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Ten4Health: EHIC-Portal: www.AOK-Europa.de
AOK Europe "EHIC-Portal"
AOK Europe
§
Medical care of foreign visitors with the European
Health Insurance Card (EHIC) in German hospitals
§
EHIC-Portal – an internet solution from permission
to healthcare treatment to reimbursement and
settlement
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Ten4Health: EHIC-Portal: www.AOK-Europa.de
EHIC instead of E111
n Introduction of the EHIC through EC – the improved alternative for the citizens
n Objective: simple and direct access to health care provision abroad
but still:
n Risks for all participants (at home and abroad)
Ÿ Deployment- and infrastructure/requirements missing
Ÿ Settlement in two/more years (depending on country)
Ÿ Compulsive commitment of payment through EHIC
Ÿ Long term limitation: double issuing, card tourism
n High demands on the health care provider
Ÿ secure settlement
Ÿ fraud prevention
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Ten4Health: EHIC-Portal: www.AOK-Europa.de
EHIC Process: treatment of German patient in the Netherlands
Insurer DE/
responsible KV* /DE
Treatment
Settlemnet, Check,
registration
Confirmation,
payment
or rejection
8
Permission by EHIC
1
2
7
Payment after
reimbursement
from contact
office NL
National contact office
DVKA
Settlement
Reimbursement,
payment
6
4
Cost statement E125
National contact
office
CVZ
Information
about
treatment
foreign
patient
€<
2 months
Germany
9
Doctor/Hospital (NL)
Reimbursement
Mistakes means the same
way forward and back
5
3
Insurer NL - AGIS
1. Request to one health insurer
2. Financing through public
health care fund
10
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Ten4Health: EHIC-Portal: www.AOK-Europa.de
EHIC Process: treatment of any patient from Europa in Germany
Settlemnet, Check,
registration
8
Confirmation,
payment
or rejection
Insurer EU /
responsible KV* / EU
Permission by EHIC
Treatment
1
Doctor/ Hospital (DE)
2
7
Payment after
reimbursement
from insurer in
Germany
National contact office
DVKA
€<
2 months
Settlement
Reimbursement,
payment
Germany
9
Information
about
treatment
foreign
patient
6
4
Cost statement E125
5
National contact office
Hauptverband AT
Reimbursement
10
Mistakes means the same
way forward and reverse
3
Insurer DE - AOK, TK, .....
(in 90 % AOK is chosen by
the foreign
patient / hospital)
4
Ten4Health: EHIC-Portal: www.AOK-Europa.de
EHIC Process: treatment of German patient in Austria
Settlemnet, Check,
registration
7
Confirmation,
payment
or rejection
Insurer DE /
responsible KV* / DE
Permission by EHIC
Treatment
6
1
Doctor/Hospital (AT)
2
Payment after
reimbursement
from contact
office AT
National contact office
DVKA
€=
24 months
Settlement
Reimbursement,
payment
Germany
8
Information
on about
treatment
foreign
patient
5
10
Cost statement E125
4
National contact office
Hauptverband AT
Reimbursement
Mistakes means the same
way forward and reverse
3
9
Insurer AT
Kärntener
Landeskrankenkasse
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Ten4Health: EHIC-Portal: www.AOK-Europa.de
Resumée of national settlement processes by using the EHIC in different countries
The analysis of the settlement and reimbursement process in three different countries
reveals significant variations:
n Depending on the allocation of responsibilities and the availability of public health funds
or not, the financial burden either is with the hospital, the health insurer or the tax payer
– the steering impacts are obvious.
n It can be assumed that there will be further variations in the other 24 EU Member States
n In addition to these there are differences in the
Ÿ Registration of the patient,
Ÿ Medical care provision,
Ÿ costs
which have not yet been counted in here and which are likely to also heavily impact the
interest concerning the (non) use or acceptance of the EHIC by citizens and hospitals
n Transparency concerning administration of medical care of foreign guests coming from
all EU countries with EHIC would be of high value.
