The European Union (EU) directive on cross-border treatment will apply to private insurance providers, the EU health commissioner Androulla Vassiliou has said, sparking fears that private medical insurance (PMI) premiums may rise.
The Association of British Insurers (ABI) has voiced concerns that such an application could lead to higher insurance costs which would be passed on to consumers.
“The application of the directive as drafted by the commission to PMI in the UK is not clear,” said Kelly Ostler-Coyle of the ABI. “On balance we would prefer to remain excluded. Cross-border healthcare can only increase, but British insurers would prefer to offer this at our own pace, driven by policyholders’ needs and safety, rather than be forced to it by legislation.”
A report produced by the House of Lords in February welcomes the directive, which would give patients the right to access healthcare in member states funded by the NHS, but it warns that its impact is “unpredictable” and must be carefully monitored.
The Lords recommend that a patient’s own healthcare provider should pay the fees directly to the provider in the member state. Their report also states that patients must be educated about their rights under the directive and the quality of care that they can expect.
Baroness Howarth of Breckland, chairman of the House of Lords EU sub-committee on social policy and consumer affairs, said: “We are pleased that the European Commission is proposing to give patients across the EU clear guidance on their right to cross-border healthcare. The current ad hoc arrangements are unsatisfactory and clear new rules are essential. Most patients will still want to be treated locally but everyone will at least have the opportunity to seek healthcare abroad, and to do so in possession of detailed information on what they can expect at each stage of the process.
In 2006 the European Court of Justice first ruled that British patients who face an “undue delay” for treatment at home can be reimbursed if doctors agree that treatment abroad is justified because of pain, disability or other pressing medical needs.
Research suggests that when the directive is implemented the actual take-up will be very low, with patients tending to express a preference for treatment near home. The London Patient Choice scheme offered 1,000 patients the choice of being treated abroad but the proportion favourable was so small that the scheme was ended in 2005.
However, a Eurobarometer survey carried out in 2007 found that 54% of UK citizens were open to the idea of travelling to another EU country. Almost 90% of this number cited quicker access as a factor compared to 61% in France and 64% across the EU. Of the 42% not willing to travel the vast majority (95%) said it was more convenient to find treatment at home. UK citizens were more likely than those in other states to be deterred by the language and financial implications.
“It is the ABI’s view that this directive should not apply to UK private medical insurers as our products are entirely voluntary,” said Julian Ross, head of policy communications at Standard Life Healthcare and a member of the ABI’s PMI committee. “This is in contrast with other EU countries where private health insurance is usually part of the social security system.”
He said that even if the directive were to apply to UK insurers it would be unlikely to have a significant impact on demand for PMI in the UK.
“I suspect the main reasons why people on the NHS would travel to an EU state would be to get treatment more quickly,” he said. “And obviously that concern is in effect removed for PMI insured customers who can get access to treatment quickly anyway. The vast majority of people will want to be close to home when they’re ill and would prefer not to have to travel abroad for their treatment.”
However, Ross highlighted an industry-wide concern about the potential impact of people becoming aware of the variations in healthcare offered across the EU.
“If they find there’s a treatment in the EU that isn’t available here yet they will be looking to access it,” he said. “You are then into a position where people will be saying “they provide it in Belgium” and demand it here.”
“There might be very good reasons why it isn’t available,” he pointed out.
Ross warned that this could accelerate demand and push up premiums.
“UK insurers price their products based on the healthcare available in this country. Prices already tend to rise each year because our cover constantly expands to include new treatments as they become available in the UK. Premiums could be pushed even higher if insurers are put under pressure to include cover for treatments that are available sooner in other parts of the EU.”