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€
-------------------------
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.”
-----------------------
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, ………….”
***************************
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.
