Expat Essentials

If you’re on a medical waiting list (or know someone who is) you need to know about this EU cross-border healthcare directive

I’m not convinced doctors are aware of the existence of the directive

I can’t remember how exactly cross-border healthcare came to my attention, possibly it was posted on one of those “What has the European Union ever done for us?!” threads that I stumbled upon on social media. For those in the dark, cross-border healthcare means in simple terms that if you are on a waiting list for a medical procedure – knee, hip, and shoulder replacements spring to mind immediately being that they are fairly common operations – then you can elect to have the procedure carried out in another EU country AND have your costs covered by your health service wherever you live, be it Spain, Ireland, Germany, Italy, France etc.

Directive 2011/24/EU on patients’ rights in cross-border healthcare is the go-to document and sets out very clearly the conditions under which an individual may travel to another EU country to receive medical care AND have the costs reimbursed (including healthcare costs as well as the prescription and delivery of medications and medical devices).

Without going into granular detail about Directive 2011/24, one paragraph – paragraph 31 – in particular stands out as being clear and unambiguous about cross-border healthcare:

… any patient who requests an authorisation to receive treatment appropriate to his condition in another Member State should always be granted this authorisation under the conditions provided for in the Unions regulations when the treatment in question is among the benefits provided for by the legislation in the Member State where the
patient resides and when the patient cannot be given such treatment within a time limit that is medically justifiable, taking account of his current state of health and the probable course of the condition ….

Knowing about the directive is a start. However, having had the opportunity to talk with people, I’m not yet convinced that doctors themselves are fully aware of the existence of the directive. If they are, it’s certainly not front of mind for them.

Case study

Someone whose doctor certainly didn’t know is William Goodwin. William was diagnosed with a degenerative hip at the relatively young age of 37. He spent years on painkillers and various other medication having been told by his doctors that at 37 he was too young to have a replacement hip. A few years later and unable to walk more than a few meters, the National Health Service agreed he was to have his hip replaced at the first opportunity. However, two years on and no closer to having the situation resolved he was still waiting, passed back and forth between two health authorities.

In December 2018, William decided that enough was enough, and out of desperation he decided to go it alone. With the help of Google, he researched “best places in Europe to have hip replacement surgery,” allowing him to narrow down his options. As luck would have it a friend of his lived in Lithuania and was not only able to offer help, he also knew of someone who had undergone a similar procedure carried out by a local and leading orthopaedic clinic.

A few weeks later, and at a cost of 7,000 euros (including flights and hotels), William had received his new hip. (Editor’s note: For reference, the price of a hip replacement in the United States is at least $30,000.)

It was during his time in Lithuania that William had rather belatedly become aware of the EU directive. Nordorthopaedics Clinic, which carried out the procedure, furnished William with all the necessary information and forms. However, despite completing and submitting the necessary paperwork, NHS England declined to reimburse William solely because he had failed seek authorisation before making the trip.

Some countries do allow individuals to claim a reimbursement for cross-border healthcare without first receiving authorisation from their doctor. But the advice is always, “check and always seek authorisation beforehand to avoid disappointment.”

Three years on from his operation William is now very active and pain free, he also spends time offering a helping hand, advice and reassurance to people in his position, determined to make sure that they don’t make the same mistakes that he did.

Over the years, I’ve personally known a good few people who have been on waiting lists for replacement surgery, and only last year, my husband’s close relative paid for a hip operation to be carried out privately. He, like me, was completely unaware of Directive 2011/24/EU. So if you do know of anyone in that position maybe give them a gentle nudge.

Of course those living in the UK will, sadly, no longer be able to take advantage of cross-border healthcare. However British expats (any expats for that matter) resident in an EU country can still take advantage of Directive 2011/24/EU. If you need any further information, your first step should be to contact your doctor.

However, I’m sure that William would be only too willing to offer advice, you can contact him by sending me a message at: [email protected] and I shall pass on your details.

About the author:

Irina Greensitt is from the far eastern town of Khabarovsk in Russia, but lived in the United Kingdom for seven years before moving to Spain in 2014 with her husband and two young children.

Irina now runs an internet business and lists walking, travel and sailing (passing her skippers exam in 2016) amongst her hobbies. 

See all of Irina’s posts here.

See more from Dispatches’ Spanish archive here.

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