Agreement on the terms for upfront coverage of costs incurred by the Puigcerda hospital for emergency care provided to members of French schemes of social security (Signed on 17/04/2003. Effective date: 01/05/2003)
This agreement led to the creation of the first crossborder hospital in Puigcerda and applies to emergency care provided to any member or beneficiary of a member belonging only to the French social security schemes for the health-maternity and industrial accident risks and who are residing or visiting the French Cerdan plateau (districts of Montlouis and Saillagousse). All other circumstances come under European regulations No. 883/2004 and 987/2009. The agreement does not cover follow-up tests and additional treatments following discharge.
Any patient sent over to the Puigcerda hospital based on a decision by the 15 emergency call assignment center or by the SMUR (medical emergency and resuscitation service) is considered an emergency under the agreement, while direct admissions to the facility are not covered.
The agreement organizes full upfront coverage of care (not including the daily flat-rate charge that is out-of-pocket for the patient), including the cost of transportation to the hospital for the purpose of admission and transfer expenses upon discharge. No prior approval is required and the Puigcerda hospital is equipped to read the patient’s French health insurance card (« carte Vitale ») to check their entitlements. This coverage is only for the patient-care disciplines listed in appendix 2 for emergency procedures with or without hospitalization. If the patient is transferred upon discharge, it can only be to a French facility’s short or medium stay unit.
Appendix 3 of the agreement lists the rates applicable by the Puigcerda hospital for hospital stays and these are regularly revised. The designated coordinating health insurance fund («CPAM de Perpignan ») pays all bills within a 6-week deadline.
An assessment is conducted each year (statistics and financial data, quality results) and presented to a joint oversight committee which is also in charge of ensuring that the agreement is working smoothly (objectives), settling disputes and appeals, and proposing any changes to the agreement. This annual report is sent to the competent authorities.
Cross-border cooperation agreement on emergency medical assistance between Osakidetza and the « Centre hospitalier intercommunal de la Côte Basque » (signed on 27/05/2010).
This agreement, applies to emergency care provided only to members of the French or Spanish social security schemes, whose location is initially circumscribed to the towns of Irun, Hondarribia, Urrugne, and Biriatou. It may later be extended to the geographic area between the towns of Bayonnne and Donostia/ San Sebastian. The health care facilities are listed in appendix II of the agreement.
Responses are always launched by the emergency call management center: SAMU on the French side of the border or the Medical coordination center in Gipuzkoa, Spain, as calls placed in this geographical area can be received by either of these centers. The two call centers have coordinated in order to redirect calls back to the country where they were placed. Under the assistance protocol, emergency response teams can be called to either side of the border and patients who are not located in their country of origin can be sent over to the area of their choice that is covered by the agreement. During a response in the neighboring country, emergency services are only authorized to perform procedures that they are licensed to carry out in their home country.
Under the agreement, emergency patients can be transferred to either of two hospitals when specialized care is needed. These are the Donostia hospital in San Sebastian (Spain) or the « Centre hospitalier de la Côte Basque » in France.
The agreement also provides for urgent, reciprocal medical assistance to be set up in the event of an incident involving multiple victims, given the large number of travel routes (road and air) that connect these two areas.
Expenses incurred are covered by the local health insurance funds where the patient is staying on the basis of the patient’s European health insurance card. The competent State then issues a reimbursement under EU regulations 883/2004 and 987/2009.
An assessment is conducted each year and presented to a joint oversight committee composed of representatives of both States’ competent authorities. The committee is also tasked with proposing any changes to the agreement.