Wednesday, May 22, 2013

Health Payments in Europe

French & European Health payments by the UK for British Pensioners

A/. It is appropriate that the retired citizens who live in France know exactly what expenses are paid  by the British Government for their health care in France.
I am eighty years old, retired, and have never earned any money in France and therefore have never subscribed to the French social security system. The UK is by EU law the ‘competent State’ for the support of our Social Security.  
Like so many others I find the costs of our health care ever rising. Some elderly couples are needing to find beyond 2,000 euros a year  for a top-up health insurance.
Under EU law France is required to ask the UK for the actual costs of our health treatment.  What is meant by ‘actual costs’?
I decided to find out the position.  This is possible via a Freedom of Information request to the Department of Health, London.   I have received very courteous mails from that department and was able to obtain details of all payments to France concerning my health payments since August 1998.  These are confidential and were sent to me by recorded delivery.
I have selected one item here which I have cross checked with details I received from the CPAM (French social security department).
Item  24th January 2012
CPAM detail
Acte Biologie      
montant dépense (actual cost)      82.08€      taux 60% (amount paid by the French State)
montant payé  (amount paid to the  institution of treatment)          49.25€
participation forfaitaire à retenir   (‘tax’ retained for future collection from patient)   -4.00€

Soins infirmiers  
montant dépense (actual cost)       4.73€      taux  60% (amount paid by the French State)
montant payé  (amount paid to the  institution of treatment)             2.84

Reglé au Laboratoire   (Amount for final settlement to the Laboratory – A sum of  34.72€ was paid by my health  insurance  making up the total of  86.81€ =82.08+4.73€)      
 52.09€.  This is equal to the above 49.25€+2.84€

Breakdown on Claim from France sent to me from the Department of Health, London on items between 15/12/2011 to 22/06/2012.
Soins paramedicaux                           2.84€
Analyses biologiques                        49.25€   i.e = 52.09€

It is clear that the French State seeks repayment of the costs which the French State would find for a French Citizen.  .

B/.The added burden of French taxation on the cost of health.
The above  CPAM detail indicates a ‘participation forfaiture’ of 4€ .   This is a tax which the French Government levies on most health transactions.  It is 1€ for each visit to a G.P. and 0.5€ for collection of a drug at a pharmacy. 
The cost out of one’s pocket for the ‘Acte Biologie’ was therefore increased by 4€. 
The cost to me of this ‘Acte +soins’  was therefore 34.72€+4€= 38.72€. The 4€ was not paid by my insurance.
Over a year, the taxes on health costs accumulate. Together with the above taxes on each medical act as indicated above one must add the taxes on health insurance. During 2012 these taxes amounted in my case to towards 200€.  The more one requires drugs and medical care the higher the taxes. Some pensioners are paying out a great deal more than this in taxes on their health. The more ill you are the more tax you pay!  The French should be ashamed of this taxation on sick people.

C/. Insurance costs
During 2012 the cost of health insurance per month was for me 128.78€ (for a couple – being 64.39€ for one person).  It has since risen in 2013 to 135.78€/month -1629.36€/year).  198.15€/year of this latter sum is a tax paid to the French Government – i.e about 12%.
D/. The EU Laws on the position of health costs.
Regulations 883/2004 and its ‘implementing regulation 987/2009 are those that concern Social Security matters. My interpretations are indicated in orange.

Basic EU Regulation No 883/2004 defines ‘institution’ as ---
"institution" means, in respect of each Member State, the body or authority responsible for applying all or part of the legislation."
The EU laws below are interpreted as referring to the ‘actual costs’ to the institution of the State not the actual costs of the institution that provided the treatment.

