Conclusions and recommendations
88. We think that a system of prior authorisation
is necessary. This will
protect the financial resources of Member States' healthcare systems.
It will also allow clinicians to explain clearly to patients the
treatment options available to them, including their respective
advantages and disadvantages. This is particularly important to
enable patients to make an informed decision and consider properly
all of their treatment options and the corresponding practical
arrangements, such as translation services (see Chapter 5).
89. A system of prior authorisation under which
a patient is reimbursed after having made a payment in the host
Member State raises issues of equity as it will exclude those
without the necessary financial resources from using cross-border
treatment. However, we recognise that issuing funds to the patient
in advance of treatment could increase the risk of fraud, a risk
that must be assessed by the Commission when reviewing the application
of the Directive.
90. These issues could be tackled by providing
that once prior authorisation has been granted, it should be
possible to transfer funds from the provider in the home Member
State directly to the provider in the host Member State. However,
in line with the principle of subsidiarity and given the different
systems in use across Member States for payment, it is important
that Member States maintain flexibility to decide whether to transfer
91. We are concerned that the definition of hospital
care does not adequately reflect clinical reality across the EU
and we query the need to distinguish between hospital and non-hospital
care for prior authorisation in the manner proposed by the Commission.
Instead, we suggest that the guidance of the European Court of
Justice should be used, whereby prior authorisation can only be
justified by overriding reasons of general interest. In recognition
of the different health systems and methods of financing across
the EU and in line with the principle of subsidiarity, we recommend
that it should be for each Member State to decide when prior authorisation
is required, subject to the principles laid down in the ECJ's
92. We agree that, where a prior authorisation
system operates, patients must have a right of appeal in case
prior authorisation is refused. This right will be distinct to
each Member State and it should be clearly communicated to the
patient, along with the procedure for exercising this right.
Failure to do so could constitute an unnecessary barrier to patients'
rights to seek cross-border healthcare.
93. We recognise the potential for Article 6
of this Directive to impact upon the equity of cross-border healthcare
and note that the prospect of additional costs may deter some
people from seeking cross-border healthcare. We consider that
it is for Member States to determine the rules for "top-up"
payments, both for medical care and for prescribed medicines.