The approval process

Most people receive their healthcare in the country they live in, through the healthcare system they are covered or insured by.

There may be times however, when you consider it beneficial to receive healthcare in another European Economic Area country and exercise your rights under the Treaty of the Functioning of the European Union.

The European Cross-border Healthcare Directive clarifies the rights of EU citizens who wish to:

  • seek any healthcare service, including private healthcare, in another European Economic Area country that is the same as, or equal to, that provided by the healthcare system where they live
  • claim reimbursement of costs up to the amount that the treatment would have cost had it been provided by their home healthcare system, or the actual cost of treatment if this is lower

Legislation

The relevant European and Scottish legislation is:

If you can't find what you are looking for on this site or would like to discuss the information with one of our health information advisers:

Approval process

For certain specialist treatments, prior authorisation is required from your local NHS Board before you travel for healthcare in another European Economic Area State and you intend to claim reimbursement on return.

You should consider applying for prior authorisation regardless of whether there is a legal requirement to do so as it provides you with an opportunity to fully discuss the process and reimbursement arrangements.

Services that require prior authorisation

There are 143 specialised services that need prior approval under the European Cross-border Healthcare Directive.

The specialised services that need prior approval under the European Cross-border Healthcare Directive are outlined in detail in the NHS England Manual for Prescribed Specialised Services.

You can find a list of tariffs for each of these services through GOV.UK.

You should contact your local NHS Board to discuss whether prior authorisation is necessary in your individual case, if this is unclear.

What does prior authorisation involve?

Prior authorisation from your local NHS Board establishes:

  • if you are entitled to the treatment
  • what level of reimbursement you can expect
  • that you are aware of all the possible treatment options in the NHS that may be more convenient to you than going overseas
  • what you should do if there is a problem with the treatment you receive

Prior authorisation does not mean that the NHS clinically approves the healthcare you plan to receive in another European Economic Area member state. Nor does it mean that the NHS accepts any responsibility for that treatment, as no duty of care is attached to the authorisation.

Your local health board must make a decision on applications within 20 working days, unless further information is required.

Why might authorisation be refused?

Your local health board can refuse authorisation if:

  • you will be exposed to a patient-safety risk that is not thought to be acceptable in relation to the benefits the treatment may bring
  • the general public will be exposed to a substantial safety hazard as a result of you receiving cross-border healthcare
  • there are concerns about the standards and guidelines on quality of care and patient safety that the provider of the treatment works to
  • the same healthcare can be provided in Scotland within a medically reasonable time limit

If prior authorisation is refused then you will be given a full explanation as to why. You also have the right to appeal the decision.

Quality and safety

Various legal frameworks govern health and care services in Scotland.

Strategy and policy is also in place to guide decisions and ensure services provided are sustainable, safe, effective and person-centred.

Below we have listed some useful resources that provide you with information on quality and safety within the NHS in Scotland.

Quality Strategy

The Quality Strategy aims to deliver the highest quality healthcare to the people of Scotland by making sure the NHS, Local Authorities and the Third Sector all work together with patients, carers and the public towards a shared goal of world-leading healthcare.

Scottish Patient Safety Programme

The Scottish Patient Safety Programme is a unique national initiative aimed to drive improvements across the whole of NHS Scotland.

Information Services Division

The Information Services Division website contains useful hospital care statistics.

Regulation of healthcare professionals

Certain health care professions are regulated by law.

There are bodies with the legal responsibility for keeping registers of people entitled to practice in the United Kingdom, including Scotland. They also set appropriate standards and take action when these standards are not met.

Further information on the regulation of healthcare professionals

NHS staff governance

NHS Scotland has a well-established reputation for providing high quality care to the population of Scotland.

Staff governance focuses on how NHS Scotland staff are managed, and feel they are managed, by one of Scotland’s largest employers. It forms part of the governance framework within which NHS Boards must operate.

Further information on staff governance and employee experience

Treatments and pricing

Under the European Cross-border Healthcare Directive, the incoming patient must be charged the same amount as the treatment would have cost had it been provided to a Scottish resident under the NHS.

This means that Scottish NHS healthcare providers must apply the same pricing criteria as they use for domestic patients when providing healthcare for patients from other parts of the European Economic Area under the directive.

NHS Scotland treatments and pricing

A copy of the Scottish tariff can be found on the Information Services Division website.

Private healthcare treatments and pricing in Scotland

Patients who wish to receive private treatment in Scotland under the directive should contact the private provider direct for information on treatments, their availability and costs.

