University of Szeged Faculty of Law

Constitutional law - The constitutional right to health in -different states-

Prof: Student: Diana Onita, Faculty of law, 3rd year

Szeged 2009

Introduction
Once with the opening of the orders for the !U "e" ers it needed to "a#e new rules$ rules that should e applied in every !U country$ eside rules a out free "ove"ent of people$ even their health care$ if they get ill during their departure in a foreign !U state% &hese rules are "ade in such way that every country and every "e" er of that country could and should respect it% &his is the "ain idea of the '!uropean Union() to have the sa"e rules in every country so not only to e easier for those who travel to have the sa"e rules as in their ho"e country$ ut to e at the sa"e high level$ even in rich countries$ even in poorer countries% In the *onvention of +u"an rights and freedo"s$ the second article fro" &itle , .ights and Freedo"s- is written the right to life that is guarantied and protected y the .o"anian *onstitution$ +ungarian *onstitution even y the !U *onstitution% .elated to this right to life$ is the right to health$ and "edical care$ assured y the national health syste" and national insurance of every !U country% &he state/s institutions that are a le to preserve this right are "any and various$ depending of the state and the state/s founds get fro" the national udget% &his founds are crated y the "oney that the wor#ers pay trough the ta0es$ the ig pro le" of this syste" is that the nu" er of people that pay the ta0es is lower than the nu" er of people that need "edical care% It is true that poorer countries$ li#e .o"ania$ get so"e e0tra founds fro" richer countries &o e a le to access this type of founds$ for "edical care% 1 person has to fill in "any conditions and to get "any approvals that they really need that "edical care$ and they disserve to get it for free$ or to get a discount% In this essay I will try to show the laws that help the people who need health care in their country$ and how they can get "edical care a road and the state pays%

1.

edical care in !o"ania.

In .o"ania the health syste"s has "any laws$ "any of the" to refor" the previous ones% &he last one regulates the pu lic part of the pu lic health syste" that is a co""on interest for everyone2 it is the law nr 23342005 regarding the "odification of the law nr 9642003 &he second article of this law states that the pu lic health care is the organized effort of the society to protect and pro"ote the health of the population$ and it is done trough all the political- 7uridical "easures$ and all the progra"s and strategies sent to the deter"inants to the health condition$ "eaning to all of those who are responsi le for the "a#ing the health syste" wor# and e efficient%

&he purpose if the health care syste" is to ensure the healthy population in a healthy environ"ent$ and the syste" is oriented toward the co""unity/s health% &he "ain authority in the health care do"ain is the 8inistry of +ealth2 it coordinates the health care syste" trough state or private "edical units$ organized y the law% &he pu lic health syste" is guarantied y the state and financed y the State udget$ local udget$ the udget of the national health insurance or y any other health insurance co"pany$ according to the law% &he protection of the pu lic health syste" is an o ligation of the pu lic ad"inistration$ central and local$ as well of the every 7uridical or civil person% &he "ain functions of the pu lic health syste" are) - 9eveloping of the strategies and progra"s that have as target pu lic health care% - 8onitoring the population/s health% - :lanning in the health care syste"% - &he "anage"ent and "ar#eting of the services of the health syste"% - .efor"ing the health syste"$ and controlling if the law is applied well% - !nsuring the ;uality of health care - I"ple"enting new solutions for health care - :reventing epide"ics/$ including the training for e"ergency situations% - Infor"ing$ educating and co""unicating to pro"ote a healthy life% - !valuating the ;uality$ easy access and efficiency of "edical care% &he principles of pu lic health care are) - .esponsi ility of the society for pu lic health% - Focalizing on s"all groups of population and pri"ary prevention - 1ctive partnership with the pu lic local and central authorities - 9ecisions "ade only on scientific evidence e0isting at that point% - In specific conditions$ funda"ental decisions according to principle of precaution% - 9ecentralization of pu lic health care% - !0istence$ in the health care syste"$ of an infor"ational and infor"atics syste" for a etter "anage"ent% Other authorities$ eside the 8inistry of +ealth$ are the *ounty :u lic +ealth 1uthorities that are 7uridical person and it represents locally the pu lic health authority% Other ele"ents are the Institutions and :u lic health care *enters that are pu lic$ regional or national institutions$ are 7uridical persons$ su ordinated to the 8inistry of +ealth$ and they coordinate$ technically and "ethodologically the activity of i"ple"enting the strategies regarding the prevention of disease$ control over spreading diseases and so on% &he "edical care is assured trough the health social insurance syste" according to the law) - pri"ary "edical care organized confor" the law trough "edical ca inets Specialized "edical care organized confor" the law$ that is granting specific healing activities trough "edical ca inets$ outpatient units of recovery$ diagnostic and treat"ent centers$ pu lic or private "edical centers% It is financed y the state udget$ health social insurance udget$ and local udget or y the direct eneficiaries%

