Activities of Anne VAN LANCKER related to 2008/0142(COD)
Plenary speeches (1)
Patients' rights in cross-border healthcare (debate)
Amendments (22)
Amendment 31 #
Proposal for a directive
Recital 5
Recital 5
(5) As confirmed by the Court of Justice on several occasions, while recognizing their specific nature, all types of medical caremedical services provided for consideration fall within the scope of the EC Treaty provisions on the freedom to provide services.
Amendment 43 #
Proposal for a directive
Recital 21
Recital 21
(21) It is appropriate to require that also patients who go for healthcare to another Member State in other circumstances than those envisaged for coordination of social security schemes established by the Regulation (EEC) No. 1408/71 should be able to benefit from the principles of free movement of services in accordance with the Treaty and the provisions of this Directive. Patients should be guaranteed assumption of the costs of that healthcare at least at the level provided for the same or similar healthcaretreatment which is the same or equally effective for the patient had they been provided in the Member State of affiliation. This fully respects responsibility of the Member States to determine the extent of the sickness cover available to their citizens and prevents any significant effect on the financing of the national healthcare systems. Member States may nevertheless provide in their national legislation for reimbursement of the costs of the treatment at the tariffs in force in the Member State of treatment if this is more beneficial for the patient. This may be the case in particular for any treatment provided through European reference networks as mentioned in Article 15 of this Directive.
Amendment 49 #
Proposal for a directive
Recital 30
Recital 30
(30) There is no definition of what constitutes hospital care throughout the different health systems of the Community, and different interpretations could therefore constitute an obstacle to the freedom for patients to receive healthcare. In order to overcome that obstacle, it is necessary to provide a Community definition of hospital care. Hospital care generally means care requiring the overnight accommodation of the patient. However, it may be appropriate to submit to the same regime of hospital care also certain other kinds of healthcare, if that healthcare requires use of highly specialised and cost-intensive medical infrastructure or medical equipment (e.g. high-technology scanners used for diagnosis) or involving treatments presenting a particular risk for the patient or the population (e.g. treatment of serious infectious diseases) and for which planning is necessary in order to maintain its balanced geographical distribution, to control costs and to prevent any significant wastage of financial, technical and human resources. A regularly updated list of such treatments shall be specifically defined by the Ccommission through the comitology procedurepetent authorities of the Member State of affiliation.
Amendment 50 #
Proposal for a directive
Recital 31
Recital 31
(31) The evidence available indicates that the application of free movement principles regarding use of healthcare in another Member State within the limits of the cover guaranteed by the statutory sickness insurance scheme of the Member State of affiliation will not undermine the health systems of the Member States or financial sustainability of their social security systems. However, the Court of Justice has recognised that it cannot be excluded that the possible risk of seriously undermining a social security system's financial balance or the objective of maintaining a balanced medical and hospital service open to all may constitute overriding reasons in the general interest capable of justifying a barrier to the principle of freedom to provide services. The Court of Justice has also recognised that the number of hospitals, their geographical distribution, the way in which they are organised and the facilities with which they are provided, and even the nature of the medical services which they are able to offer, are all matters for which planning must be possible. This Directive should provide for a system of prior authorisation for assumption of costs for hospital care received in another Member State, where the following conditions are met: had the treatment been provided on its territory, it would have been assumed by its social security system and the consequent outflow of patients due to the implementation of the directive seriously undermines or is likely to seriously undermine the financial balance of the social security system and/or this outflow of patients seriously undermines, or is likely to seriously undermine the planning and rationalisation carried out in the hospital sector to avoid hospital overcapacity, imbalance in the supply of hospital care and logistical and financial wastage, the maintenance of a balanced medical and hospital service open to all, or the maintenance of treatment capacity or medical competence on the territory of the concerned Member. As the assessment of the precise impact of an expected outflow of patients requires complex assumptions and calculations, the Directive allows for a system of prior authorisation if there is sufficient reason to expect that the social security system will be seriously undermined. This should also cover cases of already existing systems of prior authorisation which are in conformity with conditions laid down in Article 8In the light of the case-law developed by the Court of Justice, Member States may make the assumption of costs of hospital care in another Member State by their statutory social security system subject to the granting of a prior authorisation. The prior authorisation requirement is justified by the need to preserve the financial balance of their social security system and by the need to plan the number of hospital infrastructures, their geographical distribution, the mode of their organisation, the equipment with which they are provided and even the nature of the medical services they are able to offer. The aims of hospital planning are to ensure, within each Member State, sufficient permanent access to a balanced range of high-quality hospital care, to assist in meeting a desire to control costs and, so far as it is possible, to prevent wastage of financial, technical or human resources. The same reasoning applies to specialized healthcare which requires planning because it involves treatments requiring the use of highly specialised and cost-intensive medical infrastructure or medical equipment or because it involves involving treatments presenting a particular risk for the patient or the population.
