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Cross-Border Healthcare Reference Year 2016 Cross-border healthcare Reference year 2016 Frederic De Wispelaere and Jozef Pacolet – HIVA-KU Leuven October 2017 EUROPEAN COMMISSION Directorate-General for Employment, Social Affairs and Inclusion Directorate D – Labour Mobility Unit D/2 – Social security coordination Contact : [email protected] European Commission B-1049 Brussels Cross-border healthcare Reference year 2016 Directorate-General for Employment, Social Affairs and Inclusion Network Statistics FMSSFE (Contract No VC/2013/0301 ‘Network of Experts on intra-EU mobility – Lot 2: Statistics and compilation of national data’) 2017 Network Statistics FMSSFE This report has been prepared in the framework of Contract No VC/2013/0301 ‘Network of Experts on intra- EU mobility – social security coordination and free movement of workers / Lot 2: Statistics and compilation of national data’. This contract was awarded to Network Statistics FMSSFE, an independent research network composed of expert teams from HIVA (KU Leuven), Milieu Ltd, IRIS (UGent), Szeged University and Eftheia bvba. Network Statistics FMSSFE is coordinated by HIVA. Authors: Frederic De Wispelaere, Senior research associate, HIVA - Research Institute for Work and Society, University of Leuven (KU Leuven). Prof dr Jozef Pacolet, Head of the ‘Welfare State’ research group, HIVA - Research Institute for Work and Society, University of Leuven (KU Leuven). Peer reviewers: Prof dr József Hajdú, Head of the Department of Labour Law and Social Security, Szeged University. Dr Gabriella Berki, Professor Assistant at the Department of Labour Law and Social Security, Szeged University. Europe Direct is a service to help you find answers to your questions about the European Union. Freephone number (*): 00 800 6 7 8 9 10 11 (*) The information given is free, as are most calls (though some operators, phone boxes or hotels may charge you). LEGAL NOTICE This document has been prepared for the European Commission however it reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein. More information on the European Union is available on the Internet (http://www.europa.eu). Luxembourg: Publications Office of the European Union, 2018 ISBN: 978-92-79-80343-7 doi:10.2767/102957 © European Union, 2018 Reproduction is authorised provided the source is acknowledged. GLOSSARY Basic Regulation: Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems. Implementing Regulation: Regulation (EC) No 987/2009 of the European Parliament and of the Council of 16 September 2009 laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems. The Directive: Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare. Competent Member State: The Member State in which the institution with which the person concerned is insured or from which the person is entitled to benefits is situated. Member State of affiliation under the Directive: The Member State competent to grant a prior authorisation under the Regulations. Lump sum Member States: Member States claiming the reimbursement of the cost of benefits in kind on the basis of fixed amounts. Annex 3 of Regulation (EC) No 987/2009: Member States claiming the reimbursement of the cost of benefits in kind on the basis of fixed amounts: Ireland, Spain, Cyprus, the Netherlands, Portugal, Finland, Sweden, the United Kingdom and Norway. Annex IV of Regulation (EC) No 883/2004: More rights for pensioners returning to the competent Member State granted by Belgium, Bulgaria, the Czech Republic, Germany, Greece, Spain, France, Cyprus, Luxembourg, Hungary, the Netherlands, Austria, Poland, Slovenia, Sweden, Iceland and Liechtenstein. The European Health Insurance Card (EHIC): The EHIC proves the entitlement to necessary healthcare in kind during a temporary stay in a Member State other than the competent Member State. Portable Document (PD) S1: The PD S1 allows a person to register for healthcare if (s)he lives in an EU country, Iceland, Liechtenstein, Norway or Switzerland but (s)he is insured in a different one of these countries. Portable Document (PD) S2: The ‘Entitlement to scheduled treatment’ certifies the entitlement to planned health treatment in a Member State other than the competent Member State of the insured person. Introduction The Network Statistics on Free Movement of Workers, Social Security Coordination and Fraud and Error (Network Statistics FMSSFE) has established a comprehensive statistical data collection for the European Commission (DG EMPL) to assess the functioning of the coordination