&he 8inistry of +ealth is coordinating different progra"s destined to help achieve the right level of health care syste"s that is good for the population% In .o"ania if a person does not have social health insurance$ neither private health insurance$ haw to pay fro" own poc#et$ and as in "any other !uropean countries is very e0pensive$ especially the "edicines$ that "any people have to uy it even though they have insurance$ ecause "any ti"es the hospitals are running out of "edicine supplies%

#.

edical care in $ungary

Hungarys health care system is financed through the Health Insurance Fund (HIF), which is primarily responsible for recurrent health care costs. The HIF collects premiums at the national level and allocates funds to ! county branches, which in turn enter into contracts with health care providers. "lthough the owners of health care provider organi#ations (usually local governments) are technically responsible for capital costs, in practice this usually ta$es the form of grants from the national budget. The HIF is also under%financed, and the state government is obliged to cover its deficit. &o state budgetary assistance is provided for capital costs, and in pic$ing up the slac$ of under funding. The result is a mi' of ta' and social insurance%based funds responsible for financing Hungarys system (overage is universal and provides access to all ambulatory and secondary hospital health care. "ll citi#ens are covered, regardless of employment status, with the government paying contributions for groups such as the unemployed and pensioners. Health insurance contributions are collected from employees, who pay )* of their total income, and employers who pay +,* of the employees gross salary plus a lump sum ta' or -healthcare contribution. The population also pays local and national income ta', which helps to finance the investment costs of health care. .atients ma$e co%payments on certain services, including pharmaceuticals, dental care and rehabilitation. These out%of%poc$et payments have increased substantially since +//!, and currently contribute +0* to health care financing. The HIF is able to contract freely with providers, and is supervised by the 1inistry of Finance. The HIF is also regulated indirectly by the 1edical (hamber, which regulates the medical profession and may veto physicians contracts with the HIF. Initially an autonomous organisation with self%governing rights, the HIF was moved under direct control of the government in +//0, due to structural administrative problems. 2ithin the conte't of the entire healthcare system, the 1inistry of Health is the main regulatory body. 3ational policy framewor$ is drawn up by the

government, and .arliament debates bills and proposes amendments, with regulatory responsibilities in the hands of the 1inistry of Health. &he +IF rei" urses providers in various ways% +ospital outpatient clinics are paid feefor-service$ and acute4chronic centers paid according to a 9iagnosis .elated <roup ased syste" and y length of hospital stay% <:s can e paid y the local govern"ent$ as independent private practitioners$ or through the local hospital% +owever$ the "a7ority =>>?@ of <:s opt for Afunctional privatization/$ a pay"ent sche"e in which <:s contract with the +IF and are paid a capitation fee ased on a patient list% 1s a result$ the financial incentive is to refer patients on$ resulting in a wea# gate #eeping syste"% &herefore$ although choice and co"petition etween <:s is theoretically favora le to patients$ the current pay"ent syste" does not encourage <:s to serve their patients% Further"ore$ in hospitals$ the fee-for-service pay"ent sche"e discourages treat"ent as an outpatient and encourages hospitals to treat as an inpatient for financial gain$ rather than for the ideal treat"ent of the patient% In recent years the focus of the syste" has een shifted to pri"ary care% :atients are encouraged y the govern"ent to see# referral fro" a <: of their choice to li"it access to e0pensive healthcare "easures$ although in "any cases they can go directly to a specialist if they wish% Bhile <:s are "eant to e involved in preventative "edicine and education$ their role continues to e a prescription and referral service% 1 lac# of ade;uate <: training and financial incentives for physicians to retain patients are "ainly to la"e% 1s a result$ though the intention is for a <:s role in pri"ary care to e the patient/s first$ and in "any cases only$ point of contact$ this is not often seen in practice%

3. %uro&ean "edical health

:atient "o ility is only one of the four possi le types of cross- order healthcare) - *ross- order provision of services =delivery of service fro" the territory of one 8e" er State into the territory of another@2 such as tele"edicine services$ re"ote diagnosis and prescription$ la oratory services2 - Use of services a road =e0) a patient "oving to a healthcare provider in another 8e" er State for treat"ent@2 this is what is referred to as Cpatient "o ilityC% 1s stated a ove$ the !uropean +ealth Insurance *ard is intended to cover care that eco"es necessary whilst in te"porarily another 8e" er State for other reasons2 - :er"anent presence of a service provider =e0) esta lish"ent of a healthcare provider in another 8e" er State@$ such as local clinics of larger providers2 and$ - &e"porary presence of persons =e0) "o ility of health professionals$ for e0a"ple "oving te"porarily to the 8e" er State of the patient to provide services@% 1lthough the overall volu"e of patient "o ility is relatively low$ the proportion of patient "o ility can e higher in so"e circu"stances,9$ such as) - in order regions or popular tourist destinations$ where "ore than half of patients can so"eti"es e fro" a road2 - for "edical care outside hospitals$ such as dental care% In so"e of the recently 7oined

