Implementation of patients’ Directive under discussionThe EU Directive on patient's rights in cross-border health care is an excellent idea. It entitles EU citizens to access health care services in any other member state and to be reimbursed for them from their own countries. In practice, carrying out the Directive, in Finland and elsewhere, represents a challenge. The Finnish residence-based system and its funding is different from the systems in many other EU countries.
In Finland, the law on cross-border health care, which implements the Directive, has been in operation since the beginning of January this year. When the Directive came into effect, the most expedient model of the current Finnish health care system was used as the basic formula.
Now, however, the EU Commission has reckoned that Finland has not implemented all the Directive's required articles. In July, the Commission sent Finland a reasoned opinion on the matter, because in its view Finland has not enacted patients' rights with legislation and statutes in full compliance with the Directive.
"In this context, the enactment of patients' rights means that in the view of the Commission, patients should receive treatment and reimbursements on the same basis both in their own countries and in other EU member states", says MSAH Permanent Secretary Päivi Sillanaukee.
Central European modelsSillanaukee points out that the EU Commission has sent similar reasoned opinions to several other EU countries. The Directive is being applied in member states in various ways, because their health care systems are very different.
"The Directive was done largely with Central European health care systems in mind", explains Sillanaukee.
If the Commission does not think that that a member state has not complied with the opinion, it may institute proceedings and refer the matter to the European Court of Justice. The Court may impose a fine, which may amount to tens of thousands of Euros a day.
"We are studying the opinion sent by the Commission and are preparing an official reply."
What is the Patients' Directive?In practice, the Directive means that EU citizens are entitled to health care services anywhere in the EU, and to be reimbursed for them from their own countries. According to the Directive, patients coming from other EU countries must be dealt with in the same way as in their own countries or in the countries in which they reside. Patients may seek treatment without a special permit.
The Directive applies in principle to all health care regardless of how it is arranged, delivered and funded, or whether it is public or private.
Challenges and headachesThe Directive is problematic for Finland, because the national residence based health care system and the way it is funded differs from the system in most other EU countries.
One headache is that patients must be reimbursed for treatment received in another EU country on the same basis as if they had been treated in Finland.
Treatment costs are reimbursed in Finland in two ways. Reimbursements are paid for emergency treatment according to the system of residence-based public health care. If patients voluntarily seek non-emergency treatment other than public sector treatment, such as private treatment or treatment in another member state, reimbursements are paid in line with the Health Insurance Act.
Patients coming to Finland from other EU countries must, according to the Directive, be treated the same as municipal residents in Finland. In such cases, patients have to pay the actual treatment costs, and then are reimbursed for them from their own countries.
Reform takes account of DirectiveIn Finland, investigative work on the structural reform of the social and health care system, and on reforming the multi-channel funding structure is currently underway. This will be complete by the beginning of 2015. Sillanaukee points out that the reform of the funding system will take account of the requirements of the patients' Directive.
"If our existing funding model changes, the Directive's reimbursement model may change."
Despite the challenges, Finland has a positive view of the patients' Directive. It strengthens the patients' rights, increases the scope for choice, and clarifies the confusing legal situation."
Text: Kimmo Vainikainen