Thursday, October 17, 2013

Health costs and Democracy for Citizens in Europe




More comment on the Government Green paper
Concerning support for health costs in the EU
An example of why the Britons Abroad  in Europe and elsewhere  need Democratic Representation.
I appreciate the comments by readers of my circulars which have caused me to consider a further analysis of the situation on the costs of health care in Europe.
It involves a digging out of information in the EU regulations.
The consultative Green Paper is entitled
“Sustaining services, ensuring fairness”
A consultation on migrant access and their financial contribution to NHS provision in England.”
1.   This Green Paper was issued in July with a date of August 28th for the return of observations.  This is my immediate concern - The situation is unacceptable that people most affected by certain aspects are given no direct knowledge of this green paper, and no time at all to respond!

2.  The title gives no indication whatsoever that the contents also concern the health costs of British pensioners in the EU.  It is only by rare chance in October that I learned of its existence and quick action ensured that the contents were widely known.   

These concerns were particularly and rightly publicised (especially by The Connexion in France) because of the effect on the health costs of the ‘early retirees’ who would have their support for health care in the wider EU removed. 

Since then I have received comments which result in the analysis below.
The British State Pensioner abroad and treatment under the NHS.
The essence of this analysis is the ability of British State pensioners otherwise resident in other States of the EU to receive treatment under the NHS in Britain.
*See further note below for other British State Pensioners in the rest of the World.
At this present time – if you are a British State Pensioner and have at least 10 years of residence in the UK, but you happen now to be resident abroad, you are NOT entitled to free treatment under the NHS.  However many of us have received treatment in the UK.  Maybe only an eye test, sometimes more. 

[Confusion on this is introduced by the fact that the EHIC –health card – is issued by the UK to all British State Pensioners in the EU.  This card requires the UK to pay the health costs of those travelling to another EU State, which is not their resident State! Thus questioning the situation with regard to visits of pensioners to the UK.
Confusion also exists with the EU law which enables any citizen, retired or not, to travel to another State for treatment if that treatment is not available in one’s State of residence.]

The Green Paper in Annex A makes similar observations to some of the above.  It elsewhere suggests that in future the costing of  health for State pensioners in their resident  State within the EU could be thus affected:-
Clause 6.13  The benefit to the UK of allowing state pensioners to return for their planned treatment would be a discount of 5% from payments to all countries to whom we make lump sum annual payments for our pensioners. “

The second phrase underlined relating to annual payments, refers to the EU Regulation 987/2009  and  to Annex 3 of that regulation.
This lists the States claiming payment for health treatment on the basis of fixed amounts. They are:- IRELAND, SPAIN, ITALY, MALTA, THE NETHERLANDS, PORTUGAL, FINLAND, SWEDEN, UNITED KINGDOM
It is to the countries listed above that the proposal to cut the fixed amount by 5% would apply.
All other countries claim the actual amount  and would not be affected. – e.g France, Belgium, Germany, Cyprus. etc in the EU…  The actual amount is the amount which the State of Residence has to find – not, as I have ascertained, the actual amount for the treatment as charged to the patient pensioner.  So in France the French State asks of Britain something considerably less than the full cost of the treatment to the patient.
The underlined phrase ‘planned treatment’ seems unnecessary. What is the significance of that phrase?

Then we need to look at EU Regulation 883/2004.  Annex IV to that regulation lists certain States where their Pensioner Nationals can return to their native land for health treatment [there is no reference to ‘planned treatment’ nor in the referenced article 27 here] – they are BELGIUM, GERMANY, GREECE, SPAIN, FRANCE, ITALY, LUXEMBOURG, AUSTRIA and SWEDEN.
Note that the United Kingdom is not listed.  The Green Paper would one supposes result in the UK being included in Annex IV. 
One of my correspondents has informed me that this is indeed what the Government is considering.
The result would be that qualifying Pensioners in the EU beyond the UK  could return quite legally to receive treatment under the NHS  and the confusion and uncertainties which has previously existed would be removed.

*Other qualifying  British State Pensioners resident elsewhere in the World would also benefit from a change in the regulations enabling treatment under the NHS on their occasional visits.  

The relationship of all this to the need for Representation in the Westminster Government.
If we had someone to represent us in Government then this rigmarole would not be necessary.  The DoH could consult with the representatives who would seek opinion from certain groups within each country.  A real democracy could come into being.
It is quite wrong in my view that the Government can produce such a ‘green paper’ and be apparently quite incapable of making appropriate contacts with the people most affected.
This is also so patently obvious with regard to the proposed Referendum.  This would affect the British Abroad in Europe very closely and yet are not in line to be consulted.
It is essential that we are Represented.


The address of the DoH is
International Healthcare Team
Department of Health
3rd Floor
Wellington House
133-155 Waterloo Road
London SE1 8UG
Email    migrantaccess@dh.gsi.gov.uk
(Remember that the consultation on the green paper closed on August 28th 2013)
The green paper is viewable at