Der europäische Patient ‒ Verordnungen können Verantwortung nicht ersetzen

Abstract

Cross-border health care services and their remuneration are regulated in two ways in the EU. On the one hand, European secondary law, through Regulation (EC) No. 883/2004, provides an insured person a direct entitlement for the use of selected services in other European countries. In addition, the implementation of the Patient Directive 2011/24 / EU into national law has created a further basis for claims for reimbursement of costs for the import of medical services by the health insurance company. It is problematic that the two regulatory circles differ, but also clearly overlap, especially for services in the outpatient area. For service providers, for example the treating resident doctor, it is not possible to objectively recognize the legal basis on which his patient is to be treated, he dependends on the patient's honest self-disclosure. That determines whether he provides free benefits in kind or whether he provides his services to the patient for direct payments.
Because the treatment of foreign guest patients can take place outside of national budgets and price degressions of medical services do not apply, treating foreign guest patients is frequently more attractive than treating national patients.
For the patient, however, this is goes along with the risk of being reimbursed only for a part of his expenses by his insurance company. This is why from patient’s perspective there is often an incentive to fall within the scope of Regulation (EC) No. 883/2004. Here he does not have to make financial advance payments for benefits received in kind: the attending physician balances accounts with a national insurance as a helping out carrier, who in turn settles with the patient's home health insurance company.
In view of the discretionary scope for decision-making, the responsible, rule-compliant behavior of the actors is central to the functioning of cross-border European health care. The legal basis alone cannot prevent individuals - doctors or patients - from gaining advantages at the expense of the insured community. Given a significant increase in the number of benefit claims in other European countries in recent years, this is becoming increasingly important for the integrity of the health insurance system.