UK announces new rules on cross border healthcare (medical tourism) in Europe

Amid the tumult of the announcement of a general election date, the UK government and the NHS have quietly announced a U-turn on their opposition to cross-border EU healthcare. The number of people travelling to Europe for treatment paid for by the NHS is low – the NHS suggests 1,000 people travel each year but the Department of Health admits it has no figures.

The NHS is vague on whether or not this estimate includes or excludes the 1,300 foreign nationals resident in the UK who travel to their home EU country when about to give birth, to ensure the child has dual nationality. If it does then there are almost no NHS patients currently travelling overseas for surgery.

The National Health Service (Reimbursement of the Cost of EEA Treatment) Regulations 2010 amend the NHS Act 2006 by clarifying the obligations of primary care trusts with regard to the authorisation and reimbursement aspects of patient mobility and cross-border healthcare.

The Department of Health is stressing to trusts that any perceived failure to act in accordance with European law may result in legal proceedings in UK and EU courts. The UK must comply with European law on prior authorisation and reimbursement of patients’ costs. New sections 6A and 6B of the National Health Service Act 2006:

Provide for the reimbursement of the costs of health services provided in another EEA state;

Lay down the conditions that must be met before the NHS is required to reimburse the patient;

Limit the amount of the reimbursement to what it would have cost if the service had been provided under the NHS (or in relation to dental services, the average cost to the NHS of providing the service);

Provides for the deduction of applicable NHS charges

NHS Trusts must;

Establish and publish procedures for determining claims for reimbursement;

Specify and make available the form on which claims must be made and publish details of the information that must be provided with a claim;

Establish and publish procedures for determining applications for prior authorisation;

Specify and make available the form which patients must use in order to apply for prior authorisation and publish details of the information that must be provided with an application;

Publish information about the services that it provides that require prior authorisation.

Comply with the time limits set out and provide for an internal review of a decision;

Notify the applicant of a decision and of the reasons for the decision;

Offer advice and assistance to patients who are contemplating travelling to receive medical treatment in another member country.

The patient’s right to access treatment in another countryThe granting of prior authorisation by the NHS for treatment overseas is an acknowledgement of the patient’s right to access treatment in another country. It is not a process for referring patients to providers in other countries. Patients need to be aware that prior authorisation does not imply clinical approval of a patient’s planned healthcare in another country, nor does it imply acceptance of any responsibility for that treatment.

Trusts are required to remind anyone seeking medical treatment in another country to ensure that they have comprehensive medical travel insurance. Regular travel insurance does not routinely cover people going abroad specifically for medical treatment, just as many policies will automatically exclude cover for any pre-existing condition. Trusts must advise people that normal travel insurance is no use, and that there are several specialist UK providers, but the trusts are not allowed to provide the names of these providers, nor will the NHS reimburse the cost of travel insurance.

The principle of reimbursement assumes that patients will pay the overseas provider directly for the treatment they receive and then seek reimbursement from the NHS. An applicant is only entitled to reimbursement for treatment where the treatment: is necessary to treat or diagnose a medical condition, is the same or equivalent to what the NHS offers, and is not a special service for which prior authorisation is required.

In the vast majority of cases, hospital treatment required by patients in England is available on the NHS but that in itself is not a sufficient reason to refuse requests from patients for treatment elsewhere in the EEA. However, patients seeking hospital care in another EEA Member State should contact their local NHS in advance of travelling to discuss whether prior authorisation is required and what levels of cost reimbursement will apply. The Trust cannot stop a person having treatment in the EEA, but must seek to persuade them that NHS treatment is available locally or elsewhere, and ensure that the patient is aware that those going for treatment without seeking local NHS advice beforehand, run the risk getting no or only partial refund for what they paid.

If the treatment is a special service, the NHS will refuse to refund unless proper authorisation has been agreed. Special services are:

(a) A service that involves a stay in hospital accommodation for at least one night;

(b) Medical treatment that involves general anaesthesia, epidural anaesthesia or intravenously administered sedation;

(c) Dental treatment that involves general anaesthesia or intravenously administered sedation; or

(d) A service whose provision involves the use of specialised or cost- intensive medical infrastructure or medical equipment e.g. scans or radiography

Each trust has to publish a list of services that it regards as special services and which require prior authorisation. So although the NHS and the government have complied with the letter of the law, the detailed process and scope for local trusts to decide what they will or will not reimburse ensures that anyone hoping to get the NHS to pay for treatment abroad will have to be able to endure a lengthy bureaucratic process with no guarantee of getting reimbursement from the NHS.

Reimbursement from the NHSAt no stage does any GP, NHS Trust, NHS or Department of Health body get involved in arranging or deciding what country or what hospital /clinic the patient uses-their role is purely limited to deciding what, if anything, the patient is entitled to in reimbursement from the NHS. So countries, hospitals or agencies that may be seeking to get local or national deals with the NHS are wasting their time.

A large proportion of UK outbound medical and dental tourism is for cosmetic surgery and cosmetic dentistry that the NHS does not offer anyway. The rules may suggest that the NHS could pay for other dental tourism, but anyone who tries to extract money from their local NHS Trust for dental care overseas may be pursuing a lost cause.

It is worth mentioning here the medical tourism myth that has been revived by the debate on “Obamacare”; that the NHS has long waiting lists everywhere, particularly for surgery. The waiting lists are now very short and only a handful of UK people go overseas for surgery that they could have got free on the NHS. This has been covered recently in the Health Tourism Blog.

Since its launch 60 years ago, the UK NHS has grown to become the world’s largest publicly funded health service.

The NHS employs more than 1.5 million people, including:

90,000 hospital doctors

35,000 general practitioners

400,000 nurses

6,000 ambulance staff

On average, the NHS treats 1m patients every 36 hours – that’s 463 people a minute or almost 8 a second.

Each week, 700,000 will visit an NHS dentist, while a further 3,000 will have a heart operation.

NHS waiting times in England are now at the lowest levels since NHS records began with a median wait of:

7.7 weeks from referral to admitted patient treatment

4.2 weeks from referral to non-admitted patient treatment

1.9 weeks for a diagnostic test

98.1% of patients were seen, diagnosed and treated within four hours of their arrival at Accident & Emergency (The Emergency Room)