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Following a period of transformation of approximately two to three years, patients will find easier conditions for treatment abroad, within EU

Under the European trade press meeting at IDS Cologne 2011, Alfred Büttner, director of the Office of the German Dental Association in Brussels reflects on the current status of dental patients' rights abroad and objectives EU policy.

Reflections prior to a directive on patients' rights abroad

Point
¿Cheap Replacing teeth abroad? ¿Dental tourism in Europe?
In the German media can be read these headlines again and again. At first glance one might assume that, in times of empty coffers there are many patients who regularly go to other European countries to treat their teeth. However, the figures do not speak in favor of this assumption. Despite the large increase in mobility that has occurred, activities beyond the borders remain an exception. According to estimates, only 1% of the treatments that are performed in Europe is done in another country (of course this figure does not account for emergencies such as accidents occurring during holidays). However, the European Union is about to clearly improve the legal basis for medical treatment in other EU countries, in the interests of patients.

It is planned directive on patients' rights abroad.

Europe, actor of health policy
The European Union is not generally known as a giver of impulses in health policy. And yet, in recent years the European Union has become a major player in health policy. The EU member states have formally sovereignty in the organization and financing of their health systems, and this basic division of responsibilities between EU Member States and the EU itself will also continue after the entry into force of the Lisbon Treaty (cf. Article 168 of the Treaty on the Functioning of the European Union). However, the EU may partly accompany the corresponding measures of health policy in the Member States and encourage cooperation between the Member States of the EU in the field of Health, including through comparisons of "best practice".
With this policy framework for international medical care within the EU will be created, including the reimbursement of expenses.

Moreover, the EU has specific competence:
- In the fight against international dangers that threaten health.
- He is responsible for the high standards of quality and safety of organ transplantation, human tissue and blood, as well as high standards of quality and safety of drugs and medical products.
- In addition, medical treatments are classified in principle as supplies of services. Thus, all internal market legislation in the EU have considerable consequences in part on the provision of medical services.
- Finally, the Court of Justice of the EU has contributed, with a favorable consumer law, or rather "patient friendly" to facilitate patient mobility.

Objectives of the EU health policy
First, the EU wants to fight in the interests of patients, the inequalities existing national health systems.

Another argument by the EU for uniform action across Europe is the increasing mobility of high school and university students, workers and retirees in Europe.

Furthermore it is desired to develop an internal market in health services also. Now it is recognized that it is not "normal" services. Especially dental care requires training and capacity of high quality.

To provide treatment to patients in other countries, from the point of view of the EU, a legal framework which protects patients, somehow complementing the open markets of health, at a high level is required. The same is true of the rights of consumers.

Against this background, the directive on the rights of patients in the planned abroad is practically a model legislation in the health sector.

Content of the directive on patients' rights abroad

Undertone
Already today, EU citizens can ask your insurance to cover their dental treatment in other EU countries, in the same volume as would be the case in their country of origin. The basis for this is the law of the Court of Justice of the EU that has existed since 2003. Despite that case-law remains insecurities; detail many issues are unresolved. While some EU member states such as Germany have transformed the European Court of Justice in national law, other states do in practice ignore such right to reimbursement of expenses.
With this policy framework for international medical care within the EU will be created, including the reimbursement of expenses.

The reasons are obvious: you want to avoid that patients migrate, which would produce an economic collapse of the health system itself. Also in the debate on the services directive, adopted in 2006, it has raised the question of whether the health sector should fall into the scope of the directive or not; She was ultimately rejected. All these circumstances were the cause of the EU committee in 2008 present a proposal for a directive on patients' rights abroad.

End of the directive on patients' rights abroad
With the directive concerning patients' rights abroad, safeguarding the competence of Member States and on the basis of the European Court of Justice, a framework for international medical care within the EU will be created, including the repayment expense. Reference should be made to not just urgent cases that occur suddenly, but planned street or stationary treatment; ie also of dental treatments. However, the draft directive is not limited just to the beginning of the return of expenses, developed by the Court. It also contains wider proposals, all of which aim to create the practical conditions for mobility of patients outside the country.

Content of the directive on patients' rights abroad
- Prior permission and refund of expenses:
Based on the Court of Justice, the right to reimbursement of expenses that have arisen treatment abroad it will be approved. The amount will be guided by the return of costs in the country of origin.

However, for any steady-state treatment prior permission will be required. In certain circumstances, Member States may deny the permit; what it is still debate when and how much will be approved.

It is also debated whether all the medical treatments fall into the scope of the directive. For example there is a lively debate between Parliament and the European Council concerning the integration of rare diseases.

- Quality standards:
To ensure all patients an adequate level of health treatment, Member States are to define on their territory standards and clear guidelines for the quality of health services and continuous mode adapted to scientific progress.

- Establishment of European reference networks:
It is envisaged the creation of European reference networks, with the participation of patient groups and representatives professions; the EU Member States cooperate closely here.

- EHealth: eHealth; ie electronic health services play a key role in international health care; European standards will facilitate interoperability of electronic health services. It is unclear whether and to what extent the EU Commission should be given greater influence via the method of regulation; ie comitology method to ensure the interoperability of electronic health services in ordinary life.

Creation of national contact points:
The Member States, with the participation of patient organizations, certain diseases and health service providers, establish national contact points to serve as places where patients can go.

- Comprehensive patient information:
Through the national contact points, patients will receive comprehensive information on the possibility of treatment in another EU country.

In addition, the healthcare provider will inform patients about relevant issues, so that patients can make a decision about treatment.
To Büttner, the directive is an important step towards a European internal market in the health sector.

As for the information, it is:
1. Standards and quality guidelines, including national provisions for monitoring these standards.

2. The existing treatment possibilities.

3. transparent prices.

4. Possible access for people with disabilities.

5. Status of registration of a borrower of health services and possible restrictions of professional activity.

6. The existence of insurance protection or other forms of personal or professional responsibility system provider of healthcare services.

7. Possible legal remedies in case of damage.

In general, Member States have to address the points on which these rights are based is actually information given.

Current status of consultation at European level
The draft directive has come a long and controversial way. The Commission proposal dates back to 2008. The decision on the directive itself will take the European Parliament and the Member States represented in the Council, as co-legislators on an equal footing. While the European Parliament has already closed its first reading in April 2009, the Board continued the controversial debate until June 2010. Only then were able to agree politicians. We are currently in the stage of second reading in the European Parliament. The aim of the EU institutions is to achieve a consensual unity between the Council and Parliament. However, even now a dispute between the moderate position of the Council and the European Parliament's position is outlined, "more favorable for patients."

Sighted
I predict that, despite the differences, consultations on the directive finalized in early 2011. Following a period of transformation of approximately two to three years, patients will find easier conditions for treatment abroad, within EU. Let's wait to see to what extent patients make use of this offer. According to hope, will benefit from this national health systems are at a high quality level, which will be attractive to patients and health systems that are able to offer certain benefits to a level of more attractive prices. In any case, the directive is an important step towards a European internal market in the field of health.
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