Europaudvalget 2009-10
EUU Alm.del
Offentligt
Belgium
II. Health care
Benefits
1. Medical treatment:
Patient's participation
Insured person's share must not exceed
25% for general medical care. In
principle, no share borne for technical
benefits. In excess of a certain annual
amount paid by the insured themselves,
the so-called maximum ceiling, certain
categories of insured and will benefit
from this point onwards from free health
care services.Basic criteria:
* being part of a specific social category;
* being part of a household with income
under certain levels;
In concrete terms, the following incomes
and ceilings of are applying:
Bulgaria
Switzerland
Any person covered under contributions
funded scheme pays the physician,
dentist or health-care facility (providing
medical care) for each visit 1% of the
national minimum (monthly) wage
(minimum wage is currently BGN 240
(€ 123) per month).
* Fixed amount per calendar year
(excess, deductible, “franchise”):
CHF 300 (€ 202).
* In addition, share of costs: 10% of
costs above the excess up to CHF 700
(€ 471) per year.
* The insurer may offer the insured
person a form of insurance with a higher
excess - CHF 500 (€ 336), CHF 1,000
(€ 672), CHF 1,500 (€ 1,008), CHF 2,000
(€ 1,345) or CHF 2,500 (€ 1,681) for
adults, CHF 100 (€ 67), CHF 200
(€ 134), CHF 300 (€ 202), CHF 400
(€ 269), CHF 500 (€ 336) or CHF 600
(€ 403) for children (< 18 years) - in
return for a reduction in the premium.
up to € 16,114.10:
€ 450
from € 16,114.11 to € 24,772.41:
€ 650
from € 24,772.42 to
€ 33,430.75: € 1,000
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Czech Republic
Denmark
Germany
Estonia
Out-patient health care:
Group 1: No charges (treatment by the
Co-payments only for drugs and medical chosen GP or a specialist to whom he
devices.
refers the patient).
Group 2: The part of expenses which
exceeds the amount fixed by the public
scheme for Group 1.
The patient pays a practice fee of € 10
per quarter at his first visit to the doctor
in the quarter (certain medical check-
ups are excluded).
The patient' participation for aids (e.g.
massages, baths or physiotherapy)
which are part of the medical treatment
is 10% and € 10 per prescription.
Up to EEK 50 (€ 3.20) per home visit or
for a visit for out-patient specialised
medical care (set by the Board of the
Hospital).
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Greece
Spain
France
Iceland
No charges.
No charges.
General scheme for employees (Régime
général d'assurance maladie des
travailleurs salariés, RGAMTS):
Share borne by insured person:
* 30% for ambulatory treatment (GP or
specialists, in consulting room or in
hospital),
* 20% for hospital treatment,
* flat-rate co-payment of € 1 per
medical intervention within a limit of €
50 per person and per year,
* flat-rate co-payment of € 18 for
serious medical intervention (of a
minimum rate of € 91).
The insured person pays between
ISK 1,000 (€ 5.57) and ISK 2,600 (€ 15)
per visit to a health care centre or a
general practitioner.
The insured person pays ISK 3,600
(€ 20) &43 40% of the remaining costs,
but max. ISK&nbsp;25,000 (€ 139) per
visit to a specialist.
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Ireland
Italy
Cyprus
Latvia
Persons with full eligibility enjoy a full
range of general practitioner services
without charge (see above).
Persons with a GP Visit Card are entitled
to the services of a GP without charge
(see above).
Persons with limited eligibility can avail
of specialist services in public hospitals
free of charge. There are a number of
schemes which provide assistance
towards the cost of medication.
Any patient who opts for private
treatment, even in a public hospital, is
liable for the specialist fees and hospital
charges.
Insured persons pay up to € 36 for each
test carried out or each visit to a
specialist, to a physiotherapist or a
water cure; by prescription there can be
a maximum of 8 services rendered in the
same specialised field and a maximum of
6 for sports medicine or rehabilitation
benefits.
Persons entitled to medical care at
reduced fees pay € 6.83 and € 8.54 per
visit to a general practitioner and
specialist respectively plus 50% of
prescribed fees for laboratory, x-ray and
other examination.
Patients entitled to free of charge
medical care (see "Beneficiaries: Field of
application" above) make no contribution
toward fees but do have to pay € 2.00
per visit at outpatients departments.
Patient contribution system (for adult
patients):
* Out-patient visit to the general
practitioner: LVL 1.00 (€ 1.42).
* Out-patient visit to the specialist:
LVL 5 (€ 7.12).
* Home visit: the doctor can set the
price. For persons older than 80,
disabled persons, persons who need
palliative care, the contribution is LVL 2
(€ 2.85).
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Liechtenstein
Lithuania
Luxembourg
Hungary
Patients' participation in the costs for
services in the form of a franchise and a
percentage paid by the individual. The
deductible (franchise) is CHF 200
(€ 131) each year. Voluntary deductible
of a maximum of CHF 1,500 (€ 984)
each year. Maximum excess is CHF 600
(€ 394) per year.
