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Queasy over health plans

Mark Mardell | 10:21 UK time, Thursday, 3 July 2008

There are the odd political moments when you know an unlovely piece of jargon is going to be the key to a story and you just have to make sure it doesn't slip out between your lips on radio or TV. But you are grown-ups, so I will say to you "prior authorisation". That is going to be the fight ahead over healthcare in the European Union.

The British government's reaction to the European Commission's health plans were distinctly sniffy in the first place. "The Government is clear that health tourism will not be funded by the NHS." They later explain by "health tourism" they mean anything not funded by the NHS. The sort of health tourism the commission is talking about is OK. Well, OK-ish.

A colleague back in London interviewed Health Minister Dawn Primarolo for my piece on the Six O'Clock News and she repeatedly and insistently said there would be no change for anyone in Britain because of the new directive. That is of course true at the moment, but will it remain true if it becomes law in its present form?

The commission wants anybody to be able to travel to another EU country, get treatment, and be reimbursed. There are two big caveats. The treatment must be available at home (so no face tucks or nose jobs) and you only get back what it costs at home.

But there is a third caveat lurking in the woodwork. "Prior authorisation." At the moment, in Britain, you have to get permission from the local health authority before you travel for healthcare, if you want to get your money back. The government is absolutely adamant this system must not change. The health minister told my colleague this was because the NHS was based on "entitlement".

But the commission says governments should only impose this condition if the new law unleashes such a huge number of patients wanting treatment abroad that it threatens to send shockwaves through the whole healthcare system. Or, as they put it, "the consequent outflow of patients due to the implementation of the directive seriously undermines, or is likely to seriously undermine, the planning and rationalisation carried out in the hospital sector".

I'm told that's not meant to be taken lightly and governments would be expected to prove their case. Moreover, it would be very difficult to prove the case from day one: there would have to be hard evidence of this "outflow" or patients first.

But hang on. The government's own press release says: "very few people choose to do this (go abroad for treatment), and there has been no significant recent increase in numbers in recent years". So they are presumably admitting that they have no case to demand "prior authorisation".

I suspect the directive will come in for a lot more nobbling before we are done.

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