Brussels, 09/10/2014 (Agence Europe) - If a member state is unable to ensure effective medical treatment in good time for its residents, these latter have the right to seek treatment in another member state and to have their costs reimbursed by the health insurance authority of their state of residence, ruled the Court of Justice of the EU (case C-268/13) on Thursday 9 October. The judges thus did not take account of economic considerations to restrict the right, as have been highlighted by those who fear seeing massive health migration to some EU countries or, put more brutally, the development of “hospital tourism”.
Under EU law, European nationals may be treated in a member state other than their state of residence. In that way, they can receive the services needed in the same way as if they were insured under the health insurance scheme of that member state. It is the member state of residence, however, that reimburses the expenses incurred, if it is unable to provide the necessary care sufficiently quickly so as not to aggravate the condition or promote recovery. The case before the Court involved a Romanian national who underwent an operation in Germany. This is the first time the Court has been called on to rule on the right of Europeans to seek medical care in another member state as a result of shortage of provision.
In his opinion, delivered in June 2014 Advocate General Cruz Villalón argued that this right had to be limited in cases where the inability of the state of residence to provide the necessary care in good time was the result of a structural deficiency. This could be justified, he argued, on the grounds of the danger of the growth of massive migration to certain countries for health purposes and of the huge burden that would be placed on their health insurance systems as a result. The Court did not follow this reasoning. In its judgment, it said that EU law contains only two conditions which, if both are satisfied, render mandatory the granting by the competent institution of prior authorisation for the reimbursement of medical expenses. The treatment in question must be among the benefits provided for by the legislation of the member state where the insured person resides and the treatment cannot be delivered within a reasonable period of time by the state of residence.
The judges state that this inability may be as a result of a lack of medication and basic medical supplies which makes it impossible to deliver care as effectively and in as timely a fashion as in another member state. It is for the agencies which deliver the authorisations for reimbursement of healthcare abroad to decide on each case individually. They will have to decide if the care needed by the patient cannot be provided, firstly, within any of the hospital establishments in the state of residence and, secondly, in good time. (JK)