Explained when to go abroad for scheduled medical services

There are situations when, due to certain circumstances, health care services that could help cannot be provided to the insured in Lithuania. Sometimes in such cases, after the issuance of a special document, patients are sent to receive medical services in another European country. When and how are planned healthcare services provided abroad on the basis of this document paid for by health insurance funds?

Those insured with compulsory health insurance can be sent for consultation, examination or treatment with the funds of the Compulsory Health Insurance Fund (PSDF) to another country of the European Union, Iceland, Norway, Liechtenstein, the United Kingdom or Switzerland. To receive planned medical services is sent to another country when the possibilities to provide effective services paid for by health insurance funds and to apply effective treatment methods in Lithuania have been exhausted, and the treatment method abroad may have an effect, prolong life, reduce disability or prevent it from occurring. Also when it cannot be done within a medically justified time due to the person’s state of health or the course of the disease.

The process takes time, but is convenient for patients

“First of all, the attending physician sends his patient to a university or university hospital for consultation regarding the advisability of treatment abroad. The hospital organizes a consultation and if there are medical indications to send the patient abroad for treatment, evaluates alternatives, finds a treatment facility abroad, coordinates details with it. At least two weeks before the patient leaves for treatment abroad, the hospital submits to the special commission established by order of the director of the State Hospital Fund the necessary documents for making a decision: an application for issuing a permit for treatment in a foreign country in the prescribed form, the conclusion of the council of medical specialists on the need for treatment abroad, a letter from a foreign medical institution, which confirms that the treatment will be provided to the patient on the basis of document S2, and indicates the preliminary price of treatment paid by the social health insurance institution and information about the premiums applied to the patient”, explains the procedure for receiving scheduled medical services abroad by the State Hospital Fund under the Ministry of Health (VLK) International Affairs department advisor Neringa Šafranavičienė. After receiving these documents, the commission makes a decision whether the necessary planned medical services abroad can be paid for the patient from the PSDF, and informs the patient or his representative and the patient’s referring medical institution about this. If the decision is positive, VLK issues document S2 confirming the right to receive services abroad compensated by PSDF. This document is valid for one year, but this term can be extended for a maximum of 1 year if the hospital justifies such a need to the commission. Thus, the patient does not need to organize the treatment himself.

In what institution and what services?

With an S2 document, patients can only be sent to medical facilities belonging to the national health system of a foreign country and only for those medical services that are covered by the state health insurance of the foreign country providing them. Most often, they are sent to receive expensive, complex inpatient services that cannot be provided to the patient in Lithuania for reasons such as his young age, when there is a lack of experience in the required field, because, for example, there is no great need for certain operations and they are performed too little. On the basis of the medical service document S2, children are often sent to Switzerland for oncological diseases of the eyes, to Poland for liver transplantation, pregnant women to Sweden for treatment of twin transfusion syndrome, and adults for oncological diseases.

Institutions settle among themselves

Medical services provided on the basis of document S2 to a foreign medical institution are paid for by the state health insurance institution of the country providing them in accordance with the procedure and rates established by its legislation – as for local residents. And VLK pays the state health insurance institution of a foreign country for the medical services provided to a resident of Lithuania from the PSDF, after receiving an invoice from it. According to the representative of the health insurance fund, such payment is convenient for patients. It is only important to know that PSDF does not reimburse patient premiums (e.g. for bed days), paid medical services, patient travel, accommodation, transportation, translation services in the country of treatment.

Mostly – to Switzerland and Poland

According to VLK data, up to 50 patients from Lithuania are sent abroad every year for consultation, examination or treatment on the basis of document S2. Last year, the State Sick Fund paid 413.4 thousand. EUR from the PSDF for treatment abroad for patients from Lithuania based on the S2 document. The most popular destinations where patients from Lithuania are sent for planned treatment are Switzerland, Poland, Sweden, Austria, Germany, France, Estonia, Latvia and Finland. This year, 20 S2 documents have already been issued for 13 patients from Lithuania and they show that the trends are not changing – referrals for treatment in Switzerland dominate.

Press release