The European Health Insurance Card (EHIC) was introduced in 2004 to improve efficiency in health care access when temporarily staying abroad. The card replaced a system of forms required for receiving health care abroad. The EHIC can be requested free of charge when traveling abroad. It covers all acute medical care abroad and is linked to your own national health insurance. The EHIC card is only valid when you have a valid health insurance in your country of registration. The full implementation of the EHIC was meant to be completed in 2008.The final result being a uniform European card that also carries essential medical information.
As we are now in 2011 it is clear that the EHIC is far from being a functional European insurance card. At the moment the around thirty-seven per cent of the European population has an EHIC, although in most EU countries it is less than twenty per cent. The European average is influenced by counties like Austria, Italy and Switzerland which issue an EHIC for each citizen. In Greece, Spain and Poland for instance, less than five per cent of the population has an EHIC.
When consulting a national EHIC informational website, I was advised to consult my own insurance agency for information on coverage. Strikingly enough on the website of my insurance agency I was informed that my national insurance card is valid in all European countries and that the EHIC had no added benefit, but if I wanted they would be pleased to send me one. In addition people often also have travel insurance that covers medical costs abroad.
If a hospital or clinic even recognizes your EHIC you will in often still have to pay out of pocket for services. According to EU regulation you have access to health care under the same conditions as nationals of that country. If nationals have a co-payment or full out-of-pocket payment for services, you will be obliged to do the same, even if you have never had to pay directly for health care in your country of registration. When you return, you will be reimbursed for your medical costs. Nevertheless when being hospitalized costs can run up in to the thousands, which you will have to pay directly.
The EHIC is sometimes misused to provide non-acute medical care. Patients will cross borders to reduce waiting lists, to have access to cheaper and/or better quality medical care, for services that are not provided in their own country or for chronic medical assistance during vacation. The southern parts of Europe are favorite destinations for this ‘health tourism’. According to EU regulation the EHIC can only be used for ‘immediately necessary medical care’. On the other hand the European Court of Justice has, in several cases, ruled in favor of chronic health care cost reimbursements up to the level of reimbursement provided in the country of registration.
One should not expect highly specialized care or additional benefits with the EHIC. Only acute medical care as provides by the nation of registration’s social health care package is provided. In some countries this is quite sober. Additional benefits and private health care to which the patient might be entitled in its own country will not be covered by the EHIC. When opting for these benefits, again out-of-pocket payments will be required.
While a national insurance card is valid as long as the person is insured, the validity of EHIC varies per nation, from several months to several years. Each country is allowed to determine a time of validity that, in their view, allows for cross-border health care, but prevents fraudulent usage of the card. The country not only indirectly determines the maximum length of your stay abroad, but also requires you to request a new EHIC each time the card expires.
The EHIC was meant to be introduced as a sticker that covers the back of your existing insurance card. In reality very few insurance card get replaces and governments find it easier to issue an EHIC card when requested or, as is the case in countries like Luxembourg, the entire population. In addition to their national card, people will have their European card. A Euro-barometer survey showed that a third of the individuals that have an EHIC forget the card at home when traveling. And seventy percent of those that did not have an EHIC said that they had never heard of it.
The EHIC should allow anyone staying in another EU member state to receive the same medical care as nationals from that state under the reimbursement conditions of the country or registration. Currently reimbursement is provided according to the fees and tariffs of the country where the care is provided. This can leave the country of registration with costs higher than if the care were provided in its own country. Therefore patients need permission from a doctor to seek non-immediately necessary medical care abroad and permission is only granted if this care cannot be delivered in one’s own country. By providing reimbursement according to the fees and tariffs of the country of registration, those seeking better or faster health care will be forced to seek a country where the prices are similar while providing better and/or faster care or leave them to cover the costs superseding the cost for medical care in their country of registration. Furthermore countries will be less reluctant to allow patients to seek healthcare abroad, because their costs will remain the same.
A patient should have access to continued medical care when on vacation without having to pay for these services out-of-pocket. Restricting the EHIC to acute medical care leaves large a gap of patients that need medical care. The insured should also have access to private health care abroad. If in your own country you are covered for additional benefits or private health care, one expects the same treatment abroad. Some believe that the EHIC card system will stimulate health care tourism and burden the better health care systems. When looking at recent developments it is clear that cross-border health care has potential to improve national health care quality and reduce waiting lists through competition and thus needs to be stimulated as best as possible.
In order for this system to work properly all health insurance companies in the EU need to be compelled to issue an identical EHIC that mentions the nation and insurance company the insured belongs to. The validity of the EHIC will coincide with the insurance and only expire when the person becomes uninsured, which in mandatory health care systems is impossible. In this manner the insured has access to medical care when staying abroad for a longer duration. In a Europe without borders the duration of your stay abroad should not be determined by the validity of your insurance card.
Considerable costs could be involved in replacing national insurance cards by the EHIC. Especially in larger countries like Germany and France. Countries like Austria and Switzerland will be spared of these costs as they already have distributed the EHIC nationwide. To spread out these costs nations could opt to distribute the EHIC to all new health insurance clients and to those who lost their old card or requested a replacement of their old card for the purpose of traveling abroad. With the latter model of replacement a considerable time span will be involved in replacing the national insurance cards as less than five per cent of insurance cards are replaced annually.
The EHIC could be used to carry medical information, although this would make it sensitive to privacy violations. Since I recently was unable to use my bank card due to large scale hacking operations and this not being the first time such events have occurred, I don’t believe my medical information will be any safer. As long as the safety of electronic data cannot be guaranteed the EHIC should only hold information on the type of reimbursement provided by the insurance company.
The EHIC has great potential as a common European health insurance card. Nevertheless the implementation has still not been successfully completed. The card is infrequently used and its proper usage is shrouded in mystery. The limited medical coverage and validity of the EHIC hinder its full implementation. When the EHIC card system is opened up to the full cross-border medical market and reimbursement procedures are improved the usage of the EHIC and cross-border health care will increase. However care should be taken to insure privacy of medical data as further stages of the EHIC are implemented.
By Lynneth M. Mollis
IMS and JOVD member