Chapter 2

Authority (ASL) will be charged for the costs.
Indirect access to health care may be obtained by those patients who live in extra-EU countries
with which Italy has not stipulated any agreement on the matter of health care delivering.
In this last case patients must pay the total cost for treatment, up to 80% of which, may
be reimbursed by their ASL after returning to Italy and showing acknowledgement of receipt.
It is to be taken into account that such a reimbursement, in many cases, is granted on the
basis of the patient’s income.
As regards the required documentation, it varies depending on whether the patient is abroad
either for a temporary visit or for a pre-arranged treatment.
In the first case the “instrument” that entitles Italian citizens to have direct access to urgent
and necessary health care during a holiday is the European Health Insurance Card (EHIC),
which has lately substituted the old-fashioned E111 form. The EHIC is operative “only” in the
25 EU countries, in those belonging to Economic European Area 2 and in those countries
which have stipulated conventions on the matter of health care with our NHS 3 .
In the hypothesis of a transfer patient to another country to undergo surgery such as a transplant,
the documentation required to be given charge-free health care is the E112 form, and
it covers the same area as the EHIC.
Inadequacy and tempestivity are the two parameters to evaluate before deciding whether it
is suitable to go abroad to obtain surgical treatment such as a transplant. The former involves
careful assessment of the patient’s needs as well as of the equipment and procedures
available in Italy, while the latter involves careful attention to how urgent is the case, how long
the waiting list is for the required treatment and up to what extent delay in treating may worsen
patient’s condition or be life-threatening.
On considering the relevance of the above parameters, a Regional Reference Centre (CRR)
has been set up in each Italian Region with the main function to ascertain whether and how
much a case is serious and in want of urgent care abroad or transplant. These centres, which
cover most of the medical branches, are entitled to issue authorization to patient transfer
abroad to obtain both treatment and reimbursement for the costs of health care obtained
abroad.
Such an authorization, which consists in the E112 form, plays a fundamental role in health
care supplied abroad, as only authorized treatment costs can be charged to the competent
Italian ASL by the foreign sanitary structure. In this case treatment is charge-free for the
patient except when cost-sharing is required by the receiving country as arranged.
With periodically comparing the number of credit or debit bills issued by the several ASLs,
you get the positive or negative mobility balance but, until the national (TECAS) 4 and
2 Norway, Iceland, Liechtenstein and Switzerland.
3 Argentine, Australia, Brazil, Capo Verde, San Marino, Yugoslavia, Croatia, Macedonia, Bosnia-Herzegovina, Slovenia, the
Principality of Monaco and Tunisia.
4 The info project TECAS, adopted on December 15th 2004, is a useful tool supporting international mobility. It helps the
ASLs and the CRRs to exchange the recorded information easily and quickly through the Internet. This system should grant
a complete flow of data on Italian patient transfer for treatment abroad, a continuous monitoring of the transfer and a better
handling of the international mobility. This would result in more proper use of resources with remarkable cost reduction.
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CEIS Health Report 2006