EU Regs 883/2004 Article 24 covers the situation relating to Pensioners who have retired to live in another State…I quote verbatim.
“No right to benefits in kind under the legislation of the Member State of residence
1. A person who receives a pension or pensions under the legislation of one or more Member States and who is not entitled to benefits in kind under the legislation of the Member State of residence shall nevertheless receive such benefits for himself and the members of his family, insofar as he would be entitled thereto under the legislation of the Member State or of at least one of the Member States competent in respect of his pensions, if he resided in that Member State. The benefits in kind shall be provided at the expense of the institution referred to in paragraph 2 by the institution of the place of residence, as though the person concerned were entitled to a pension and benefits in kind under the legislation of that Member State.”
[Observations/Interpretation :- It states that one should receive medical treatment in the same manner as one would expect under the legislation of the UK as if the patient resided in the UK.
                                    The costs are to be borne by the UK – the ‘competent State’ for your social security.
                                    The medical care is supplied as to a French person under French legislation as though he/she were a state pensioner of France.]
“2. In the cases covered by paragraph 1, the cost of benefits in kind shall be borne by the institution as determined in accordance with the following rules:
(a) where the pensioner is entitled to benefits in kind under the legislation of a single Member State, the cost shall be borne by the competent institution of that Member State;”
[Interpretation – The UK is bound to pay the medical costs]
“Article 35
Reimbursements between institutions
1. The benefits in kind provided by the institution of a Member State on behalf of the institution of another Member State under this Chapter shall give rise to full reimbursement.”
From the Complementary ‘Implementing’  EU Regulation 987-2009 we read..
“Article 62
1.  For the purposes of applying Article 35 and Article 41 of the basic Regulation, the actual amount of the expenses for benefits in kind, as shown in the accounts of the institution that provided them, shall be reimbursed to that institution by the competent institution, ………….”
The difficulty lies in the interpretation of the clause: copied in above--
“The benefits in kind shall be provided at the expense of the institution referred to in paragraph 2 by the institution of the place of residence, as though the person concerned were entitled to a pension and benefits in kind under the legislation of that Member State.”

I observe that this clause has no mention of costs.  It relates to the provision of the medical treatment.  This has to be provided as though one is a French citizen.

One notes the contradiction with  the previous clause which states that
the pensioner’  shall nevertheless receive such benefits for himself …., insofar as he would be entitled thereto under the legislation of the (United Kingdom) [Member State] competent in respect of his pensions, (as) if he resided in (the United Kingdom) [that Member State].
the cost shall be borne by the competent institution (DoH) of that Member State (the United Kingdom).

So we should get treatment as though we lived in the UK and the UK should cover the cost.
The law appears to me contradictory – It is written that one should receive the medical treatment as though one lived under the legislation of the UK and ALSO as a French citizen pensioner would receive it under the legislation in France.

Many French Citizens – those on 100% CMU cover – pay nothing for their health care.  In short –  the cost to the patient is variable according to the circumstances of the patient! Since the British pensioner has costs covered (in theory!) by the Department of Health, London, it would be reasonable to suppose that these patients should also fall into the 100% cover category. I explore that thought ina European context……

E/. Other European National Citizens in France.
EU laws must be applied equally to all nationals across Europe The provision of health care for a state pensioner varies widely from  Estonia to Portugal.   It would seem almost impossible to provide health care for every ‘mobile’ pensioner under two systems of legislation at the same time.  The current interpretation seems inadequate.
It is also a restriction and distortion on free movement of pensioners.   The pensioner nationals who move from most other European countries to the UK obtain free health care.  Clearly with the UK pensioners moving to other countries in Europe, it is very often and usually not so. 

F/. Reform? And a solution?
Would it not be sensible to transfer 100% of the costs from the State of Residence  to the administration of the  ‘competent States’ for the support of Social Security and then that administration should seek appropriate repayments according to the legislation of that State from the  pensioner patient ‘as though they lived in their home country’?  Is this indeed that which the EU regulations are seeking? i.e the costs should be  borne by the 'competent State?

The pensioner should then settle their bills (if appropriate so to do) in a manner according to the legislation of the ‘home’ State.

G/. The need for Representation on these matters at a political level.
There is no-one in the British Government or Administration with any responsibility to look after the interests of British Pensioners in mainland Europe.  
There should be someone who has the responsibility to negotiate with the EU or other national governments concerning the condition of British Pensioners abroad in Europe.

