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Health Insurance and Europe Hungary’s example

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Presentation on theme: "Health Insurance and Europe Hungary’s example"— Presentation transcript:

1 Health Insurance and Europe Hungary’s example
Peter Ötvös, National Health Insurance Fund, Hungary

2 Brief Outline Overview of the European Legislation Co-ordination of Social Security as a Tool for the Free Movement of Persons Freedom to Provide Health Care Services – Questions related to Financing Planned Directive on Cross-Border Health Care Cross-Border Co-operations

3 Rules Related to Health Insurance
Council of Europe (Strasbourg): European Social Code – basic principles European Social Charter – basic standards Model-agreement for co-ordination EC-Treaty: Free movement of persons Free movement of services Co-ordination-regulations: 1408/71, from 2010: 883/04 Planned directive on health services mandatory only for ratified articles

4 Co-ordination of Social Security in the EU
Co-ordination = Harmonisation Means: EC-Treaty (Art. 42) Regulation (EC) 1408/71 and 883/04 Jurisprudence of the European Court of Justice Decisions of the Administrative Commission Mandatory application !

5 Principles of Co-ordination
Single State of insurance Equal treatment (no discrimination, equal rights and access to services) Aggregation of periods of insurance (consideration of insurance periods in other Member States) Export of benefits (payment to other Member States) AIM Ensuring that persons are not disadvantaged in terms of social security when they move from one Member State to the other

6 Applicable legislation – a single State
Legislation of the State where the person is employed a single State is responsible for insurance

7 Special rules - posting
Company in another Member State Hungarian company State of employment Sending State Currently months, from 2010: 24 months

8 Sickness and maternity
EQUAL TREATMENT Care which becomes medically necessary during the temporary stay (as of 1/06/2004) Also: dialysis, oxygen therapy, chemotherapy Right to all services (residence in other Member State) Authorised treatment in another Member State

9 Competent institution Institution of the place of stay
Temporary Stay Competent institution Authorisation for treatment in other Member State Health care provider Insured person Institution of the place of stay

10 This procedure applies for
Tourists Posted workers, workers in international transport, posted civil servants Students Unemployed seeking employment in the other Member State („unemployment tourists”) their family members

11 Use of the EHIC the entitled person can directly consult a service provider with the EHIC or the replacement form (no former administration) most of the Hungarian service providers are contracted with the NHIF practically no co-payment exists

12 In case of lack of entitlement certificate
the service provider can issue a bill – the exact costs of the medical treatments in these cases are fixed in a protocol, which might be different for each provider Conditions: - no discrimination, same price for the same service, - the price has been made public at home: reimbursement the treatment costs at the tariff used in the country where the care has been provided

13 Planned medical care and rehabilitation
authorization of the competent authority at home pre-check by the service provider is necessary without form the doctors are not obliged to provide the treatments or no reimbursement is due Spa is only available upon referral Dental treatment to a very limited extent!

14 Entitlement of residents
insured persons with residence outside the competent state, e.g. diplomats, frontier workers and the members of their families pensioners and the members of their families entitled to all benefits in kind =

15 Use of the entitlement forms
the forms are issued by the competent authority and answered by the health insurance institution the forms are not directly applicable at the service provider An insurance number/certificate will be issued for the entitled person Institution of the place of residence Competent institution examination; registration

16 Example: Health Care for Residents in Hungary
entitled person  Hungarian health care provider TAJ NHIF   Pharmacy

17 From May 2010 (?) New Regulations What changes?
Modernized and Simplified Regulations ‘simplification’ would not necessarily make the procedures easier Expected for 1st May 2010 – with a transitional period of 2 years Always the more favorable provisions apply Dynamic Process – Electronic Exchange of Information: SED Making Citizens’ Rights More Effective – Efficient Service and Information

18 EESSI Network – Exchange of ‘SEDs’
CI CI CI CI CI National Network Member State 2 CI National Network CI CI Member State 1 EESSI International Network sTESTA CI National Network Member State 3 CI National Network Member State “n” CI CI CI National Network CI National Network Member State 4 CI CI CI CI CI Coordination Node CI Competent Institution Access Point Source: European Commission 18

19 EESSI information flows
What a Mess! God Save the Health Insurance Administrations! Portable Forms & Paper SEDs

20 Freedom to Provide Services
Legal Basis: EC-Treaty Interpreted by judgments of the European Court of Justice Health Care = Service (with some limitations) Consequence: all obstacles shall be eliminated Difference to the co-ordination: no equal treatment but the services shall be regarded as if they were provided in the home country Reimbursement at domestic tariffs

21 Most important ECJ-Judgments
1998: Mr. Kohll and Mr. Decker (LU): Health care provided in another Member State is to be reimbursed according domestic tariffs 2001: Ms. Geraets-Smits and Mr. Peerbooms (NL): Prior authorization may restrict the freedom of services only if necessary and proportionate Ms. Vanbraekel (BE): The highest possible amount shall be reimbursed 2003: Ms. Müller-Fauré (NL): No authorization for out-patient treatment 2006: Ms. Watts (UK): Reimbursement is due even if there are no domestic tariffs (rate: 100%)

22 A Planned Directive on Cross-Border Health Care
Aims: Transposition of the Court judgments Guaranteeing the freedom to provide health care services (guidelines and standards) Enhance patients’ rights (non-discrimination, correct price setting, information, medical records) Reimbursement of planned treatment (at domestic rates) Recognition of prescriptions European Reference Network Co-operation in eHealth and Technology Assessment still debated

23 How to Seek Health Care in Europe?
Planned treatment Unexpected treatment Out-patient In-patient Authorization Domestic tariffs Full reimbursement NO refund

24 Working Cross-Border Co-operations
Current Situation (Survey by HOPE) Provision of health care in border regions (Belgium-Netherlands-Germany, Northern Countries, UK-Ireland); Co-operation between providers

25 Thank you for your attention

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