8e" er States$ patients fro" a road can e a third of the total in so"e dental clinics$ for e0a"ple% <reater clarity is needed over the possi ilities given to the 8e" er State of treat"ent =i%e% the 'receiving country(@ to ensure that treating patients fro" other 8e" er States will not prevent the provision of a alanced healthcare service open to all or under"ine the overall sustaina ility of the health syste" of the 8e" er State =for e0a"ple$ in ter"s of organisation and delivery of services@% 1 solution for those who travel in !urope is the !uropean +ealth Insurance *ard% &he card ensures that you will get the sa"e access to pu lic sector health care =e%g% a doctor$ a phar"acy$ a hospital or a health care centre@ as nationals of the country you are visiting% If you have to receive "edical attention in a country that charges for health care$ you will e rei" ursed either i""ediately$ or after you go ho"e to your own country% &he idea is that you are given the care you need to allow you to continue with your stay% +owever$ it is i"portant to note that the card does not cover your health care costs while a road if you are traveling in order to o tain treat"ent for an illness or in7ury that you had efore traveling% Dor does the card cover you for private sector health care providers% &he "odel for the !uropean +ealth Insurance *ard is the sa"e across the !U$ although the language of the card will depend on the national language=s@ of the 8e" er State which issues it$ so that health care providers in each 8e" er State can identify the card i""ediately% &here are also variations on the reverse side of the card fro" one country to another% 9epending of the legislation of the country where you are staying$ health care is either free or$ if you have to pay$ you will e rei" ursed% If you have to pay up-front$ the card will guarantee that you receive "oney ac# in that country or$ if you were not a le co"plete the rei" urse"ent procedure$ soon after you return ho"e y your local health authority% &he health care is provided in accordance with the legislation of the country that you are visiting% If you have any dou ts a out what health care and which costs your card covers you for$ you are advised to contact that country/s health authority% If the need arises$ you will still receive the treat"ent necessary to ena le you to continue your holiday without having to return ho"e for treat"ent% Eut re"e" er that the card will "a#e it easier for you to access free "edical care on the spot or for you to e rei" ursed if you have to pay up front% &hat is why$ when you travel to another 8e" er State of the !uropean !cono"ic 1rea or Switzerland, whether for private or professional reasons$ you are strongly advised to do so with a !uropean +ealth Insurance *ard 8edical ethics dictate that a doctor cannot refuse to treat you if your state of health re;uires treat"ent% +owever$ there is no guarantee that your costs will e rei" ursed under the sa"e conditions as if you had een a le to prove that you had social security insurance at the ti"e y presenting the card or an e;uivalent docu"ent% &he doctor or

"edical esta lish"ent "ight well as# you to pay the full cost or to pay up front a proportion of the costs which an insured person in that sa"e 8e" er State would not e as#ed to pay% In an e"ergency your local health authority "ight e a le to help y fa0ing or e-"ailing you a provisional replace"ent certificate$ which gives you the sa"e protection as the !uropean +ealth Insurance *ard Eoth these categories of people =students and posted wor#ers@ are issued with a !uropean +ealth Insurance *ard which in their case replaces the ! ,25 for"% &he !uropean +ealth Insurance *ard gives the" access to treat"ent that is necessary ta#ing account of the duration of their stay% In the case of posting or studying$ the period can e relatively long$ and the range of treat"ent accessi le "ay e "ore e0tensive than for a tourist staying only for a few days% &he ! ,25 for" was used in case of wor#ers or students go a road to rei" urse their "edical care$ if they enefited of any. 1nother for" that is co""only used this is the ! ,,2% 1ccording the *ouncil/s .egulation =*!!@ nr ,05,>, and nr 6>F,>2 says that a person that is insured in one of the country "e" ers of !U to have the right to "edical care in other "e" er states is he4she has the approval of the ho"e co"petent institutions% &he co"petent institutions in .o"ania are the *ounty +ealth Insurance +ouse$ or the Dational +ealth Insurance +ouse% So the article 22 of the .egulation nr ,F05,>, says that a person has the right to "edical a road is the co"petent institutions of the ho"e country approves$ on the ho"e countries e0pense Usually the co"petent institutions approve this for" if there is so"eone with an illness that cannot e treated in .o"ania% !ven though the !U *o""unity/s target is to "a#e e;ual the "edical care$ and other syste"s in the "e" er states it will ta#e "any years fro" now on to acco"plish that%

'i(liogra&hy: ,% www.an".ro #. law nr ##)*#++, 3. www.stiri"edicale.ro -. www.cnsas.ro