Tight implementation harms danish patients' rights

Requiring pre-apporval in Denmark keeps patiens from utilizing their European patient rights

Summary While Danish politicians are once again in a debate over public versus private treatment, the waiting lists at Denmark’s public hospitals continue to grow. But private hospitals cannot cut waiting lists down alone, and more private treatment will not address the shortage of doctors within a number of specialist areas in which waiting lists are particularly high.
However, the EU’s directive on patients’ rights in cross-border healthcare, which came into force on 1 January 2014, offers a unique opportunity to tackle the long waiting lists. But the government has chosen to implement the directive so restrictively, by imposing extensive demands on things such as so-called pre-approvals, that it barely meets the EU’s minimum requirements. This creates more work for the regions that have received extra funding to carry out the new jobs. The money has, however, not been used, as the regions lack both the overview and organisation to handle them. At the same time there are significant regional differences as to what is done for patients who wish to receive treatment in another EU country.
This leaves patients in an administrative jungle, where they risk having to fund their own treatment abroad – as opposed to the otherwise high Danish standards of healthcare. Against this backdrop it is not surprising that most Danish patients wait for treatment in Denmark rather than seeking faster treatment in another EU country. Until now only 83 Danes have applied for pre-approval for treatment in another EU country. It is an option that is basically unconsidered.
This memo shows that the governments and the regions have been responsible for the tough approach Denmark has taken to the EU’s directive on patients’ rights, and the option to change this practice also lies in their hands.

Main conclusion
  • The Danish government’s implementation of the EU’s directive on patients’ rights in cross-border healthcare makes it difficult for Danish citizens to exercise their rights. It means that it is much more difficult for a Dane to go to Sweden to get treatment funded by the Danish state than it is for a Swede who comes to Denmark.
  • Extensive Danish requirements for pre-approval of treatment abroad puts considerable pressure on the regions that have to handle the individual cases.
  • It is not clearly defined as to when the regions are able to approve treatments in other EU countries. It is instead up to the individual region or specialist handling the case to judge when, for example, a waiting list is too long. This creates uncertainty for the patients.
  • Strict requirements for pre-approval and uncertainties have left patients in an administrative jungle. Few can afford to seek treatment abroad.
  • Until now, the regions have found it difficult to carry out the administrative task of making citizens aware of their rights. There are significant regional differences in information and practical management.
  • The regions have received extra funding to bring the directive on patients’ rights to life, but a large amount of the money has not yet been spent. An evaluation conducted in the new year will focus on where the greatest challenges lie.