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Sparring over healthcare

• Mark Mardell
• 2 Jul 08, 09:10 AM

Given that pictures are so important for TV it is perhaps funny that I sometimes form such strong mental images of the people I am going to interview. On my way to Ghent, to film ahead of today's proposals on healthcare, I imagined the Italian gentleman I was going to meet ahead of his hip operation. In my mind's eye he was a rather wizened, bent chap in his 80s, wearing a dark green checked suit and for some reason an alpine hat.

turned out to be rather different - a muscled, vigorous man in his 50s in shorts and a sports vest, who tells me he is an international sportsman, a three-time world karate champion, who it turns out has established his own . But he's done his hips in, and an earlier operation hasn't helped.

So he's come to a clinic along Ghent's leafy millionaire's row to be put right. Now, in Italy, and I presume in most EU countries, you can get hip operations as part of the national health service or its insurance-based equivalent. Ever since 1998 the has been making rulings, on the grounds of free movement, that patients have the right to get their money back for healthcare received abroad within the EU that they could, in theory, have got at home.

But Paolo tells me the Italian government couldn't tell him if he would get at least some of his money back. "I just went there and asked and they said they would have to think about it. They're still thinking. They say they have the summer time, vacations, and lots of things to do. That's the problem." And they didn't want him to have the op before they had made their decision.

"They said: 'You can't have the operation until we give you permission. If you do it first we don't feel like giving you the money'. So I told them the doctor said I needed it urgently. But they said: 'We don't care. You can only go once you have the permission, because of bureaucracy, and we'll tell you in August or September'." So he probably won't get any money, but he will have the operation.

It's exactly to make the rules clearer after all the court cases that the European Commission has been working on new laws. In fact they have been working on them for five years now. Their plans were meant to be unveiled just before Christmas, when I wrote a couple of articles about the ideas. But the directive was pulled at the last minute, apparently because of objections by the left and some nation states.

We will know the exact details later today, but it will still say that member states have to reimburse the cost of any healthcare that would be provided in their own country, but in the case of hospital care they can insist that the patient gets approval from the relevant authority if "member states can provide evidence that the outflow of patients resulting from the implementation of this directive has such an impact that it serious undermines the planning and rationalisation carried out in the hospital sector".

Whatever this means I am sure many governments will try to prove that their planning would be seriously undermined, so they keep control of the situation.
A lobby group for patients' consumer choice, , very much welcomes the plans. But one of its directors, Kajsa Wilhelmsson, says they have been watered down. For instance, a reference to getting your money back in three weeks has totally disappeared.

"It means that you will potentially have to wait for a very long time before you are reimbursed. Can all patients really afford that? I would doubt it. You might know how much it will cost, but you wouldn't necessarily know when you would get the money back, and you would have to pay upfront in several countries for the care given."

She thinks many governments are just frightened of the plans. "I think they're a bit scared of this, as it will give more powers to the patient and transform healthcare by increasing the transparency in different quality of care in different countries and they will be pointed out that maybe they are not as good as they claim to be."

Bu others think they are right to be scared. The former UK Health Secretary, Frank Dobson, told me: "Matters to do with healthcare systems are supposed to be a responsibility of national governments, but the European Court and the Commission have decided to poke their nose in and they shouldn't be doing it. And if there are benefits from it for people in Britain they'll go to people who are better off, because they will be able to afford to go to get treatment somewhere in Europe, rather than in Britain. And also people will be allowed to top up the cost. If they persist in pushing this I think Gordon Brown should just tell them to stuff it."

Back in Ghent, Paolo is preparing for life after today's operation. An expert not only in unarmed combat but also oriental weapons, I catch him experimentally twirling his crutches. Maybe the Italian government should take note, and pay up.

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