Wednesday, May 22, 2013

Health Payments in Europe




French & European Health payments by the UK for British Pensioners

A/. It is appropriate that the retired citizens who live in France know exactly what expenses are paid  by the British Government for their health care in France.
I am eighty years old, retired, and have never earned any money in France and therefore have never subscribed to the French social security system. The UK is by EU law the ‘competent State’ for the support of our Social Security.  
Like so many others I find the costs of our health care ever rising. Some elderly couples are needing to find beyond 2,000 euros a year  for a top-up health insurance.
Under EU law France is required to ask the UK for the actual costs of our health treatment.  What is meant by ‘actual costs’?
I decided to find out the position.  This is possible via a Freedom of Information request to the Department of Health, London.   I have received very courteous mails from that department and was able to obtain details of all payments to France concerning my health payments since August 1998.  These are confidential and were sent to me by recorded delivery.
I have selected one item here which I have cross checked with details I received from the CPAM (French social security department).
Item  24th January 2012
CPAM detail
Acte Biologie      
montant dépense (actual cost)      82.08€      taux 60% (amount paid by the French State)
montant payé  (amount paid to the  institution of treatment)          49.25€
participation forfaitaire à retenir   (‘tax’ retained for future collection from patient)   -4.00€

Soins infirmiers  
montant dépense (actual cost)       4.73€      taux  60% (amount paid by the French State)
montant payé  (amount paid to the  institution of treatment)             2.84

Reglé au Laboratoire   (Amount for final settlement to the Laboratory – A sum of  34.72€ was paid by my health  insurance  making up the total of  86.81€ =82.08+4.73€)      
 52.09€.  This is equal to the above 49.25€+2.84€

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Breakdown on Claim from France sent to me from the Department of Health, London on items between 15/12/2011 to 22/06/2012.
Soins paramedicaux                           2.84€
Analyses biologiques                        49.25€   i.e = 52.09€

It is clear that the French State seeks repayment of the costs which the French State would find for a French Citizen.  .

B/.The added burden of French taxation on the cost of health.
The above  CPAM detail indicates a ‘participation forfaiture’ of 4€ .   This is a tax which the French Government levies on most health transactions.  It is 1€ for each visit to a G.P. and 0.5€ for collection of a drug at a pharmacy. 
The cost out of one’s pocket for the ‘Acte Biologie’ was therefore increased by 4€. 
The cost to me of this ‘Acte +soins’  was therefore 34.72€+4€= 38.72€. The 4€ was not paid by my insurance.
Over a year, the taxes on health costs accumulate. Together with the above taxes on each medical act as indicated above one must add the taxes on health insurance. During 2012 these taxes amounted in my case to towards 200€.  The more one requires drugs and medical care the higher the taxes. Some pensioners are paying out a great deal more than this in taxes on their health. The more ill you are the more tax you pay!  The French should be ashamed of this taxation on sick people.

C/. Insurance costs
During 2012 the cost of health insurance per month was for me 128.78€ (for a couple – being 64.39€ for one person).  It has since risen in 2013 to 135.78€/month -1629.36€/year).  198.15€/year of this latter sum is a tax paid to the French Government – i.e about 12%.
D/. The EU Laws on the position of health costs.
Regulations 883/2004 and its ‘implementing regulation 987/2009 are those that concern Social Security matters. My interpretations are indicated in orange.

Basic EU Regulation No 883/2004 defines ‘institution’ as ---
"institution" means, in respect of each Member State, the body or authority responsible for applying all or part of the legislation."
The EU laws below are interpreted as referring to the ‘actual costs’ to the institution of the State not the actual costs of the institution that provided the treatment.

