The implementation of Directive 2011/24 in Austria: current status and future perspectives

1. The implementation of Directive 2011/24 in Austria:current status and future perspectives Dr. Martin Gleitsmann Head ofSocialPolicyandHealth Department Austrian Federal EconomicChamber ConvegnoAiopGiovani Lazio, 13.2.2014

2. current status Directive2011/24 on patient‘srights in cross-borderhealthcare: • noimplementation in Austria yet, but at the final stage • scheduled: • nextTuesday (18.2.2014): Council of Ministers • Parlament • Entry intoforceassoonaspossible

3. implementing laws • Law on the „Gesundheit Österreich GmbH“ • Supplementary Law to the General Social Security Act (SV-EG) • Federal Hospitals Act (KaKuG) • various occuptational laws (Law on Doctors, Law on Music Therapy, Law on Psychotherapy, Law on Dentists etc.)

4. national contact point 1/2 • the „Gesundheit Österreich GmbH (GÖG)“ will bethe national contactpoint (NCP) • web presenceofthe NCP at thepublichealthportal(www.gesundheit.gv.at); link tothe NCP web presence on themainpageoftheMinistryofHealth (www.bmg.gv.at) • information via webpageande-mail

5. national contact point 2/2 • German and English language • The GÖG has to inform the employers‘ and the employees‘ representations on its activities („jour fixes“) • liability exclusion for the GÖG concerning completeness and permanent availability of information

6. reimbursement of health care costs:current status 1/2 Austria alreadyknows a reimbursementsystem: • legal basis: § 150 ASVG (inpatient care) and § 131 ASVG (outpatient care) and parallel provisions • mainprinciples: • inpatientandoutpatient care receivedabroad will bereimbursed • nopriorauthorisationrequired

7. reimbursement of health care costs:current status 2/2 • level of reimbursement: • outpatient care: 80% of the costs, that the competent health insurance institution would have paid to a contracting partner for the treatment • inpatient care: costs that would have occurred had the patient undergone treatment in an Austrian hospital, which is not financed by the provincial funds and which is no contracting partner -> the level of this grant is regulated in the statutes of the health insurance institution

8. reimbursement of health care costs:implementation of the Directive 1/3 • legal basis: § 7b Supplementary Law to the General Social Security Act (SV-EG) • main principles: • prior authorisation needed for • inpatient care • ambulant care with highly specialised and highly cost-intensively medical infrastructure and equipment • treatments presenting a particular risk for the patient or the population • treatment provided by a healthcare provider that could give rise to serious and specific concerns relating to the quality or safety of the care

9. reimbursement of health care costs:implementation of the Directive 2/3 • may not refuse to grant prior authorisation when healthcare cannot be provided on its territory within a time limit which is medically justifiable (see Art 8 (5) Directive 2011/24 and § 7b (5) SV-EG) • reimbursement: • in cases of required authorisation: only if authorisation has been given. • BUT: if in such cases no authorisation requested or negative authorisation given: reimbursement according to national system

10. reimbursement of health care costs:implementation of the Directive 3/3 • level of reimbursement: • inpatient care: LKF-tariffs • outpatient care: • basically: 80% of the costs, that the competent health insurance institution would have paid to a contracting partner for the treatment • where prior authorisation needed and given (like for highly specialised ambulant care): 100% of the costs, that the competent health insurance institution would have paid to a contracting partner for the treatment

11. reimbursement of health care costs:Regulation 883/2004 • We should not forget the directly applicable Social Security Coordination Regulation 883/2004! • for planned medical care: prior authorisation for inpatient and outpatient care. • level of reimbursement: according to the tariffs in the Member State of treatment

12. information obligations • Original proposal : „Hospitals arerequiredtoinformpatients on the total estimatedcostsofthetreatmentand on possible subsequent costs“ • Now: „Hospitals arerequiredtoinformpatients on the total estimatedcosts, asfarastheyarepredictable at the time ofreception

13. non-discriminatory tariffs • Original proposal: „thecostsforthepatienthavetobecalculated in an objective, non-discriminatorymanner“ • Now: • „thecostsforthepatientin termsofDirective 2011/24 havetobecalculated in an objective, non-discriminatorymanner

14. future perspectives • Opportunities for private health care providers: • it will be easier for patients to cross borders & there is more information on X-border health care • outpatients: reach the foreign patients directly: direct marketing; reimbursement according to Union law • inpatients (incl. specialised ambulant care): contracts with foreign health insurance institutions

15. Thankyouforyourattention!