WRITTEN QUESTION E-3031/00

by Erik Meijer (GUE/NGL) to the Commission

(26 September 2000)

Subject: Shortage of capacity in Dutch hospitals and refusal by health insurers to pay for admission to hospitals in other Member States

1. The Commission recently revealed that the Netherlands has a poor record regarding the number of heart and liver transplants carried out and likewise regarding the number of surgeons, gynaecologists and cardiologists. Is the Commission also aware that, as a result of these shortages, which arise partly from past cuts in spending on health care and a big reduction in the number of hospital beds, waiting lists for various types of medical treatment at Dutch hospitals (endarterectomy, open-heart surgery, lung diseases, general surgery, neurology and dental surgery) have grown so long that many patients seek treatment abroad?

2. Does the Commission agree that every Member State of the European Union, and in principle every region within the Member States too, should itself be able to provide adequate hospital treatment for its residents, rather than relying on neighbouring countries to provide it instead, and that it is not acceptable if over a long period of time, due to inadequate capacity, the number of residents requiring hospital treatment abroad exceeds the capacity simultaneously available for treating patients from abroad?

3. Is the Commission aware, moreover, that health insurers in the Netherlands refuse to reimburse the cost of hospital treatment outside the Netherlands which it is desirable for patients to undergo on account of the inadequate capacity at home, or agree to reimburse it only in a few exceptional cases where the hospitalisation was not predictable, and that they do not accept the argument that the treatment provided abroad will be better or will be made available significantly earlier, so that only those who can afford to pay for the treatment themselves and those who have taken out costly policies providing additional cover for examination and treatment abroad are eligible for such treatment?

4. Are health insurers in EU Member States free to refuse to pay for treatment outside the country of residence, even if a lack of capacity in the country of residence means that essential treatment can only be carried out sufficiently promptly in other Member States?

5. If the answer to question 4 is affirmative, what will the Commission do to improve the position of patients as regards funding of necessary hospital treatment in a different Member State of the European Union?

Answer given by Mrs Diamantopoulou on behalf of the Commission

(15 November 2000)

The Commission is aware that waiting lists may exist for patients seeking particular types of treatment, but has no precise figures. The Commission understands that in the Netherlands funds have recently been allocated for reducing waiting times and that a long-term strategy has been agreed for managing waiting lists.

Regarding the right to reimbursement of medical expenses incurred in another Member State, at Community level we have Regulation (EEC) No 1408/71(1), Article 22(1)(c), which coordinates national social security systems and regulates precisely the kind of situation that arises when a person insured in a Member State goes to another Member State with the express intention of obtaining medical care and programmes of medication. This requires the person concerned to obtain prior authorisation from his/her health insurance scheme in order to be reimbursed for the cost of medical care.

In this situation, Regulation (EEC) No 1408/71 Article 22(2) stipulates that this authorisation may not be refused where the treatment in question is among the benefits provided for by the legislation of the Member State on whose territory the person concerned resides and where he cannot be given such treatment within the time normally necessary for obtaining the treatment in question in the Member State of residence, taking account of his current state of health and the probable course of the disease.

Consequently, the authorisation system concerned leaves significant discretion to the Member States as to whether they grant or refuse authorisation for treatment abroad, since the cost of treatment must ultimately be borne by the Member State in which the person is insured.

As for the possibility of obtaining reimbursement for medical expenses incurred in another Member State without authorisation, the Court of Justice passed judgment in the context of the two joined cases C-158/96 (Kohll v. Union des caisses de maladie) and C-120/95 (Decker v. Caisses de maladie des employés privés) on 28 April 1998. In these judgments, the Court held that the condition of preliminary authorisation for reimbursement for spectacles and dental care is not in line with the principles guaranteeing free movement of goods and the freedom to provide services if such authorisation is not required for internal transactions(2).

The Court of Justice has not yet ruled on the right to reimbursement for hospital care and is due to clarify its case law in connection with three other preliminar(3) rulings currently pending.

The Commission would also like to inform the Honourable Member that some Commission-sponsored joint health care projects, including several involving the Netherlands, are actively promoting cross-border health care in border regions where care obtained from institutions abroad may be more convenient in terms of distance and travel time for patients. To date, however, it seems that cross-border flows, even in these border regions, have been very small, at significantly less than 1 % of the total value of health service expenditure.

(1) Most recent consolidated version: Council Regulation (EC) No 118/97 of 2 December 1996 amending and updating Regulation (EEC) No 1408/71 on the application of social security schemes to employed persons, to self-employed persons and to members of their families moving within the Community and Regulation (EEC) No 574/72 laying down the procedure for implementing Regulation (EEC) No 1408/71 (OJ L 28, 30.10.1997).

(2) ECR 1998, I-1831 and I-1931.

(3) Cases C-368/98 (Vanbraekel and others v. Alliance Nationale des Mutualités Chrétiennes; C-157/99 (Smits/Peerbooms) and C-385/98 (Muller/Van Riet).