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Benefit baskets and tariffs.

Autor
Busse R, van Ginneken E, Schreyögg J, Velasco Garrido M
Verlag
In: Wismar M, Palm W, Figueras J, Ernst K, van Ginneken E (eds.) Cross-Border Healthcare in the EU: Mapping and Analysing Practices and Policies. Copenhagen: WHO on behalf of European Observatory on Health Systems and Policies, S. 91-120

 

 

Abstract

Lupe
Lupe

Even though there are vast differences between Member States in terms of how benefits are defined, only minor variations exist between countries if statutorily covered benefits are analysed by categories. However, since the applied taxonomy to sort and describe health services differs widely from country to country, and sometimes from region to region, huge differences may exist in the way patients with identical conditions are treated between and within Member States, which partly results from differences in the choice of technologies, procedures, staffing mix and usage intensity. This could motivate European patients to utilize their legal options to seek statutorily paid health care across borders, expecting to receive reimbursed treatment with, for example, newer technologies or a more broadly defined treatment that includes services not included at home. However, the differences that have also been observed in tariffs could constitute a severe hurdle in terms of accessibility of care across borders, as a payer may be more likely to refuse authorization on this basis. With regard to "non-hospital" services, for which pre-authorization is not considered necessary, differences in tariffs could impede access if the payer in the home country is not willing to compensate the (possibly) higher tariffs in the country of treatment. Although differences between statutory benefits in Member States exist, they might not be known to citizens across the EU. Easily accessible information of the tariffs, services and benefits across the Member States seems essential.