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05-03-2021

The possibilities of treatment abroad vary

Iliustracija

The Panevezys Territorial Health Insurance Fund (THIF) notes in its practice that patients are provided in healthcare institutions with information about access to planned healthcare in other countries of the European Union, European Economic Area or Switzerland (hereinafter — EEA), which are not quite correct. Often, patients hear from medical professionals that cross-border healthcare is equivalent to healthcare provided under the S2 document, which allows for planned treatment in another EEA country. This is not the case, so we provide information on the difference between these two treatment options.

According to Lina Noreikienė, the Head of the International Affairs Division of the National Health Insurance Fund (NHIF), people, insured with  compulsory health insurance (CHI) can receive planned health care services abroad in accordance with two legal mechanisms.

One of them is a Description of procedures for sending patients for consultation, examination and/or treatment in the countries of the European Economic Area and Switzerland, approved by order of the Minister of Health. According to it, consultation, examination and/or treatment of CHI insured persons with the funds from the budget of the Compulsory Health Insurance Fund (CHIF) may be organized abroad if relevant or equally effective consulting, testing and/or treatment services provided by the CHIF budgetary means, cannot be granted to the persons in need of such means and measures due to their health condition and presumed course of illness within a medically justified period of time. In this case, the decision on sending the patient for treatment abroad is taken by the commission operating in the Ministry of Health (MOS) after receiving the necessary documents from medical institutions: referral of a prescribed form, an extract from medical documents in Lithuanian and foreign language, a letter of a foreign medical institution a letter guaranteeing that the patient will be provided with medical assistance on the basis of S2 document and informing him of the patient's paid bonuses for these services.

According to L. Noreikienė, this route is more favourable to the patient, because the cost of services on the basis of S2 document is paid by the health insurance institution of the country of treatment in accordance with national legislation and basic price rates, while the patient himself has to pay patient bonuses or costs not directly related with the provision of the service (e.g. transport, hotel, translation services). However, the Head of the International Affairs Division stresses that in order for the patient to be able to obtain the S2 document, medical institutions must carry out certain organizational actions — organize a consilium and, after analysing alternatives, decide on the need for treatment abroad, find a service provider abroad and to coordinate with him the time of provision of the service, and receive information about the preliminary cost of the service. Such preparation takes a lot of time, so usually those patients who need expensive, usually inpatient services are sent for treatment abroad, when due to lack of experience and/or the young age of the patient such services could not be provided in Lithuania or on time. For example, children are sent for the treatment of eye cancerous diseases and liver transplantation abroad, although adults are successfully provided with such healthcare services in Lithuania. Patients can be sent to the Sigulda Hospital of our closest neighbour of Latvia with a document S2 to treat trigeminal neuralgia or melanoma of the eye (choroid malignant tumour) with Cyberknife technology.

According to the NHIF, in 2017 there were 40 cases of sending (S2) of patients for treatment abroad, in 2018 — 54. In 2019, 29 patients were sent abroad, in 2020 — 37 patients. In these cases, the number of S2 documents issued is higher than the number of sent patients, since more than one S2 document is often issued per patient (if part of the services is carried out in different institutions or branches of institutions in the same country or when different documents are required for the recipient and donor). In recent years, the most common directions of treatment abroad have been established: children are sent to Switzerland to treat eye tumours, and liver transplants performed in Poland or Germany. Pregnant women in the presence of twin transfusion syndrome are sent to Sweden.

The second legal mechanism, which allows the insured by CHI to receive scheduled healthcare abroad, is the treatment provided for abroad in the Cross-Border Healthcare Costs Compensation Scheme approved by the Ministry of Health. L.Noreikienė points out: according to the procedure set out in the description, insured persons have the opportunity to receive reimbursement of the costs of healthcare provided in EEA countries and paid at their own expense. Expenditure shall be reimbursed to the extent that the relevant healthcare services are paid by the PSDF budget to the Lithuanian health care institutions. On the one hand, this mechanism is less favourable to the patient, since he has to pay not only for transport, but also for the health care itself or for non-healthcare services. On the other hand, the procedure is simpler, the patient is given the freedom to make a decision and choose a service provider, because after receiving a doctor's referral, he himself decides whether to wait for the relevant services in Lithuania or to go to another country.

The Panevezys THIF points out that people insured with CHI must apply to the THIF one year from the date of receipt of the services provided in EEA countries and paid for at the patient's own expense.

The NHIF invites you:

Your questions are welcome by email [email protected] or phone: local (8 5) 232 2222, international +370 5 232 2222.

Last updated: 26-05-2021

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