Basically, health care is free of charge.
There is a list of health care services,
which are approved as paid services that
are financed entirely from the person's
own resources according to a set price
list.
Co-payment by insured person: 20% of
the ordinary tariff for visits for the first
medical visit in any 28 days period; 10%
for other visits or consultations.
Co-payment by insured person of 10%
for medical outpatient treatment
expenses up to a maximum of € 5 per
visit. This measure does not concern
haemodialysis, chemotherapy,
radiotherapy treatments nor preventive
medical tests.
Visit fee (vizitdíj) and hospital daily fee
(kórházi napidíj) were abolished as of 1
April 2008, due to a referendum held on
9 March 2008.Co-payments are charged
in the following circumstances:
* unnecessarily changing the contents of
prescription treatment, causing extra
costs,
* extra services (better room, meal
condition etc.),
* accommodation, nursing,
pharmaceuticals and meal costs for
those suffering from designated
ailments, confirmed by primary health
care provider,
* using sanitary provisions,
* in case of certain dental prosthesis,
orthodontic braces provided for persons
under the age of 18,
* change of external sex organs with the
exception of developmental abnormality.
The amount of the co-payment is fixed
by the service provider.
Control of entitlement As of 1 April 2007
service providers are obliged to control
the entitlement of patients for health
services.
From 1 January 2008 it became more
rigorous:
* service providers have to control the
entitlement of the patient before
providing treatment (except emergency
services),
* failure to control the entitlement will
be sanctioned,
* if the patient is not entitled the
provider should give information about
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Malta
The Netherlands
Norway
Austria
No charges.
Health Insurance Act
(Zorgverzekeringswet, Zvw):
Mandatory deductible. See Table I
“Sickness and Maternity – Benefits in
kind”.
* Up to a ceiling of NOK 1,780 (€ 198) a
year, the patients pay cost-sharing
charges for consultation of doctors,
psychologists, for important medicines
and nursing articles, radiological
examinations/ treatment, laboratory
General Exceptional Medical Expenses
tests and travel expenses.
Act (Algemene wet bijzondere
* For a standard GP consultation NOK
ziektekosten, AWBZ):
132 (€ 15) is paid by the patient, for a
For most types of care under the Act,
specialist consultation NOK 295 (€ 33).
insured persons over 18 are required to * A second ceiling of NOK 2,560 (€ 285)
make personal contributions towards the applies to cost-sharing charges for
costs.
physiotherapy, reimbursable non
orthodontic dental treatment, organised
health travels and stays in medical
rehabilitation centres.
The entitlement is proven towards the
doctors by e-card, an electronic sickness
insurance card. The annual fee is € 10
(with the exception of children,
pensioners and the needy).
A contribution of 20% of the agreed fee
is required for benefits provided by
psychotherapists or clinic psychologists.
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Poland
Portugal
Romania
Finland
No participation in case of basic
treatment by the chosen general
practitioner or by the specialist to whom
the general practitioner has referred the
patient.
Scope of basic treatment is determined
by Minister of Health (Minister Zdrowia),
all treatment outside this is left to
private sector.
No other direct payments.
The payment of the insured person's
share borne varies according to the
medical visit:
* visit at home,
* normal or urgent visit,
* visit in a central or regional hospital,
* visit in a health centre.
Or also depends on the diagnosis and
therapy auxiliary elements.
Health centre:
Doctor visit maximum € 11 for the first
three visits in a calendar year or an
annual fee of maximum € 22 for 12
months depending on the municipality;
most other services free of charge.
However, € 15 may be charged for an on-
call-visit to a health centre at night-time
and on weekends.
Private doctor:
The patient pays doctor's basic fee
which, as far as it does not exceed a
fixed tariff, is refunded by 60% from the
sickness insurance. For treatment costs
on prescription by certain other medical
staff, the patient's own liability is
€ 13.46 and 25% of the amount
exceeding a fixed tariff.
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Slovenia
Slovakia
Sweden
United Kingdom
Patients make co-payments of between
5% and 75%. Voluntary supplementary
insurance for co-payments is available.
Medical services like cosmetic surgery
and homeopathy are paid entirely by
patients.
For services related to health care the
patient's participation is:
The insured person pays between SEK
100 (€ 9.33) and SEK 200 (€ 19) per
visit to a doctor.
* € 1.99 for each visit at the emergency For specialist care, the patient pays
service,
between SEK 200 (€ 19) and SEK 300
* € 0.17 for each prescription,
(€ 28).
* € 0.07 for each km of transport.
Emergency cases: between SEK 100
(€ 9.33) and SEK 300 (€ 28).
No charges to patients ordinarily
resident in the UK or charge-exempt
overseas visitors for NHS hospital
services, but see below for prescription
and other charges.
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