GP commissioners could face battles with foundation trusts cashing in by treating foreign patients privately under a new EU cross-border healthcare directive, it emerged this week.
The directive, which applies to member states of the EU – plus Ireland, Leichtenstein and Norway – clarifies the rights of patients travelling abroad for NHS-funded healthcare and will come into force in the UK in 2013.
An analysis of the directive by the NHS European Office, published last week, warned that providers will have opportunities to market themselves to foreign patients to help diversify their income – particularly given the current financial climate and the proposed removal of the private patient income cap for NHS Foundation Trusts as part of the government´s NHS reforms. Dr Mike Dixon, chair of the NHS Alliance said: ‘I could foresee a situation where the NHS tariff is fairly low and would create a market elsewhere in Europe for UK treatment. It certainly would be a problem for commissioners if foundation trusts were full of foreign patients paying more. There need to be checks and balances on this but I´m not sure where they´ll come from. ‘The real fear might be contra-accounting by trusts, making prices cheap for private work to get patients in and cover their margins and charging commissioners more. Dr Dixon said the plan to remove the private income cap on trusts would be acceptable as long as trusts had to be open and accountable about their private income. ‘It´s difficult to police. But those that play a closed hand should expect commissioners to show their muscle. A lot will depend on commissioners being astute and not have the wool pulled over their eyes by trusts.’ Elisabetta Zanon, director of the NHS Confederation’s European Office said: ‘The Government’s proposed removal of the private patient income cap will enable NHS Foundation Trusts to take full advantage of some of the opportunities which this directive offers to market themselves to non-UK patients. How do we ensure that NHS trusts do not do this to the detriment of NHS patients?’ Consortia will also have to draw up a costed list of the types of healthcare they fund to comply with the directive. The stipulation that NHS patients will have a right to seek abroad any healthcare that they would have received under the NHS and to be reimbursed by their commissioner up to the amount that their treatment would have cost the NHS to provide means commissioners will need to have a clear, transparent list of which types of healthcare they do or do not fund, an NHS Confederation briefing paper on the directive said. The NHS analysis also warned that commissioners´ ability to plan and prioritise could be affected because authorisation for treatment abroad could not be refused in cases of ‘undue delay’. ‘Another challenge for commissioners relates to determining domestic prices for healthcare, especially for those procedures not covered by a tariff and subject to significant local variations,’ i
Dr Mike Dixon