EU域内で医療アクセスの自由化/欧州医療事情

 EU域内27ヶ国でどこでも事前の認可なしに医療を受けられるようになる。承認されれば2010年から施行される。
 「医療旅行(医療ツーリズム)」の大規模な増加を恐れるいくつかの国のため何ヶ月も延期されていたが、待機リストが長い国に住んでいる住民にオプションを拡張することができた。しかし、受給資格は、母国で公的に提供される治療にだけあてはまり、医療費払い戻しは、その国でかかる治療費の範囲に留まる。
 ヨーロッパ人が、彼らが医療を受け取る国の国民と平等な待遇を与えられなければならないとしている。患者が国境を越える医療への権利を行使することができる方法で明確化することをめざしているという。
 EUでは過去1年に4%の人が別の加盟国で治療を受けたという。
 英国ではNHSからの支払いが増加することを恐れているが、英国政府は追加の受給を防止するための十分な免責を得たという。
 普遍性・アクセス可能性・平等は医療の根本的な価値を構成するものである。
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European Plan Would Expand Health Care Access Within the Bloc
http://www.nytimes.com/2008/07/03/world/europe/03health.html?_r=1&oref=slogin

By STEPHEN CASTLE
Published: July 3, 2008

PARIS ― People living within the European Union will be able to receive most health care treatment anywhere in the 27-nation bloc without getting prior authorization if a long-awaited proposal published on Wednesday becomes law.

画像Olivier Hoslet/European Pressphoto Agency

Androulla Vassiliou, the European health commissioner, said a proposal clarifies how patients can exercise their right to cross-border health care in Europe.

Postponed for months because of fears in some countries of a large-scale increase in “health tourism,” the plan could extend options to European residents who live in countries where waiting lists are long.

But the entitlement applies only to procedures that are publicly financed in European residents’ home countries, and reimbursement would be only up to the amount the procedure would cost in that country.

The small print of the draft also allows countries to introduce a system under which their residents abroad would require prior authorization before seeking in-hospital overnight treatment and some outpatient treatments, like cataract operations.

The measures, which have to be approved by governments and the European Parliament, would apply to all residents in the union and could be put into effect in 2010.

They were issued Wednesday as part of a social agenda package that also includes a proposal for a new directive to combat discrimination on grounds of religion or belief, age, sexual orientation and disability.

The health proposals would clarify the law for governments that have already been forced to offer reimbursement to patients who travel abroad because of judgments in the European Court of Justice.

Under the draft law, patients will have to pay upfront for treatment but will be entitled to reimbursement. The legislation says that Europeans must be given equal treatment with the nationals of the country in which they receive health care.

“This proposal aims to clarify how patients can exercise their rights to cross-border health care, while at the same time providing legal certainty for member states and health care providers,” the European health commissioner, Androulla Vassiliou, said in a statement.

According to a survey published last year by Eurobarometer, which monitors public opinion for the European Union, 4 percent of Europeans had received medical treatment in another member state in the previous 12 months.

Patients in border areas are most likely to take advantage of another country’s health service; in Luxembourg, every fifth citizen had sought health care abroad, the survey found.

It said that more than half of Europeans were open to travel to another country to seek medical treatment, usually in the hope of quicker or better quality treatment.

European citizens can be reimbursed now for urgent treatment anywhere in the bloc, providing they contribute to a health insurance program at home.

But for nonurgent care, including procedures like hip operations, they first need permission from their insurer. That will change in most cases, and the insurer will be obliged to offer reimbursement as if the treatment were carried out at home.

In Britain, where medical services are provided by the state without health insurance, the National Health Service will make the reimbursement, raising fears among some that the measure will prove expensive for the government.

But the British government has won enough exemptions to prevent significant additional entitlements.

Dr. Terry John, chairman of the British Medical Association’s International Committee, said it was “understandable” why some people want to seek treatment abroad.

“However, these proposals must not be allowed to erode the fundamental values of universality, accessibility and equality that should underlie health care,” he said. “Patient mobility must not just be for the wealthy and educated.”

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