AOK Europe Medical care of foreign visitors with the European

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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



                                                                                      1
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



                                                                                    2
Ten4Health: EHIC-Portal: www.AOK-Europa.de

EHIC Process: treatment of German patient in the Netherlands


     Insurer DE/                                    Permission by EHIC        1      Doctor/Hospital (NL)
 responsible KV* /DE
                           Settlemnet, Check,        Treatment                2
     Confirmation,

      or rejection
       payment




                              registration
 8                                              7
                                                                                                          Information
                                                                                      Payment after
                                                                                                          about
                                                                                      reimbursement
                                                                                                          treatment
                                                                                      from contact
                                                                                                          foreign
                                                                                      office NL
                                                                                                          patient

 National contact office
          DVKA                                                                           €<
             Germany
                                                                                      2 months
       Reimbursement,



                        Settlement
           payment




 9                                              6                                       4                     3



                                                        Cost statement E125   5         Insurer NL - AGIS
                                                                                   1. Request to one health insurer
     National contact                                                              2. Financing through public
          office                                                                      health care fund
           CVZ                                            Reimbursement       10
                                                    Mistakes means the same
                                                    way forward and back                                                3
Ten4Health: EHIC-Portal: www.AOK-Europa.de

EHIC Process: treatment of any patient from Europa in Germany

    Insurer EU /                                   Permission by EHIC           1            Doctor/ Hospital (DE)
responsible KV* / EU
                          Settlemnet, Check,        Treatment
                                                                                2
     Confirmation,

      or rejection



 8                                             7
       payment




                             registration
                                                                                                               Information
                                                                                             Payment after
                                                                                                               about
                                                                                             reimbursement
                                                                                                               treatment
                                                                                             from insurer in
                                                                                                               foreign
                                                                                             Germany
                                                                                                               patient

National contact office
         DVKA
             Germany
                                                                                                 €<
                                                                                              2 months
       Reimbursement,



                        Settlement
           payment




 9                                             6                                               4                 3


                                                                                    5
                                                       Cost statement E125                 Insurer DE - AOK, TK, .....
 National contact office                                                                   (in 90 % AOK is chosen by
   Hauptverband AT                                                                                  the foreign
                                                         Reimbursement              10           patient / hospital)

                                                                 Mistakes means the same
                                                                 way forward and reverse                                 4
Ten4Health: EHIC-Portal: www.AOK-Europa.de

EHIC Process: treatment of German patient in Austria

     Insurer DE /                                   Permission by EHIC          1
 responsible KV* / DE                                                                   Doctor/Hospital (AT)
                                                     Treatment
                           Settlemnet, Check,
                                                                                2
      Confirmation,

       or rejection


  7                                             6
        payment




                              registration
                                                                                                        Information
                                                                                        Payment after   on about
                                                                                        reimbursement   treatment
                                                                                        from contact    foreign
                                                                                        office AT       patient

 National contact office
          DVKA
              Germany
                                                                                           €=
                                                                                        24 months
        Reimbursement,



                         Settlement
            payment




  8                                             5
                                                                                          10              3

                                                                                    4
                                                        Cost statement E125
  National contact office                                                                   Insurer AT
    Hauptverband AT
                                                                                             Kärntener
                                                          Reimbursement             9   Landeskrankenkasse

                                                          Mistakes means the same
                                                          way forward and reverse                                 5
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     Countries         Code   EU-insured   in %
to nationality
                                       Poland           PL            779      20,81
                                       Greece           EL            196       5,24
06/2006 until 12/2009                  Hungary          HU             73       1,95
                                       Bulgaria         BG             63       1,68
                                       Czech Republic   CZ             62       1,66
EHIC-Portal overall more than 3,700    Rumania          RO             45       1,20
                                       Slovakia         SK             28       0,75
                                       Lithuania        LT             21       0,56
                                       Slovenia         SI             18       0,48
                                       Cyprus           CY              2       0,05
                                       Malta            MT              2       0,05
                                       Italy            IT            451      12,05
                                       Great Britain    UK            340       9,08
                                       Netherlands      NL            334       8,92
                                       Spain            ES            253       6,76
                                       Belgium          BE            228       6,09
                                       France           FR            214       5,72
                                       Austria          AT            200       5,34
                                       Portugal         PT             74       1,98
                                       Luxembourg       LU             67       1,79
                                       Switzerland      CH             93       2,48
                                       Sweden           SE            104       2,78
                                       Norway           NO             39       1,04
                                       Ireland          IE             23       0,61
                                       Finland          FI             17       0,45
                                       Denmark          DK             17       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:

                         Kreiskranken-                    Ev.     Kreiskranken-      Ev.     Städtisches Helios
          Uniklinikum,                   Klinikum,
                             haus,                   Krankenhaus,     haus,     Krankenhaus, Klinikum, Klinikum,
            Aachen                       Dortmund
                         Grevenbroich                 Düsseldorf  Gummersbach       Köln      Solingen Wuppertal
   year                                                   Eu insured
   2006        23                           34           26            10           6           18        25
   2007        28              1           122           52            29           39          30        62
   2008       136             40           156           74            46           64          43        94
   2009        12              3            20            2             4           4            7         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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posted:8/7/2011
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