Cross-border shopping for drugs on the rise
After a two-year lull, Flemings are again travelling to Dutch pharmacies where drugs are cheaper – and sometimes even free - making use of their European Health Insurance Card. But the practice is illegal
Insurers union says fraud puts strain on national social security
The icing on the cake? Flemings can buy the bulk of their drugs in the Netherlands for free. The only thing they have to do is flash their European Health Insurance Card (EHIC) at the counter.
It’s just kind of illegal.
This is how it works. In Belgium and the Netherlands, residents pay remgeld, a small out-of-pocket contribution for medical services and drugs, usually a fraction of the real end price. Health insurers (the mutualities) cover the remainder. But the typical co-pay sums asked in Belgium and the Netherlands differ, with some drugs in the Netherlands requiring no co-pay at all.
This is where the EHIC comes in, as it allows cardholders to buy drugs at the tariffs of whatever European member state they are in. With the Dutch border just a short drive away, cunning Flemings can this way get their drugs for free. The caveat: The bill is sent to Flemish mutualities, and law-abiding fellow citizens end up paying the price.
The National Illness and Disability Insurance Institute (Riziv) recently found that Belgians used their EHIC abroad for €2.4 million worth of drugs in the 2010-2012 period. The institute also discovered that 40 people, most of them Flemings living close to the Dutch border, individually bought at least €5,000 worth of drugs in just three years’ time.
“That is an insane amount, which strongly suggests improper use of the health insurance card,” says Christian Horemans, international affairs expert at the National Union of Independent Health Insurers (MLOZ). “We had never expected the problem to be this big.”
Fraud, pure and simple
Despite the free movement of goods and services within the borders of the EU, Horemans says, this is fraud. “It puts a burden on our national social security,” he explains, adding that the card was only meant to cover unforeseen medical expenses during stays abroad. He cites examples like skiing accidents or patients continuing treatment of a chronic disease while away from home. “It is against the law to use the card for a planned displacement with the sole purpose of acquiring drugs.”
It puts a burden on our national social security
Because no data are collected on which specific drugs were bought, it has proven impossible to penalise the cross-border shoppers. Instead, the insurers’ union contacted the big spenders. Flemings suspected of misusing the European card were informed that, from now on, they are to abide with the law. That means paying full price for the drugs in Dutch pharmacies and submitting the receipt to their own health insurer, who will subsequently reimburse the money minus the Belgian co-pay.
The worst offenders were also told that penalties might follow in the future. “For the patients spending less than €5,000, we don't really know what to do. It might be possible they really needed the medication.”
Not a new problem
According to Riziv, cross-border shopping for drugs is not a new problem. It was Flemish pharmacies “along the border that first sounded the alarm in 2007 because of unfair competition,” explains Chris Segaert, international relations advisor at Riziv. “After meetings with our Dutch colleagues, measures were taken and the amount of money to be paid to the Netherlands decreased.”
The Netherlands have the duty to observe the European rules
In 2012, Flemish pharmacies again cried foul. They were seeing record numbers of patients with split prescriptions, one for Belgium and one for the Netherlands. “This spring, we started a new and more extensive research project,” says Segaert, “and indeed, there seemed to be a problem.”
The Flemish and Dutch unions again met a few months ago and agreed on new measures to battle misuse of the European card. AGIS, the Dutch insurer for foreigners temporarily staying in the Netherlands, is now checking which drugs Belgians bought at pharmacies suspected of bending the rules. In 2014, these pharmacies will be more strictly supervised.
But not everyone is convinced that the Dutch will live up to their promises. “It all depends on their goodwill,” Horemans says. Adding that Dutch insurers have nothing to gain by addressing the problem, he says: “It is mainly our problem.”
Riziv, on the other hand, is trusting its Dutch partners and is pointing to the European legislation that affirms the Belgian law on use of the EHIC. “The Netherlands must observe the European rules,” Segaert says. He also points to a new network of nations fighting fraud in national social security systems, where fraudulent practices can be reported. “At this moment, we are having informal meetings with colleagues across the border to resolve the matter,” he says. “But if nothing comes from this, we will file a formal complaint within this network.”
Health-care system
national health-care system is born
percent of salary employees contribute to social security
to 75% of healthcare costs reimbursed by mutuality
- NIHDI
- European Observatory on Health Systems and Policies
- Crossroads Bank for Social Security
