 2.Greater demand for “health tourism”; 3.Different entitlements of patients under the national health care systems and restricted national health budget; 4.Impact of the Eu law and European Court of Justice rulings on the right to access health care services. THE BACKGROUND

EUROPEAN HEALTH PROTECTION SYSTEMS IN THE EU - I THE EUROPEAN HEALTH CARE SYSTEMS VARY CONSIDERABLY AMONG MEMBER STATES BUT UNDERLYING ALL OF THEM IS A COMMON MODEL BASED ON SOCIAL SOLIDARITY AND UNIVERSAL COVERAGE

EUROPEAN HEALTH PROTECTION SYSTEMS IN THE EU - II HEALTH CARE SYSTEMS IN MEMBER STATES ARE GENERALLY DIVIDED INTO TWO CATEGORIES: 1. National Health Systems (Beveridge Model) (e.g. United Kingdom, Italy, Spain, Denmark or Sweden) - These systems are funded by taxation; - The entitlement is usually straightforward and provided to the whole population resident within the Country in question;

EUROPEAN HEALTH PROTECTION SYSTEMS IN THE EU - III 2. Social Insurance Systems (Bismarck Model) (e.g. Germany, Belgium, Netherlands, Austria, France, Slovenia,) - The law determines who is compulsory insured (in these cases a part of the population can be exempted or excluded on the assumption they can make alternative arrangements). - The system is financed by the payment of premiums (income- related). - The administration is entrusted to local semi-public bodies (Sick- ness funds).

EUROPEAN HEALTH PROTECTION SYSTEMS IN THE EU - VI ART. 152 (5) EC TREATY PROVIDES THAT: “COMMUNITY ACTION IN THE FIELD OF PUBLIC HEALTH SHALL FULLY RESPECT THE RESPONSABILITIES OF THE MS FOR THE ORGANISATION AND DELIVERY OF HEALTH SERVICES AND MEDICAL CARE” (Which includes their national health-insurance systems: ECJ Cases: 238/82 Duphar, 158/96 Koll)

EUROPEAN HEALTH PROTECTION SYSTEMS IN THE EU - IV ALL THESE HEALTH SCHEMES HAVE A COMMON CHARACTERISTIC: THE RIGHT TO MEDICAL CARE IS A TERRITORIAL RIGHT THIS MEANS IN PRINCIPLE THAT PEOPLE ARE ONLY ENTITLED TO HAVE THE COST OF MEDICAL CARE REIMBURSED IN THEIR OWN NATIONAL TERRITORY

EUROPEAN HEALTH PROTECTION SYSTEMS IN THE EU - V REGARDING THE ACCESS TO HEALTH CARE SERVICES: 1. IN EACH MEMBER STATE A CLAIM BY AN INDIVIDUAL IS WHOLLY DEPENDENT UPON THE AVAILABILITY OF THE PARTICULAR SERVICE IN THEIR OWN STATE 2. WITHIN THE EU THE DETAILS OF LEGAL ENTITLEMENTS OF PATIENTS ARE ESSENTIALLY DETERMINED BY THEIR OWN NATIONAL LAW

EUROPEAN HEALTH PROTECTION SYSTEMS IN THE EU - VII HOWEVER THESE PROVISIONS OF NATIONAL LAW ARE AFFECTED BY EU LAW IN SEVERAL WAYS THROUGH BOTH LEGISLATION PROMULGATED AT EU LEVEL AND LITIGATION BASED ON DIRECTLY EFFECTIVE PROVISIONS OF COMMUNITY LAW

THE IMPACT OF THE EU LAW ON THE RIGHT TO ACCESS HEALTH CARE SERVICES THE IMPACT OF THE EU LAW ON THE RIGHT TO ACCESS HEALTH CARE SERVICES

ON THE BASIS OF: - THE CURRENTLY IN FORCE EU LAW, - AND THE RELEVANT BODY OF ECJ CASE LAW: EU PATIENTS MAY SEEK HEALTH CARE SERVICES IN A MEMBER STATE DIFFERENT FROM THEIR OWN FOR A NUMBER OF REASONS SUCH AS: -Value for money; -Waiting times; -Quality of care; -Particular health care service available (right to access a particular type of health care service). EUROPEAN LAW CURRENTLY IN FORCE - I

