Chapter 2

CEIS Health Report 2006
• retired people who live in country different from that of origin (as in Spain);
• borderline community people who sometimes may like to be treated beyond the borders
(as in the Euroregion “Meuse Rhine” including parts of Belgium, Germany and The
Netherlands);
• patients who prefer to be treated or to buy medication and/or sanitary equipment in a
foreign country because of expected higher quality services, easier accessibility and cheaper
price (especially as regards out-of-pocket payments);
• patients who are encouraged to go abroad by their own NHS to circumvent internal capacity
constraints (as in the case of Malta).
Let’s examine the hypothesis by which the cost of treatment is afforded directly by the
patient. In this case the choice among several health care providers, located in different
European areas, is taken on the basis of the expected quality treatment (effectiveness, adequate
care supply tempestivity, way of treatment delivery), and also on the total cost resulting
from the direct costs for treatment itself plus the costs not directly connected with treatment.
These last include: journey and accommodation for the carer; transfer costs in terms
of time; psychological costs connected with the journey in a foreign country, language problems,
and may be lack of local assistance.
As far as it is concerned with direct costs, the international transactions in the health sector
are supposed to include highly-specialized services which are usually very expensive. So, in
this case the chance to get health care abroad is based on patient’s economic condition, on
the ability to obtain and select information on the range of health care offered in other countries,
on how much relevance is given to good health, and on up to what extent patients can
afford the costs of maintaining and improving their health condition.
On the assumption that patients will be charged for the whole cost of health care, they or
their GP are entitled to take their choice about the sanitary structure where they prefer to be
treated.
Actually, in most cases, it is the “the third payer” that is almost entirely charged for the costs
of health care provided abroad. In the case of Italy, the third payer is the NHS.
5.4.2 Regulation of mobility in Italy
The community rule (art. 22 of the EC regulation n. 1408 and following changes, especially
the EC regulation n. 631/2004) recognizes the right to all European citizens, and consequently
also to Italians, to be granted health care out of the borders of their mother country
or residence country. In this case, health care delivery during the stay abroad is connected
with both Health Ministry and Ministry of Foreign Affairs.
On observing more closely how health care delivery abroad is arranged inside our NHS, it is
important to make a twofold distinction: in the first instance the access system to health
care, and in the second instance the several different types of documentation required to
obtain health care abroad.
Access to health services abroad may be of two types: either direct or indirect. All citizens
living in EU and in extra-EU countries with which Italy has stipulated agreements accordingly,
may have direct access to health services with filling out and showing the required forms. In
this case Italian citizens are entitled to obtain charge-free health care while their Local Health
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