WRITTEN QUESTION E-3031/00 by Erik Meijer (GUE/NGL) to the Commission. Shortage of capacity in Dutch hospitals and refusal by health insurers to pay for admission to hospitals in other Member States.
Date: 2000-09-26
Institutions: European Parliament, Provisional data
Subjects: Netherlands, State health service, cross-border cooperation, health insurance, health legislation, hospital expenses, right to health, social security legislation

C 136 E/164

Official Journal of the European Communities

EN

8.5.2001

(cid:129) Italian territory has for some time been subject to a series of natural disasters resulting in loss of life,
disasters which were moreover foreseeable and often indirectly caused by a lack of preventive action
by the relevant public bodies;

can the Commission answer the following questions?

(cid:129) Has the Italian Government published a map of areas at environmental risk?

(cid:129) Are those areas receiving the attention of, and being monitored by, the Commission?

(cid:129) Are the Italian national authorities properly carrying out their duty to ensure the safety of European

citizens and protect the national territory?

Answer given by Mrs Wallstr(cid:246)m on behalf of the Commission

(10 November 2000)

The Commission deplores the loss of human life, injuries and environmental damage caused by the recent
floods at Solverato in Calabria.

The Commission is not empowered to act in this area and regrets that it does not have in its possession
the information requested.

However, the Commission would like to inform the Honourable Members that, under the Community
support programme for the Mezzogiorno during the 1994-1999 programming period, the Calabria region
received a contribution from the European Regional Development Fund amounting to € 57 million for
environmental-safeguard activities, one of which concerned the prevention of this type of hazard.

(2001/C 136 E/192)

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?

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Are health insurers in EU Member States free to refuse to pay for treatment outside the country of
4.
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?

If the answer to question 4 is affirmative, what will the Commission do to improve the position of
5.
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
(cid:145)programmes(cid:146) 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 (cid:145)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.(cid:146)

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 employØs
the condition of preliminary
privØs) on 28 April 1998.
authorisation for reimbursement
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).

for spectacles and dental care is not

the Court held that

In these judgments,

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 MutualitØs ChrØtiennes; C-157/99 (Smits/

Peerbooms) and C-385/98 (Muller/Van Riet).