Taking your prescription to another European Economic Area (EEA) country

If you are planning to have your prescription dispensed in another EEA country then there are certain criteria that need to be on your prescription form. The criteria are set out in the Annex to Directive 2012/52/EU:

Read the regulations on the Recognition of Medical Prescriptions Issued in Another Member State (PDF, 714KB)

Appeals, complaints and claiming back costs

Further information on the European Cross-border Healthcare Directive including, appeals and complaints, claiming back the cost, insurance, travel expenses and privacy.

Appeals and complaints

If you are unhappy with the decision you receive from your local health board regarding European cross-border healthcare, then you have the right to appeal.

This appeal should be in writing and within the complaints timeframe that your local health board has set out.

Each local health board in Scotland has a system in place for dealing with such feedback and complaints. You can find their contact details within our contacts in Scotland section.

More about the NHS feedback and complaints procedures

Claiming back the cost

Under the European Cross-border Healthcare Directive, when accessing healthcare in another European Economic Area State, you will be expected to pay the costs of treatment to the overseas healthcare provider.

Claim for reimbursement is made to your local NHS Board when you return.

When requesting reimbursement you will need to provide:

  • evidence of clinical need
  • evidence of prior authorisation, if this was required
  • itemised receipts and proof of payment for the treatment or service you purchased

How is the amount calculated?

The amount you will be reimbursed is up to the amount that the same, or equivalent, treatment would have cost the NHS had it been provided by your local NHS Board in Scotland.

This means that if the treatment you received overseas is more expensive than it would have been if provided by the NHS at home, you pay the additional costs. If the treatment is cheaper, you cannot profit from it. In such circumstances, the actual cost is all that is reimbursed.

When calculating reimbursement, NHS Boards will use the mandatory tariff or the published national average reference costs.

A copy of the Scottish tariff can be found on the Information Services Division website.

What about insurance?

If you are going abroad for medical treatment in another country we strongly advise you to have comprehensive independent medical insurance for your trip that fully covers your requirements.

NHS Scotland will not reimburse the cost of health insurance.

What about travel expenses and accommodation?

Travel costs will only be reimbursed if you would have been eligible to receive travel costs in Scotland under existing NHS means-tested schemes.

Reimbursement of travel costs will be by the cheapest reasonable means of transport. This means you reach the place of treatment in a reasonable time and without detriment to your condition.

The cost of accommodation is not reimbursable.

Privacy

The European Cross-border Healthcare Directive requires the right to privacy during the processing of personal data.

On request, your are entitled to be supplied with a copy of your medical treatment record to take back with you to your home clinicians.

A health record can be recorded in computerised or manual form, or in a mixture of both.

More information can be found in the Data Protection Act 1998.

Contacts in and outside of Scotland

Contact information for locations in and outside of Scotland in relation to the European cross-border healthcare directive.

Contacts in Scotland

Healthcare in Scotland is split between the public and private sector, with public sector healthcare provided free by the NHS and private sector care available at a cost through independent providers.

If you are looking to compare healthcare costs with those in your own country, you should always check with providers in both sectors as the price and availability of treatment will vary.

Local NHS health boards

NHS Scotland provides public sector healthcare through 14 health boards.

Each board covers a different area of Scotland and is responsible for the delivery of healthcare and services to the local population.

Within each board, a dedicated contact for European cross-border healthcare will be available to take enquiries and give help and support.

Find a contact at an NHS health board

Private healthcare providers

The private healthcare sector in Scotland includes the following organisations (note - this list is not comprehensive). We have noted a main contact for each, who will be able to advise on European cross-border healthcare enquiries.

Find a contact at a private healthcare provider

Contacts outside of Scotland

NHS clinicians and NHS Boards cannot be held liable for any failures in a treatment you receive in another country under the European Cross-border Healthcare Directive.

In seeking healthcare in another European Economic Area State, you are stepping outside of NHS jurisdiction and duty of care. This means that the law of the country you want to go to for treatment will apply, not the legislation that the NHS in Scotland is held accountable by.

It is therefore your responsibility to make sure that you know who is accountable for ensuring your safety and that standards are maintained when receiving treatment in another part of the European Economic Area under the directive.

National Contact Points outside the UK are:

Other countries in the UK

Health is a devolved matter for the five administrations that make up the UK. Therefore, the other 4 countries will apply their own processes in managing cross-border healthcare under the directive.

European cross-border healthcare only applies at European Member State level. It does not apply internally between the countries and regions that make up the UK.

National Contact Points for the other 4 administrations that make up the UK are: