Presenting to fellow European members of parliament her recommendations on cross-border health care for a second reading, French rapporteur Francoise Grossetete insisted she would be uncompromising on the issue of prior authorisation. While she does not question this principle, she rejects the quality and security criteria added by the Council, which would make it possible for a member state to arbitrarily refuse to grant authorisation to a patient, “I believe that this criterion is unacceptable because it would make it possible for prior authorisation to be refused at any time without explanation. It is inconceivable and would, in the end, lead to new appeals before the European Court of Justice”.
The objective of the proposal for a directive is to standardise case law of the Court of Justice of the European Union and avoid the ambiguity faced by patients. The Commission is attempting to clarify the rights of patients treated in another member state, including the issue of the reimbursement of care. As a general principle, it establishes that patients treated in another member state will receive the same level of reimbursement anticipated for the same treatment or for a similar treatment in their national health system, if they are entitled to this treatment in their country of affiliation.
Grossetete is an influential MEP and her stance could help influence changes in the Second Reading later this year. Her worry is that the latest version still enables member states to limit the application of rules relating to the reimbursement of cross-border health care by demanding prior authorisation for certain treatments. According to the rapporteur, prior authorisation must be based on the need for health care planning and rationalisation, but cannot be abused in order to deny patients the right to travel for treatment. She therefore proposes even tougher restrictions- limiting prior authorisation to hospital treatment (a stay of more than one night in hospital), specialised care or treatment that poses a particular risk to the patient or the population.
Grossetete believes that this text must be urgently concluded under the best possible conditions because the question has been open for too long. She makes a valid point that less than one per cent of the European population would even consider state paid healthcare in another country, as most people prefer to be treated at home. Her argument is that if states are offered the opportunity for prior authorisation and reimbursement, unless carefully controlled, the practice in some member states will make the whole concept unmanageable.
Grossetete will be intransigent on the issue of rare diseases, as she wants patients suffering from rare diseases to have access to care in another member state and be reimbursed, particularly if the treatment is not provided in their member state. She joins an increasing number of MEPs arguing that rare diseases must not be subject to prior authorisation. She points out an area that was not resolved in the latest version from Council, but appears to be yet another get out clause agreed earlier this year by health ministers. This is the stipulation that patients who have obtained prior authorisation must provide advance payment to the hospital .Her argument is that this makes a nonsense of the whole agreement and the logic must be that if any advance payment is allowed, then this should only be in those few countries where at home, the patient has to pay an advance fee to the hospital before reclaiming from the state after the treatment.
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