1. CURRENT ISSUES
1.4. Buying from non-UK providers
1.4.1 Could the Department please update
the information provided in response to last year's questionnaire
concerning NHS spending on health care provided outside the UK?
[1.4.1]
1. There are two separate systems in operation.
Regulations (EEC) 1408/71 and 574/72 co-ordinate the social security
and health care systems of the member states of the European Community
and the European Economic Area. These Regulations cover, amongst
other things, emergency health care for temporary visitors (the
E111 arrangements) and referral of patients specifically for treatments
of pre-existing conditions (the E112 scheme).
2. A direct referral scheme outside the
scope of the European Community arrangements is also available
in England. Between January and April 2002 there was a pilot scheme
in south east England whereby a number of surgical procedures
were commissioned directly by the NHS from healthcare providers
in France and Germany. One hundred and ninety patients were treated
under this pilot at a cost of £1.1 million.
This was extended for orthopaedic treatment
overseas, with patients drawn from five different areas at a further
£2.1 million cost. A total of 477 patients to date have been
referred for treatment abroad as part of the overseas treatment
programme The option of receiving treatment abroad has also been
offered as part of two patient Choice pilot schemes. The London
Patient's Choice Project has spent a total of £148,766 on
funding overseas treatment. This includes all programme costs,
for treatment, travel, comprehensive rehabilitation and outpatient
clinics run within the UK by European clinicians.
A total of 19 cardiac patients have to date
also been treated abroad. Costs are not yet available.
3. The data in Table 1.4.1 below
shows, in resource terms, costs of treatment provided under the
terms of the EC Regulations to UK insured persons. Actual treatment
costs are used for both emergency care (E111) and for patients
referred specifically for treatment (E112) as well as other categories
of persons covered. But claims do not necessarily distinguish
between categories so that no cost distribution between E111 and
E112 arrangements is available. Patient numbers are not available
since claims may cover several episodes of care for a single individual.
However, the UK approved the following number of patient referrals
under E112 arrangements as follows:
| 2000-01 | 1,075
|
| 2001-02 | 1,167 |
| 2002-03 | 1,070 |
4. Lump sum costs cover, in particular, state pensioners
who have relocated to other member states; the costs of their
health care lie with the member state paying the pension (unless
they also have a pension from the member state of residence).
5. No precise information is available on types of treatment
covered. For E111, emergency care covers the range from minor
ambulatory care to major trauma. E112s cover maternity care, ongoing
treatment begun in the UK, specialised care not available in the
UK and care for which there is a long UK waiting time.
Table 1.4.1
EXPENDITURE/INCOME UNDER REGULATIONS (EEC) 1408/71 AND
574/72
| | | (£'000)
|
|
| Year | Claim type
| Other Member States
claims against the
United Kingdom
| UK claims
against other Member States
|
|
| Total | 188,400
| 25,500 |
| 2000-01 | Actual cost
| 26,600 | 13,300
|
| Lump sums | 161,800
| 12,200 |
|
| Total | 231,900
| 31,300 |
| 2001-02 | Actual cost
| 28,200 | 15,800
|
| Lump sums | 203,700
| 15,500 |
|
| Total | 249,700
| 31,500 |
| 2002-03 | Actual cost
| 26,500 | 14,200
|
| Lump sums | 233,200
| 17,300 |
|
Notes:
1. Figures relate to the UK and are based on the latest
available information as used in the 2002-03 Resource Accounting
and Budgeting (RAB) outturn exercise. This information is compiled
in line with the requirements of "Government Accounting 2000"
and National Audit Office (NAO);
2. Claims against the UK are made in national currency
and converted in sterling by using the quarterly mean exchange
rates published by the EU Commission;
3. Actual costs under Article 93 of Regulation 574/72
include E111s (temporary visitors) and E112 cases (referred patients);
4. Lump sums under Articles 94 and 95 of Regulation 574/72
include E121s (pensioners).
5. £334 million initial resource provision has been
made in the Estimates for 2003-04 for treatment under the Regulation
in other EC member states
|