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Ten4Health: EHIC-Portal: www.AOK-Europa.de
Initial situation: European Health Insurance Card (EHIC)
n Foreign guests staying in Germany make use of healthcare services
n „EHIC“ European Health Insurance Card is being used
- besides different national insurance cards an
n Entitlement to benefit: EHIC constitutes and entitlement to healthcare if prove can be
obtained that it is medically required during a visitors‘ stay abroad
n Very often, EHIC is not accepted - due to the high administrative effort for processing and
reimbursement on the side of the healthcare provider
n Nearly 90% of these cases in Germany are transacted through AOK in Germany
n AOK Europa EHIC Portal could become an option also in other countries to reduce
bureaucracy and improve data quality
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Ten4Health: EHIC-Portal: www.AOK-Europa.de
AOK Europa "EHIC-Portal"
n AOK Europa EHIC Portal established to ease administrative procedures
n Utilisation for insured citizens from all over Europe
n 190 Hospitals offer the service
n Centrally administered IT- platform, open and flexible for changes
n Online patient data registration using EuropaServer followed by permission to treat for
hospitals
n Online service instead of paper based procedures
n Direct and immediate transfer of information
n Error rate down from ~30% to zero
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Ten4Health: EHIC-Portal: www.AOK-Europa.de
Handling EHIC via Internet – www.aok-europe.de
n Presentation of EHIC by citizen
n Access web site www.AOK-Europa.de
n Data capture:
Ÿ Entry of EHIC data into template
Ÿ Copy identity card
Ÿ alternative: Scan „EHIC“ and identity card (planned)
n Online transfer of data to AOK via EuropeServer
n Settlement
Ÿ in Germany through „AOK Europa“
Ÿ through DVKA (national German contact and liaison office) via use of EuropeServer
data
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Ten4Health: EHIC-Portal: www.AOK-Europa.de
Usage of the EHIC-Portal according
to nationality
06/2006 until 12/2009
EHIC-Portal overall more than 3,700
Countries
Poland
Greece
Hungary
Bulgaria
Czech Republic
Rumania
Slovakia
Lithuania
Slovenia
Cyprus
Malta
Italy
Great Britain
Netherlands
Spain
Belgium
France
Austria
Portugal
Luxembourg
Switzerland
Sweden
Norway
Ireland
Finland
Denmark
Code
PL
EL
HU
BG
CZ
RO
SK
LT
SI
CY
MT
IT
UK
NL
ES
BE
FR
AT
PT
LU
CH
SE
NO
IE
FI
DK
EU-insured
779
196
73
63
62
45
28
21
18
2
2
451
340
334
253
228
214
200
74
67
93
104
39
23
17
17
in %
20,81
5,24
1,95
1,68
1,66
1,20
0,75
0,56
0,48
0,05
0,05
12,05
9,08
8,92
6,76
6,09
5,72
5,34
1,98
1,79
2,48
2,78
1,04
0,61
0,45
0,45
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Ten4Health: EHIC-Portal: www.AOK-Europa.de
Usage referring to hospitals in Northrhine-Westfalia
Increasing use of the EHIC-Portal by hospitals:
Uniklinikum,
Aachen
year
2006
2007
2008
2009
23
28
136
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Kreiskrankenhaus,
Grevenbroich
1
40
3
Klinikum,
Dortmund
34
122
156
20
Ev.
KreiskrankenEv.
Städtisches
Helios
Krankenhaus,
haus,
Krankenhaus, Klinikum, Klinikum,
Düsseldorf
Gummersbach
Köln
Solingen Wuppertal
Eu insured
26
52
74
2
10
29
46
4
6
39
64
4
18
30
43
7
25
62
94
3
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Ten4Health: EHIC-Portal: www.AOK-Europa.de
AOK Europe – EHIC-Portal
Summary:
n AOK Europa EHIC Portal = success!
Ÿ Participation of 190 hospitals
Ÿ Increasing use of the EHIC-Portal in hospitals
Ÿ Hospitals give positive feedback
–
–
Error rate down to „0“
Settlement without delay
Ÿ More than 3,700 cases of treatment of patients coming from all EU countries
n Less bureaucracy – improved quality – extension
Ÿ Satisfied hospitals
Ÿ Well treated and satisfied patients
Ÿ Motivated staff in hospitals and at AOK
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