EU Regs 883/2004 Article 24 covers the situation relating to Pensioners who have retired to live in another State…I quote verbatim.
“No right to benefits in kind under the legislation of the Member State of residence
1. A person who receives a pension or pensions under the legislation of one or more Member States and who is not entitled to benefits in kind under the legislation of the Member State of residence shall nevertheless receive such benefits for himself and the members of his family, insofar as he would be entitled thereto under the legislation of the Member State or of at least one of the Member States competent in respect of his pensions, if he resided in that Member State. The benefits in kind shall be provided at the expense of the institution referred to in paragraph 2 by the institution of the place of residence, as though the person concerned were entitled to a pension and benefits in kind under the legislation of that Member State.”
[Observations/Interpretation :- It states that one should receive medical treatment in the same manner as one would expect under the legislation of the UK as if the patient resided in the UK.
                                    The costs are to be borne by the UK – the ‘competent State’ for your social security.
                                    The medical care is supplied as to a French person under French legislation as though he/she were a state pensioner of France.]
Continue....
“2. In the cases covered by paragraph 1, the cost of benefits in kind shall be borne by the institution as determined in accordance with the following rules:
(a) where the pensioner is entitled to benefits in kind under the legislation of a single Member State, the cost shall be borne by the competent institution of that Member State;”
[Interpretation – The UK is bound to pay the medical costs]
“Article 35
Reimbursements between institutions
1. The benefits in kind provided by the institution of a Member State on behalf of the institution of another Member State under this Chapter shall give rise to full reimbursement.”
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From the Complementary ‘Implementing’  EU Regulation 987-2009 we read..
“Article 62
Principles
1.  For the purposes of applying Article 35 and Article 41 of the basic Regulation, the actual amount of the expenses for benefits in kind, as shown in the accounts of the institution that provided them, shall be reimbursed to that institution by the competent institution, ………….”
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Commentary.
The difficulty lies in the interpretation of the clause: copied in above--
“The benefits in kind shall be provided at the expense of the institution referred to in paragraph 2 by the institution of the place of residence, as though the person concerned were entitled to a pension and benefits in kind under the legislation of that Member State.”

I observe that this clause has no mention of costs.  It relates to the provision of the medical treatment.  This has to be provided as though one is a French citizen.

One notes the contradiction with  the previous clause which states that
the pensioner’  shall nevertheless receive such benefits for himself …., insofar as he would be entitled thereto under the legislation of the (United Kingdom) [Member State] competent in respect of his pensions, (as) if he resided in (the United Kingdom) [that Member State].
And…
the cost shall be borne by the competent institution (DoH) of that Member State (the United Kingdom).

So we should get treatment as though we lived in the UK and the UK should cover the cost.
The law appears to me contradictory – It is written that one should receive the medical treatment as though one lived under the legislation of the UK and ALSO as a French citizen pensioner would receive it under the legislation in France.

Many French Citizens – those on 100% CMU cover – pay nothing for their health care.  In short –  the cost to the patient is variable according to the circumstances of the patient! Since the British pensioner has costs covered (in theory!) by the Department of Health, London, it would be reasonable to suppose that these patients should also fall into the 100% cover category. I explore that thought ina European context……

E/. Other European National Citizens in France.
EU laws must be applied equally to all nationals across Europe The provision of health care for a state pensioner varies widely from  Estonia to Portugal.   It would seem almost impossible to provide health care for every ‘mobile’ pensioner under two systems of legislation at the same time.  The current interpretation seems inadequate.
It is also a restriction and distortion on free movement of pensioners.   The pensioner nationals who move from most other European countries to the UK obtain free health care.  Clearly with the UK pensioners moving to other countries in Europe, it is very often and usually not so. 

F/. Reform? And a solution?
Would it not be sensible to transfer 100% of the costs from the State of Residence  to the administration of the  ‘competent States’ for the support of Social Security and then that administration should seek appropriate repayments according to the legislation of that State from the  pensioner patient ‘as though they lived in their home country’?  Is this indeed that which the EU regulations are seeking? i.e the costs should be  borne by the 'competent State?


The pensioner should then settle their bills (if appropriate so to do) in a manner according to the legislation of the ‘home’ State.

G/. The need for Representation on these matters at a political level.
There is no-one in the British Government or Administration with any responsibility to look after the interests of British Pensioners in mainland Europe.  
There should be someone who has the responsibility to negotiate with the EU or other national governments concerning the condition of British Pensioners abroad in Europe.