of social security systems.1 Insured persons have different routes at their disposal to receive cross-border healthcare. They can be treated under the Basic Regulation and its Implementing Regulation; or under Directive 2011/24/EU2; or under their own national legislation. The figures reported in this report relate to cross-border healthcare provided under the Regulations. The report aggregates separate data on cross-border healthcare collected within the Administrative Commission3 by four questionnaires related to cross-border healthcare.4 Cross-border healthcare within the EU5 can be defined as a situation in which the insured person receives healthcare in a Member State other than the Member State of insurance (i.e. competent Member State). Three cross-border healthcare situations are identified and regulated in the Coordination Regulations. (1) There is unplanned cross- border healthcare when necessary and unforeseen healthcare is received during a temporary stay outside the competent Member State. (2) Planned cross-border healthcare may be received in a Member State other than the competent Member State. Finally, (3) persons who reside in a Member State other than the competent Member State are also entitled to receive healthcare. 1 Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems (Basic Regulation). Regulation (EC) No 987/2009 of the European Parliament and of the Council of 16 September 2009 laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems (Implementing Regulation). 2 Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare. 3 The Administrative Commission for the coordination of social security systems comprises a representative of the government of each EU country and a representative of the Commission. It is responsible for dealing with administrative matters, questions of interpretation arising from the provisions of regulations on social security coordination, and for promoting and developing collaboration between EU countries. The composition, operation and tasks of the Administrative Commission are laid down in Articles 71 and 72 of the Basic Regulation. 4 The Network would like to thank all Member States and their competent institutions for providing these data. Without their support no data would be available at EU level and no analysis could be made. Moreover, we would like to thank the Commission (DG EMPL – Directorate D – Unit D2) for remarks, comments and exchanges on previous versions. 5 The term "Member States" is used in this report to indicate the 28 countries belonging to the European Union, the European Economic Area (EEA) and Switzerland. EU-15 Member States: Belgium (BE), Greece (EL), Luxembourg (LU), Denmark (DK), Spain (ES), Netherlands (NL), Germany (DE), France (FR), Portugal (PT), Ireland (IE), Italy (IT), United Kingdom (UK), Austria (AT), Finland (FI) and Sweden (SE). EU-13 Member States: Croatia (HR), Romania (RO), Bulgaria (BG), Poland (PL), Czech Republic (CZ), Latvia (LV), Lithuania (LT), Slovenia (SI), Estonia (EE), Slovakia (SK), Hungary (HU), Cyprus (CY) and Malta (MT). In addition to the 28 EU Member States, EU social security coordination rules also apply to EFTA countries via the EEA Agreement in the case of Iceland (IS), Liechtenstein (LT) and Norway (NO) and via a bilateral agreement in the case of Switzerland (CH). Unplanned healthcare: The European Health Insurance Card (EHIC) proves the entitlement to necessary healthcare in kind during a temporary stay in a Member State other than the competent Member State of the insured person; Planned healthcare: The Portable Document S2 (PD S2) certifies the entitlement to planned health treatment in a Member State other than the competent Member State of the insured person; Persons residing in a Member State other than the competent Member State: The Portable Document S1 (PD S1) allows the insured person to register for healthcare in a Member State other than the competent Member State of the insured person. This is typically the case of pensioners residing abroad and of cross-border workers who work in one Member State but reside in another. The first chapter ‘The European Health Insurance Card’ (EHIC) presents data concerning the use of the EHIC from 1 January to 31 December 2016 as well as difficulties in using the EHIC. Furthermore, the amounts of reimbursement related to necessary healthcare in kind during a temporary stay in a Member State other than the competent Member State are reported. The second chapter ‘planned cross-border healthcare’
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