By Gordana Basovic

New Serbian health insurance card has been made and designed after the European model. Nevertheless, for the time being, a health policyholder from the town of Prokuplje has fewer possibilities for medical treatment throughout Serbia than an average Romanian or Pole has in the territory of all 27 European Union member-states or even in Lichtenstein, Island, Switzerland and Norway.

Patients` mobility is one of the important EU achievements since the European health insurance card enables its owner to receive healthcare in 31 European countries. This simple card has no medical data but only the name and surname of its holder, personal identification number and birth date. However, it makes necessary medical treatment possible during temporary stay in one of the member-states.

The use of the new health insurance card in Serbia is still limited for not all the healthcare institutions have the hologram scanner. According to Vladan Ignjatovic from the Serbia Republic Health Insurance Fund, health insurance card with hologram will contain all the patient data.

"The application of this system has started in most towns and the plan is to implement it fully by 2009. In case of urgent medical help, policy holders with health insurance card can get medical treatment in any Serbian town," explains Ignjatovic.

However, in case someone from the town of Vranje needs specialist checkup in Novi Sad, he or she needs to have doctor`s recommendation sealed by the Serbia Republic Health Insurance Fund subsidiary seal. In that case only the treatment will be free of charge and the doctor`s recommendation can be obtained just in case the intervention is not performed in the place of residence.

During the course of the European Union association process the Serbian healthcare system will have to be adapted in order to make greater patients` mobility within the state and after joining the EU in all the European countries.

European health insurance card is the substitute for numerous forms that are currently being used by tourists, international companies, students, workers, and unemployed who are coming from other countries and looking for work in the EU member-states.

This card provides the treatment in accordance with the member-state rules the treatment is obtained in and the price is brought into accord with a tariff scale applied in the country in question. For example, if the health service is free of charge in the country the care is needed it will be provided gratis thanks to health insurance card or other equivalent document. The health insurance card guarantees reimbursement on the spot or upon the policyholder return to his or her residence country.

All member-states have identical card design that has European symbol and each policyholder in any of the member-states is entitled to this card.

The European card covers only the expenses that are medically necessary during the stay in one of the member-states. With this card it is not possible to choose the country for treatment. It allows only the medical care that provides safe stay in the transit country. It does not cover the service you wish to have in one the member-states, such as a nose plastic surgery.

Nevertheless, in case the treatment requires patient`s hospitalisation, certain health insurance institution seeks for authorisation. The treatment price will be covered according to the price list of the country that provides it and in case the treatment price is higher than the one guaranteed by his or her health insurance the price difference has to be paid by the policyholder himself or herself. In case of the insurance company lack of compliance, the price of treatment is born by the policyholder while it is not certain whether the money will be refunded upon his or her return to the residence country.

European health insurance card introduction in 2004 has still not solved the patients` rights problem of cross-border healthcare. Therefore, in July the European Commission has made public proposal of the Directive on the Application of Patients` Rights in Cross-Border Healthcare. This way the Commission is trying to apply the Court of Justice ruling stating the EU citizens have the right to ask for medical care in other EU member-state and to refund expenses from their healthcare system.

However, resistance from several states and statements made by several unnamed diplomats characterising this as "the beginning of the long row" indicate that the adoption of such decision would take a long time. While the opponents rebuke legal inconsistency since the healthcare systems are in the competence of the member-states not EU administration, proponents point out patients` benefits.

According to Robert Madelin, the Director General at the Commission`s Health and Consumer Protection Department, the Directive just shapes the right that the Court of Justice has already determined.

"This is not the end of the world as the health managers see it", he points out.

Regardless debates, prompting states to cooperate in the field of solving cross-border problems in healthcare sphere is one of three main goals of the European Union health authorities.