European Union law precludes national legislation that in all cases excludes reimbursement of the costs of an emergency treatment undergone by a patient in a Member State other than his or her country of residence, the Court of Justice of the European Union ruled on Wednesday 23 September (Case C-777/18).
A Hungarian national with longstanding eye problems scheduled a medical appointment with a doctor in Germany at the end of September 2016 for 17 October 2016. He was informed by the doctor that he might need to extend his stay until 18 October for a possible ophthalmological operation. On 15 October, a medical examination in Hungary revealed that the Hungarian patient had abnormal intraocular pressure. On 17 October, the German doctor decided that the operation should be performed urgently on 18 October to save the patient’s sight.
The Hungarian national challenges the refusal by his country’s administration to reimburse the cost of healthcare provided in Germany on the grounds that Hungarian legislation requires, in all circumstances, prior authorisation as provided for in Regulations 883/2004 and 987/2009 on the coordination of national security systems.
In its judgment, the Court finds that healthcare received in a Member State other than the one in which the insured person resides, on his or her own initiative, constitutes scheduled care within the meaning of the regulations, and the receipt of such treatment is subject to the granting of an authorisation by the competent institution of the Member State of residence.
In this context, the European Court of Justice recalls its case law (Case C-173/09), according to which, even in the absence of a prior authorisation duly issued before the start of care provided in another Member State, the insured person is entitled to obtain direct reimbursement of the costs which he has incurred in connection with that care up to an amount equivalent to what would normally have been covered if the insured person had had such authorisation. This situation exists when, for reasons of urgency, the insured person has been prevented from applying for such authorisation or has not been able to await the decision of the competent institution on his application for authorisation.
It is for the Hungarian institution, under the national court’s supervision, to determine whether the case is, in principle, characterised by special circumstances. According to the Court, the medical examination carried out in Hungary on 15 October shows that the patient could not have waited for the decision of the competent institution on an application for authorisation at the risk of losing his sight.
In the case in which the Hungarian courts conclude that a Hungarian national is not entitled to obtain reimbursement for treatment provided in Germany on the basis of the regulations on the coordination of social security systems, the Court considered whether the principle of freedom to provide services and the Directive (2011/24) on cross-border healthcare preclude the Hungarian legislation at issue.
According to the Court, the argument that the Hungarian legislation is justified in order to control healthcare costs can be applied only in the case of major (non)-hospital care. It is therefore not applicable in the case of medical consultation. It is for the referring court to check whether the ophthalmologic procedure constitutes major (non)-hospital care.
And even if the Hungarian courts were to find that ophthalmological intervention constitutes major (non)-hospital care, the Court considers that the Hungarian legislation contains a disproportionate restriction on the freedom to provide services and therefore infringes EU law.
See the judgment: https://bit.ly/2HqpOot (Original version in French by Mathieu Bion)