Amendment 52 #
Proposal for a directive
Recital 32
Recital 32
(32) In any event, if a Member State decided to establish a system of prior authorisation for assumption of costs of hospital or specialised care provided in another Member States in accordance with the provision of this Directive, the costs of such care provided in another Member State should also be reimbursed by the Member State of affiliation up to the level of costs that would have been assumed had the same or similar healthcaretreatment which is the same or equally effective for the patient been provided in the Member State of affiliation, without exceeding the actual costs of healthcare received. However, when the conditions set out in Article 22(2) of Regulation (EEC) No 1408/71 are fulfilled the authorisation should be granted and the benefits provided in accordance with that Regulation. This applies in particular in instances where the authorisation is granted after an administrative or judicial review of the request and that the person concerned has received the treatment in another Member State. In that case Articles 6, 7, 8 and 9 of this Directive shall not apply. This is in line with the case law of the Court of Justice which has specified that patients who received a refusal of authorisation subsequently held to be unfounded, are entitled to have the cost of the treatment obtained in another Member State reimbursed in full according to the provisions of the legislation in the Member State of treatment.
Amendment 53 #
Proposal for a directive
Recital 33a (new)
Recital 33a (new)
(33a) Refusals to grant prior authorisation cannot be merely based on the existence of waiting lists enabling the supply of hospital care to be planned and managed on the basis of predetermined general clinical priorities, without carrying out in the individual case in question an objective medical assessment of the patient's medical condition, the history and probable course of his illness, the degree of pain he is in and/or the nature of his disability at the time when the request for authorization was made or renewed.
Amendment 59 #
Proposal for a directive
Article 1
Article 1
This Directive establishes a general framework for the provision of safe, high quality and efficient cross-border healthcarecommon rules to ensure patient mobility and to coordinate specific areas of cross-border healthcare whilst fully respecting the responsibility for the definition of social security benefits related to health and the organisation and delivery of healthcare, medical care and social security benefits.
Amendment 71 #
Proposal for a directive
Article 3 - paragraph 2
Article 3 - paragraph 2
2. When the circumstances under which an authorisation to go to another Member State in order to receive appropriate treatment under Article 22 of Regulation (EC) No 1408/71 must be granted are met, the provisions of that Regulation shall apply and the provisions of Articles 6, 7, 8 and 9 of this Directive shall not apply. Conversely, when an insured person seeks healthcareThis Directive does not address the assumption of costs of healthcare which become necessary on medical grounds during a temporary stay of insured persons in another Member State. Nor does this Directive affect patients' rights to be granted an authorisation for a treatment in another Member State in owhere ther circumstances, Articles 6, 7, 8 and 9 of this Directive apply andonditions provided for by the regulations on coordination of social security schemes, in particular Article 22 of Council Regulation (EEC) No 1408/71 shall not apply. However, whenever the conditions for granting an authorisation set out in Article 22(2) of Regulation (EC) No 1408/71 are fulfilled, the authorisation shall be accordedof the Council of 14 June 1971 on the application of social security schemes to employed persons and their families moving within the Community and Article 20 of Council Regulation (EC) No 883/2004 of the European Parliament and of the benefits provided in accordance with that Regulation. In that case Articles 6, 7, 8 and 9 of this Directive shall not applyCouncil of 29 April 2004 on the coordination of social security systems are met.
Amendment 75 #
Proposal for a directive
Article 4 - point a
Article 4 - point a
(a) "healthcare" means a health service provided by or under the supervision of a health professional in exercise of his profession, and regardless of the ways in which it is organised, delivered and financed at national level or whether it is public or privateto patients in order to assess, maintain or restore their state of health. For the purpose of Articles 6, 7, 8, 9, 10 and 11, healthcare means treatments that are among the benefits provided for by the legislation of the Member State of affiliation;
Amendment 98 #
Proposal for a directive
Article 6 - paragraph 1
Article 6 - paragraph 1
1. Subject to the provisions of this Directive, in particular Articles 7, 8 and 9, the Member State of affiliation shall ensure that insured persons travelling to another Member State with the purpose of receiving healthcare there or seeking to receive healthcare provided in another Member State, will not be prevented from receiving healthcare provided in another Member State where the treatment in question is among the benefits provided for by the legislation of the Member State of affiliation to which the insured person is entitled. The Member State of affiliation shall reimburse the costs to the insured person, which would have been paid for by its statutory social security system had the same or similar healthcaretreatment or treatment which is equally effective for the patient been provided in its territory. In any event, it is for the Member State of affiliation to determine the healthcare that is paid for regardless of where it is provided.
Amendment 104 #
Proposal for a directive
Article 6 - paragraph 2
Article 6 - paragraph 2
2. The costs of healthcare provided in another Member State shall be reimbursed by the Member State of affiliation in accordance with the provisions of this Directive up to the level of costs that would have been assumed had the same or similar healthcaretreatment or treatment which is equally effective for the patient been provided in the Member State of affiliation, without exceeding the actual costs of healthcare received.
