Although Directive 2011/24/EU allows it, cross-border healthcare services are very rare at the Hungarian-Slovak border. The exception is the Vaszary Kolos Hospital in Esztergom, where, however, the patients contracted by the Slovak Dôvera Health Insurance Company are not treated under the Directive, but on a commercial basis, under a contract signed in 2004 and renewed in 2009.
The main reason for the lack of patient migration is the absence of an agreement between the two countries clarifying the financial reimbursement conditions for services systematically used across the border. As a result, on the one hand, the health authorities in the two countries are developing their capacities in parallel and, on the other hand, potential territorial complementarities are not being exploited.
Thus, while in the modern hospital in Komárno, the Slovak health insurance company provides funding for 10 examinations per day for the MRI equipment, which means half-day use, patients in Komárom are examined in Tatabánya under a similar system. Given the high cost of purchasing and operating high-value diagnostic equipment and the shortage of staff in both countries, it would be rational to share capacity and joint financing. In the example case, the full-time use of the MRI equipment would allow patients in Komárno to benefit from this diagnostic service close to their place of residence without queuing, and the equipment would be better utilised with co-financing from the Hungarian health insurance (NEAK).
An even more fundamental problem was reported by the Slovak mayors representing small municipalities who attended the workshop in Balassagyarmat. In their case, the hospital in Balassagyarmat is closer and has more specialists than nearby hospitals in Slovakia. The quality and speed of care for local residents could be higher if they could receive treatment on the Hungarian side. This would also benefit the hospital on the Hungarian side, as they can only accept specialist residents if there is a senior doctor in the hospital. However, the employment of senior doctors is conditional on a sufficient number of patients, which smaller border hospitals cannot provide because of their “one-sided” (180 degrees) coverage.
The cross-border health working group set up on the Hungarian side at the ministry level has dealt with the issue in a superficial manner, on which two comprehensive analyses have already been prepared by Dr. Tamás Balogh within the framework of the CESCI’s legal accessibility project (in 2018 and 2019; in 2021 the organisation also dealt with the impact of COVID).
A significant difference between the two countries is that the Slovakian side has a three-pillar insurance system, while the Hungarian side has a private insurance system that was significantly restricted by administrative means in the early 2010s. This is the reason why patients of a Slovak private insurer can be treated in Esztergom, while the reverse is not possible.
No, but cooperation between ambulance services is expected to force closer cooperation between hospitals, as ambulances will have to transport patients somewhere.
There are many good examples from across Europe, from the Austro-Czech outpatient care in Gmünd to the French-Belgian cross-border health care zones to the Spanish-French Cerdanya Hospital in the Pyrenees.
As a first step, a comprehensive analysis of the available capacities in the border zone should be carried out as a basis for capacity sharing and joint financing. This should be followed by a model that can ensure a balance in the transfer of charges. This could be the basis for an agreement between the two governments and the two public health insurers, for which the Franco-Belgian agreement could provide a model. The Belgian-French system could also serve as an example for the systematic collection and use of statistical data on benefits within the framework of a regional observatory.
Students living on one side of the border, but attending school on the other side and playing sports at a competitive level, cannot use the sports medicine service that is much closer to their school and training place, but due to the inflexibility of social security system, they have to travel to the doctor where they live, even if it is in another settlement.
This proven to be not entirely the case, since the relevant legislation allows that if a competitor of foreign nationality competes in the colors of the given country, the necessary health screenings can be carried out free of charge in the country of the registered sports club (and not necessarily in the country of residence). However, it may happen that there is no sports doctor in the given settlement, so the athletes are instead directed to the nearest sports doctor in their place of residence for examination and obtaining the necessary certificate.
Slovak certificates of absence due to specialised medical examination are not accepted at Hungarian workplaces.
Hungarian labour law does not recognise the institution of a one-day medical certificate, which is common in Slovakia. Officially, a Hungarian employer is not obligated to accept a one-day stamped medical certificate of a specialist medical examination for an employee in the framework of an employment contract, neither in paper nor electronic form. The Slovak practice has been communicated to the General Administration Department of the Hungarian National Health Insurance Fund Management. The approximation of the different regulations and practices will be examined at the next revision of the Labour Code. In order to approximate the two practices we will get in touch with the Hungarian and Slovakian contact points of the European Labour Authority (ELA). Considering that the ELA mediates on labour law issues between EU Member States and facilitates the exchange of information between Member States, it is worth asking for their help in dealing with the issue of approximation of divergent rules.
The project is financially supported by the European Union,
within the framework of the Interreg Hungary – Slovakia Programme.
For more information visit www.skhu.eu.
The project is financially supported by the European Union,
within the framework of the Interreg Hungary – Slovakia Programme.
For more information visit www.skhu.eu.