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Sunday 27th May 2018

Payment for treatment abroad

31st May 2006

31052006_walking_stick1Q.jpgThe European Court of Justice in Luxembourg has ruled the NHS must reimburse UK patients who travel to another European Union member state for treatment when they face “undue delay� at home.

The ruling involves the case of Yvonne Watts, 75, who had a ÂŁ4000 hip operation in France, but was told that Bedford Primary Care Trust would not pay for it. This judgment will have significant implications for the NHS, although the Department of Health said that the wait for a hip operation was now down to six months.

The European court judged that EU rules on free movement of services oblige a healthcare system in one EU state to pay the cost if a patient goes to another member state because of delays.

A high court judge had ruled in 2003 that Mrs Watts should not be reimbursed because the three to four month wait she faced did not amount to an undue delay; the case will now go back to the Court of Appeal, which referred it to Europe, to decide whether Mrs Watts should get her ÂŁ4000 back. Mrs Watts was originally told she could expect to wait 12 months when she was put on a waiting list for the operation in October 2002. In February 2003 she was told a slot was available on 6 May. She then opted to go to France instead, where she had the operation on 7 March.

The Luxembourg court has ruled in the past that healthcare insurers in one state must pay for patients to have health care in a neighbouring country if there are undue delays at home, but the Department of Health argued that because the NHS was different from the other EU systems the principle did not apply. Luxembourg judges have now said that the obligation to reimburse the cost of hospital treatment provided in another member state also applies to a national health service which provides such treatment free of charge.

They went on to say that to be entitled to refuse a patient authorisation to receive treatment abroad on the ground of waiting time for hospital treatment in the state of residence, the NHS must show that waiting time does not exceed a medically acceptable period having regard to the patient’s condition and clinical needs.

Bedford Primary Health Care Trust refused to issue Mrs Watts with authorisation for EU treatment on the grounds that her operation could be provided within the government’s NHS Plan targets and therefore without what the Trust regarded as undue delay. However the judges said the decision on what amounted to an undue delay should not be based on NHS waiting lists or government targets, but only on the individual patient’s medical condition and circumstances.

The chairman of the BMA’s international committee, Dr Edwin Borman, said, “When patients seek treatment overseas, doctors should be free to make a decision based on their clinical need."

The chief executive of the NHS Confederation, Gill Morgan said that as the NHS moves towards treating every patient within 18 weeks, problems like this should cease to be an issue. If patients do need to wait, then trusts will ensure that those patients are kept under review in case their situation should deteriorate.

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