Health in Europe

To  go to the start and also the INDEX  click here

There is much more on this subject which can be accessed through CONCERN 1- which can be raised by going to the start of the blog under 'Concerns'.
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 The EU Regulations which cover health are laid forth in the following regulations, which are here linked.

THE EU REGULATIONS:- The year of its formulation is given. The click note is the access point. They are all large and will take time to download.

1. The earliest EU Regulation 1408- date 1971, before the UK joined the EU in 1973. It lays down rules for Social Security. Click.

Each EU Regulation has a twin Implementing Regulation which states how the basic regulation is to be implemented.

2. Implementing Regulation for 1408-1971. 574-1972. click.

3. The above Regulation was modified, and superseded by 883- 2004. It was not brought into operation until May 1st 2010. Many ‘articles’ in the earlier regulation are copied in and some of the earlier are still operative. click

4. The implementing Regulation for number 3 above is 987-2009. click

The Strange Case of M. Chollet

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Those who follow this blog site will be aware that  recently I wrote and soon after scrapped the story of Monsieur Chollet. Why? How I wish that one could have a civilised dialogue with the Department of Health! We really do need a Minister for the Expatriate in Europe. There is no-one to whom one can turn in the British Government to discuss our problems. We are sidestepped and ignored. The case of M. Chollet has been placed before the European Court of Justice ever since 2006.

The case has some bizarre features. M. Chollet is a French citizen who was resident in Spain and therefore came under the Spanish regulations relating to Health Care. He was entitled to 100% of the cost in Spain.  He went on holiday to France and fell ill. In France the CPAM charged him approximately 20% of the cost of treatment. M. Chollet considered that this went against the principle of free movement and petitioned the European Commission.

The EC eventually took the matter to the European Court of Justice [ECJ]. In February 2010 the Advocate General (M. Mengozzi) gave an opinion in favour of the EC (and M. Chollet) against Spain.

Spain sought the support of the UK, Belgium, Finland and Denmark in this matter. This was my state of knowledge until recently. I had stated this case with the Department of Health [one cannot discuss!] and their reply gave me no indication that anything else had occurred. Unfortunately I have learned that the case has changed again. It is the normal circumstance that the Advocate General’s opinion is accepted in a full hearing of the ECJ. He is, after all, a learned judge of high reputation. I have recently received the account of the full hearing of the ECJ which happened in June. Once again, the Governments of the UK, Belgium, Finland and Denmark have intervened. This time the decision was reversed. The Advocate General’s opinion was rejected and the European Commission lost the case.

Why is this important? If the original opinion of M. Mengozzi were upheld then the health costs of all British Citizens visiting France would have been paid 100%. By extension one might suppose the situation of British residents in France whose competent State for health care is the UK, would have improved.

The Future? The above case was brought under the EU Regulation 1408/1971. Since then in May 2010 the Regulations have changed. This gives us hope.

The new Regulation 883/2004 seems to indicate a much stronger support in health care for pensioners who are titular holders of the form S1 (E121).  It would seem that the European Commission are inclined to support our needs.  But there remain difficulties which one suspects the UK Government will make sure are brought to the fore.

The above indicates the power of the State against the individual. We pensioners have, after 15 years non-residence in the UK, no democratic say at all in the way the British Government acts. It acts in its own interest, not in the interest of the citizen. We citizens in Europe are profoundly affected by treaties and discussions held in our name, but cannot ourselves intervene in such discussions in any manner whatsoever. There is no-one to represent us!  Unless it is the EU!  Few are interested in us.

The UK Government [Whitehall?] seems to imagine that if it had to pay 100% of the health care costs in France for us, that a bottomless pit of costs would open. This is just not true. But it seems that it is impossible to argue the case with any informed person in Whitehall.

One remains frustrated and ignored.

HEALTH MATTERS - Monthly Comment April 2010

A further item has been posted on this subject - Refer to the INDEX for developments.
 
BACKGROUND

Few expatriate OAPs in Europe realise that they enjoy health-care support because of EU agreements and THAT THE FINANCE COMES FROM THE UK – in effect from the NHS.

The EU Regulations (essentially 1408/1971 and 883/2004) state that the costs of health care for the Old Age Pensioner is the responsibility of the State to whom the OAP has paid his/her social security contributions. That State will pay your Old Age Pension and support your old age health care! This State is defined as the ‘competent State’ - For almost all expatriate elderly Britons this competent State is The United Kingdom.

Clearly it must be understood that if you have not paid into the Social Security regime of France (or other country) because you had not lived there in an employed category, there is no logical reason why you should be supported under the health-care system of France (or other country)! Only an EU agreement gives you this support. And someone must pay for it! Let us look more closely….

A quote from Article 24 of EU Regulation 883/2004….

“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.”

The institution referred to in the following paragraph 2 is indicated as the “competent institution of the Member State” in effect - the NHS. In other words: - you should be treated by the health system of France (your place of residence) and charged to the institution of your competent State (the UK).

Read the highlighted parts again --- It says that you will receive benefits insofar as you would be entitled under the legislation of the competent State (the UK) as if you resided in that Member State (the UK).

That says that if you get 100% cover in the UK you should also get it in France! Or anywhere else in the EEA.

Under the above Article it would seem that we have two situations – firstly The State of Residence is obliged to treat you as though you come under the social care legislation of that State, but the competent State should also ensure that you have the benefits as though you were resident in the competent State. The only way to resolve this is in France to be treated as a French citizen would be (which one is), but that the full cost is picked up by the UK. I have an uncomfortable feeling that the UK is being charged by France at somewhere about the full cost and that the British OAP resident in France is being asked to find up to 30% of the cost as well - via a ‘mutuelle’ or his pocket! This 30% (approx) should not be necessary.

To the current date every EEA country has transferred grants between themselves of a sum of money to cover the health costs of their expatriate OAPs. (Regulation 574/1972 Article 95 – now 38 years old and before the time of electronic data  transmission! And before the UK joined the EU in 1973!) The calculation of these grants are somewhat convoluted.

Two supplementary articles are in consequence appended to this introduction.

Click on a title to view.

1. The matter of the European Health Insurance Card [EHIC]

A matter of confusion?

2. The costing of the health support of the expatriate OAP in Europe.
This item is updated with additional statistics from the Dept of Health London April 14th. 2010
Is the UK and the British Citizen being ripped off by France? The charge to the UK for pensioners in France is 192% higher than for pensioners in Italy and healthcare in Italy is totally free. This link also links in turn to all the relevant legal extracts. It also indicates the way forward.  

You may well find these items interesting reading.

The whole sorry affair indicates that we need a Minister for the European Expatriate in Westminster. After the general election it will be necessary to write to the Minister of Health.  If necessary a draft letter will be published next month.  In the meanwhile... You may wish to report this matter to your MP or send a petition to the EU Commission.  For  ideas contact me DEBOUT!  click
In the meanwhile if you live in France you  must follow the French law and pay up!