Articles 3/p, 18, 39, 42, 49 and 50 EC Treaty;Articles 3/p, 18, 39, 42, 49 and 50 EC Treaty; EC Reg. 1408/ 1971 (revised by the new EC EC Reg. 1408/ 1971 (revised by the new EC Reg. 883/2004); Reg. 883/2004); EC Reg. 574/ 1972; EC Reg. 574/ 1972; EC Directives 90/364 – 90/ / /96; EC Directives 90/364 – 90/ / /96; EUROPEAN LAW CURRENTLY IN FORCE - II

1. MIGRANT PATIENTS AS MIGRANT WORKERS Reg. 1408/ 71 art. 22,1, a) – Temporary stay:Reg. 1408/ 71 art. 22,1, a) – Temporary stay: - Whoever takes up a temporary period of stay in any other MS for whatever reason and requires medical treatment, costs will be borne by the MS to which the citizen belongs. - The right of access to medical treatment is proven by the MS to which the citizen belongs through the EHIC. EUROPEAN LAW CURRENTLY IN FORCE - III

Reg. 1408/ 71, art. 22,2, - Authorized health care:Reg. 1408/ 71, art. 22,2, - Authorized health care: Whoever requires health care abroad must be authorized in advance (Form E-112) by the MS of membership. Whoever requires health care abroad must be authorized in advance (Form E-112) by the MS of membership. Conditions*: A) - The applicant must have the right to request health treatment by the legislation of the MS in which the person concerned resides: B) – The treatment cannot be provided in this MS within the time normally necessary taking in account the current state of health and the probable development of the disease) *ECJ rulings in PIERICK I, , C- 117/ 77 and PIERICK II , C EUROPEAN LAW CURRENTLY IN FORCE - IV

2. MIGRANT PATIENTS AS RECIPIENTS OF SERVICES Art. 49 EC foreseen that “restrictions” on the freedom to provide services within the EU “shall be prohibited”.Art. 49 EC foreseen that “restrictions” on the freedom to provide services within the EU “shall be prohibited”. According to the art. 50 EC. “services” are, in this context:According to the art. 50 EC. “services” are, in this context: All activities of an industrial, commercial, artisanal or professional character normally provided for remunaration, insofar they are not governed by the provisions related to freedom of movement for goods, capital and persons. All activities of an industrial, commercial, artisanal or professional character normally provided for remunaration, insofar they are not governed by the provisions related to freedom of movement for goods, capital and persons. (Please note that art. 54 EC provides that MS maintain restrictions on the freedom to provide services) EUROPEAN LAW CURRENTLY IN FORCE - V

THE APPLICATION OF EU LAW TO HEALTH CARE SERVICES ACROSS BORDERS WITHIN EU - I Based on the interpretation of the above- mentionned rules and principles, successive decisions of the European Court of Justice have raised the expectations of patients for increased possibilities of medical treatment abroad. Based on the interpretation of the above- mentionned rules and principles, successive decisions of the European Court of Justice have raised the expectations of patients for increased possibilities of medical treatment abroad. The rulings mean that: 1.The EU citizens have in some case the right to access to health care services abroad; 2.These treatments will be paid by the patient's own national health protection system.

Case Law Nr KOHLL (C- 158/ 96) & DECHER (C- 120/ 95) This case law relates to the right of reimbursement of costs borne by the applicant for health services and products in a foreign MS on the basis of rates currently in force in the membership country without requiring prior authorization. This case law relates to the right of reimbursement of costs borne by the applicant for health services and products in a foreign MS on the basis of rates currently in force in the membership country without requiring prior authorization. THE APPLICATION OF EU LAW TO HEALTH CARE SERVICES ACROSS BORDERS WITHIN EU - II

The ECJ, stated that: 1.It is up to the single MS to manage and structure their National Health System; 2.The areas of Social Security and Health Care Services are not exempt from the application of community law; 3.Art. 22 /Reg. 1408/ 71 does not prevent the riembursement of health care costs borne abroad without prior authorization; THE APPLICATION OF EU LAW TO HEALTH CARE SERVICES ACROSS BORDERS WITHIN EU - III

