E-15/23 K v the National Office for Health Service Appeals

Contentverzamelaar

E-15/23 K v the National Office for Health Service Appeals

EFTA-case 

Klik hier voor het dossier van het EVA-hof (voor zover beschikbaar).

Deadlines: Motivation ministry:    3 January 2024
Written observations:                    19 February 2024

Keywords: reimbursement, discrimination

Subject:

-             Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare: Article 7;

-             Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications: Annex V.

-             EEA Agreement: Article 36.

Facts of the case:

Appellant ‘K’ has applied for the reimbursement of the costs to cover dental treatment in Poland in the period 16 August to 24 October 2017. This reimbursement was refused by the Norwegian Health Economics Administration (hereafter: Helfo) on the ground that the treating dental practitioner in Poland does not have the specialization required to be able to claim reimbursement for similar treatment in Norway.

K lodged a complaint against the decision of Helfo before the respondent, the National Office for Health Service Appeals (hereafter: NOfHS). K argued that the requirement of specialization is contrary to Article 36 of the EEA Agreement and Article 7 of the Directive 2011/24/EU. The National Office upheld the decision of Helfo on 25 February 2021. On 7 April 2021, K appealed against this decision to the National Insurance Court. The NOfHS re-examined its decision and arrived at the same conclusion. It stated that there is nothing preventing a person from receiving treatment from a dental practitioner not in possession of the necessary specialization. The National Insurance Court ruled that the regulation on the requirement of specialization in order to claim reimbursement was not contrary to EEA law. The State itself can determine which healthcare services can be covered and how much is to be covered. It is therefore possible to impose the same conditions for reimbursement in Norway as for treatment abroad. The parties to the case before the National Insurance Court are in disagreement as to whether a requirement may be imposed to the effect that the treating dental practitioner must have the same specialization as what is required for reimbursement under the third paragraph of Section 3 of the Dental Regulation.

Request for an advisory opinion:

1. Is it compatible with Article 36 of the EEA Agreement and Article 7 of Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare to refuse reimbursement of costs for dental treatment in another EEA State on the ground that the treating dental practitioner does not possess the required specialisation in order to have equivalent treatment reimbursed in the service recipient’s home State?

2. Does it affect the answer to question 1 if the specialisation required in the service recipient’s home State is included in Annex V to Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications?

3. If the specialisation is not included in Annex V to Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications, must the competent authorities in the service recipient’s home State also conduct an assessment under Article 36 of the EEA Agreement in order to determine whether the treating dental practitioner has equivalent competence to that required under national law?

Cited (recent) case-law: C-205/84 Commission v Germany; C-398/95; C-157/99; C-173/09; C-372/04; C-444/05.

Policy Area: VWS