Wednesday, May 8, 2013

Harry Shindler's claim for voting rights rejected by The European Court for Human Rights

The European Court of Human Rights has turned down (7th May 2013) Harry Shindler’s  claim to be allowed to vote for an MP in the House of Commons.
The full text (which runs to 38 pages) can be read here!

Harry is 91. He fought in World War II at the Anzio Beach-head.[Anzio is south of Rome and north of the stalemated front line of Monte Cassino – The beach-head played an important if bloody role in the Allied advance in 1944].  Harry is both a proud Briton and proud European.
The ECHR judgement gives much space to the Parliamentary Assembly of the  Council of Europe [page 10 et seq.]   [The CoE comprises 47 signatory countries far beyond the EU, including  Russia, Turkey and Armenia]
Neither the ECHR nor the CoE are agencies of the European Union!

The Parliamentary  Assembly recommends as follows [page 10 ]
Par. 39 “c. consider the possibility of harmonising member states’ laws in the interests of maintaining the voting rights of their nationals living in another member state with regard to nation-wide elections and referenda, especially with a view to enabling votes to be cast by post or through diplomatic or consular missions;
d. envisage, if appropriate, the drawing up of a protocol to the European Convention on Human Rights whereby member states would undertake to respect such voting rights for their nationals living in another member state and refrain from hindering the exercise thereof by any measure whatever.
Further it is noted [page 11]…
Par. 42 - 4. The Parliamentary Assembly believes that it is in the interest of states to ensure that their expatriate nationals continue to actively exercise their rights linked to nationality and contribute in a variety of ways to the political, economic, social and cultural development of their countries of origin
And [page 11/12].
Par. 43 c. to take account of their expatriates’ interest in policy making, in particular concerning questions of nationality; political rights, including voting rights; economic rights, including taxation and pension rights; social rights, including social schemes; and cultural rights .
And Again [page 12]!!
Par. 47 --b. grant electoral rights to all their citizens (nationals), without imposing residency requirements;
c. facilitate the exercise of expatriates’ electoral rights by providing for absentee voting procedures
And the analysis of the Parliamentary Assembly  comments continues to page 15…
The report comments on the deliberations of the Committee of Ministers of the  Council of Europe which generally support the observations given above.
Considerable space is also afforded [pages 16-19] to deliberations of the Venice Commission – which is another offshoot of the Council of Europe and concerns itself with the issue of Democracy!  This account is an historical  progress and one should read from page 18 paragraph 68 onwards for the latest observations.
Note well it recommends on ‘voting’ ---
Sub paragraph 66. It ensures that citizens maintain ties with their country of origin and boosts their feeling of belonging to a nation of which they are members regardless of geographical, economic or political circumstances.”
70. In the case of states whose citizens live abroad in large numbers, to the extent that their votes could appreciably affect election results, it seems more appropriate to provide parliamentary representation for the citizens resident abroad by pre-defined numbers of members of parliament elected by them.
Pge 19 – para 74 The document lists the 35 States (out of the 47 in the CoE)  which permit unlimited voting by non-resident nationals.
In spite of all this detail the ECHR decided unanimously against Harry Shindler.
The legal argument centred on Article 3 of Protocol No. 1 to the Convention of Human Rights.
“The High Contracting Parties undertake to hold free elections at reasonable intervals by secret ballot, under conditions which will ensure the free expression of the opinion of the people in the choice of the legislature.”
1. Declares the complaint concerning Article 3 of Protocol No. 1 admissible and the remainder of the application inadmissible;
2. Holds that there has been no violation of Article 3 of Protocol No. 1 to the Convention.

You can judge for yourself.
What will Harry do now!  
He will take his case to the United Nations International Court of Justice.

UNLESS – The British Government will take fair measures to uphold the Rights of  British Nationals to be able to influence the British Government on decisions made by HMG in their name!
Much has been written already on why British Nationals – most especially those residing within the EU/EEA – should have this representation.    The first link below has numerous comments by British Nationals why this should be so…

You can make your own protestations and petition via the following two links.   Here to place your observations.
and – direct to the Government site ---

Author Brian Cave –