4. The obligation to obtain prior authorization discourages recourse to medical health services in another MS, thereby constituting an obstacle to the free circulation of patients; 5. In the case in point preventive AUTORISATION cannot be justified and do not constitute a grave risk either for the financial equilibrium of the Social Security System or for other public health reasons; THE APPLICATION OF EU LAW TO HEALTH CARE SERVICES ACROSS BORDERS WITHIN EU - IV

Case Law No. 2 – :Case Law No. 2 – : C- 368/ 98 - VANBRAEKEL vs Alliance Nationale des Mutualitees Chretiennes (ANMC) Case Law Nr. 3 – : C-157/ 99 GERAERTS- SMITS vs Stichtin Ziekenfonds and PERBOOMS vs Stichting CZ Groep (health insurances) Case Law Nr :Case Law Nr : C- 385/ 99 of : MULLER- FAURE’vs Onderlinge Waarborgmaatsshappij Oz. ZORG., and VAN RIET vs Onderlinge WaNDERLINGE Waar. Zao ZORG. THE APPLICATION OF EU LAW TO HEALTH CARE SERVICES ACROSS BORDERS WITHIN EU - V

Case Law Nr. 5 – :Case Law Nr. 5 – : C- 326/ 00, IDRYMA KOINONYKON ASFALISEON (IKA) vs VASILEIOS IONNIDIS Case Law Nr. 6 – : C-153/ 01: VAN DER DUIN vs Onderling Waarborgmaastshappij Anoz. Zorg. Case Law Nr. 7 – : C-56/2001, Patricia INIZAN vs Caisse Primaire d’Assurance Maladie Case Law Nr. 8 – : C - 08/2002: Ludwig LEICHTLE vs Bundesanstalt fur Arbeit. THE APPLICATION OF EU LAW TO HEALTH CARE SERVICES ACROSS BORDERS WITHIN EU - V

Prior authorisation is justified: Can only be refused if same or equally effective treatment is available without undue delay in a contracted estalishment Undue delay: take into account actual medical condition (incl. degree of pain and nature of disability) and medical history Prior authorisation is not justified: Member States are allowed to fix reimbursement amounts to which cross-border patients are entitled (provided they are based on objective, non-discriminatory and transparent criteria) IN-PATIENT CARE Cases Smits-Peerbooms Van Riet OUT-PATIENT CARE Cases Kohll-Decker Müller-Fauré

TEAM (E111) – Cure necessarie durante un soggiorno temporaneo in altro SM se previste dalla legislazione dello Stato che le fornisce; AUTORIZZAZIONE PREVENTIVA - E112 – Autorizzazione per cure in un altro SM, che non puo’ essere rifiutata se: > La cura e’ prevista dallo SM di residenza; > La cura non puo’ essere fornita entro un tempo medicalmente giustificato; Il beneficiario riceve il trattamento come se fosse assicurato /iscritto nello SM dove il trattamento viene eseguito, quindi: –Secondo le tariffe dello SM del in cui il trattamento viene eseguito; –Alle condizioni e secondo le formalita’ dello SM del trattmento; Il pagamento viene regolato tra gli Organismi finanziari degli SM Artt Nuovo Reg. CE 883/2004 (Libera circolazione delle persone e Coordinamento Sicurezza Sociale)

Servizi Non-Ospedalieri: Nessuna Autorizzazione preventiva puo’ essere richiesta se coperti dalla legislazione dello SM di residenza; Servizi Ospedalieri: Possono essere subordinati ad Autorizzazione ai sensi degli artt. 49 e 50 Tr.CE. Lo SM non puo’ rifiutare l’Autorizzazione se: –La cura e’ prevista dallo SM di residenza; –La cura non puo’ essere fornita entro un tempo medicalmente giustificato; Il beneficiario e’ soggetto alle condizioni dello SM di residenza per quanto riguarda: –Le tariffe ed i rimborsi; –Condizioni amministrative e formalita’ dello SM di residenza Il Pagamento viene fatto direttamente dal paziente che deve poi chiedere il rimborso. Art Proposta di Direttiva CE 2004/2, sui Servizi nell’UE (Libera circolazione di beni e servizi)