Amendment 106 #
Proposal for a directive
Article 6 - paragraph 3
Article 6 - paragraph 3
3. The Member State of affiliation may impose on a patient seeking healthcare provided in another Member State, the same conditions, criteria of eligibility and regulatory and administrative formalities for receiving healthcare and reimbursement of healthcare costs as it would impose if the same or similar healthcaretreatment or treatment which is equally effective for the patient was provided in its territory, in so far as they are neither discriminatory nor an obstacle to freedom of movement of persons.
Amendment 110 #
Proposal for a directive
Article 6 - paragraph 4
Article 6 - paragraph 4
4. Member States shall have a mechanism for calculation of costs that are to be reimbursed to the insured person by the statutory social security system for healthcare provided in another Member State. This mechanism shall be based on objective, non-discriminatory criteria known in advance and the costs reimbursed according to this mechanism shall be not less than what would have been assumed had the same or similar healthcaretreatment or treatment which is equally effective for the patient been provided in the territory of the Member State of affiliation.
Amendment 114 #
Proposal for a directive
Article 6 - paragraph 5 a (new)
Article 6 - paragraph 5 a (new)
5a. The provisions of this chapter shall not affect the conclusion of cross-border contractual arrangements for planned healthcare.
Amendment 116 #
Proposal for a directive
Article 7
Article 7
The Member State of affiliation shall not make the reimbursement of the costs of non-hospital care provided in another Member State subject to prior authorisation, where the cost of that care, if it had been provided in its territory, would have been paid for by its statutory social security system.
Amendment 128 #
Proposal for a directive
Article 8 - paragraph 1 – point b
Article 8 - paragraph 1 – point b
(b) healthcare, included in a specific list, that does not require overnight accommodation of the patient for at least one night. This list shall be limited to and for which planning is necessary in order to maintain balanced geographical distribution of healthcare, to control costs and to prevent any significant wastage of financial, technical and human resources. This list shall cover at least: - healthcare that requires use of highly specialised and cost-intensive medical infrastructure or medical equipment; - healthcare involving treatments presenting a particular risk for the patient or the population.
Amendment 136 #
Proposal for a directive
Article 8 - paragraph 2
Article 8 - paragraph 2
2. This list shall be set up and may be regularly updated by the Commission. Those measures, designed to amend non- essential elements of this Directive by supplementing it, shall be adopted in accordance with the regulatory procedure with scrutiny referred to in Article 19(3)e competent authorities of the Member States of affiliation shall set up this list and notify it to the Commission.
Amendment 141 #
Proposal for a directive
Article 8 - paragraph 3
Article 8 - paragraph 3
3. The Member State of affiliation may provide for a system of prior authorisation for reimbursement by its social security systemmake the assumption of the costs of hospital care provided in another Member State where the following conditions are met: (a) had the healthcare been provided in its territory, it would have been assumed by the Member State's social security system; and (b) the purpose of the system is to address the consequent outflow of patients due to the implementation of the present Article and to prevent it from seriously undermining, or being likely to seriously undermine: (i) the financial balance of the Member State's social security system; and/or (ii) the planning and rationalisation carried out in the hospital sby its statutory social security system subjector to avoid hospital overcapacity, imbalance in the supply of hospital care and logistical and financial wastage, the maintenance of a balanced medical and hospital service open to all, or the maintenance of treatment capacity or medical competence on the territory of the concerned Member Statethe granting of prior authorisation.
Amendment 158 #
Proposal for a directive
Article 8 - paragraph 5 a (new)
Article 8 - paragraph 5 a (new)
5a. The Member State of treatment may take appropriate measures to address the inflow of patients and to prevent it from seriously undermining, or being likely to seriously undermine the planning and rationalisation carried out in the hospital sector to avoid hospital overcapacity, imbalance in the supply of hospital care and logistical and financial wastage, the maintenance of a balanced medical and hospital service open to all, or the maintenance of treatment capacity or medical competence on the territory of the concerned Member State. The Member State of treatment shall refrain from discriminating with regard to nationality and shall ensure that the measures restricting free movement shall be limited to what is necessary and proportionate. The Member State of treatment shall notify the measures to the Commission.
Amendment 163 #
Proposal for a directive
Article 9 - paragraph 3 a (new)
Article 9 - paragraph 3 a (new)
3a. The Member State of affiliation may refuse the prior authorisation referred to in Article 8(3) where the treatment which is among the benefits provided for by its legislation, can be provided to the patient on its territory within a time limit which is medically justifiable, taking into account his/her current state of health and the probable course of his/her illness.
Amendment 166 #
Proposal for a directive
Article 9 - paragraph 4 – point d a (new)
Article 9 - paragraph 4 – point d a (new)
(da) the medical history of the patient.
Amendment 205 #
Proposal for a directive
Article 18 - paragraph 3 a (new)
Article 18 - paragraph 3 a (new)
3a. The collection of data within the framework of this Article shall be done in close cooperation with the collection of data foreseen by the Administrative Commission on Social Security for Migrant Workers.