Europe opens the door to a medical marketplace

  • Belgium adopts the directive for a medical Europe without borders.
  • Numerous restrictions remain.

Kholl and Decker must be blushing with pleasure. Despite themselves, these two Luxembourg residents are responsible for a European directive that will gently revolutionize health care. One bought a pair of eyeglasses in Belgium, and the other sought orthodontic care in Germany. To their surprise Luxembourg refused to reimburse them. Years later, in 1998, the European Court condemned Luxembourg resulting in a swarm of legal actions in the health care sector. The case also inspired a directive making national health systems permeable. Approved in 2011, the directive must be adopted into national legislation by October 25th. Belgium is putting the final touches on the text, which is to be published in Le Moniteur by the end of the week.

“Medical progress means that health services can no longer be offered on a strictly national basis. Sometimes, people have to cross borders to receive care,” said Françoise Grossetête, the text’s sponsor in the European parliament, in 2011. She went on to say that although individuals may go elsewhere to receive quality care, Europe is not a medical supermarket. “We have to clarify some misconceptions,” said Inami’s Chris Segaert, “because the new directive does not completely open up the market, instead it organizes the market: many benefits will still require authorization.” Philippe Loncke (Christian Mutual) adds, “It also provides a way to deal with the risk of destabilizing national systems.” 

1. The current situation. European regulations coordinating social security systems already allow receiving benefits in other countries with prior authorization. They are managed by the national social security system without any outlay of funds except on the patient’s part. This only applies to benefits within the public health care system. The same thing applies, often without prior authorization, for a number of ambulatory services, including dentistry and family medicine.

2. The new directive’s principle. The directive clarifies the rules for everyone. An individual may receive care in another country in the public system, and in the private system for planned services or unexpected needs, such as during a vacation. The patient must pay for the treatment. He will in turn hand the bill to his own country’s mutual. Payment will be made on the basis of the treating country’s rate as long as the benefit is reimbursable.

3. Restrictions in the new directive. Each state has the right to establish a list of procedures for which prior authorization is required. For Belgian patients every procedure that requires at least one day of hospitalization will require prior authorization. That authorization will only be given if the procedure cannot be provided in Belgium within a reasonable time period. The same restrictions apply to some medical imaging and radiation therapy.

4. In practice. Each country must create a “point of contact” dedicated to this issue. In Belgium Inami will serve as the contact for foreign patients. On the other hand for those who are affiliated with Belgian social security, the mutuals are the contact point. They will determine which is the most advantageous: the “rule” (see 1) or the new directive. Additionally, each country must support the creation of “European referral networks” to allow patients to seek expertise in other countries that may not exist in their own. As Inami itself acknowledges, all of the work on this matter is still to be done.


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