The European Union decided on the introduction of a European Health Insurance Card (EHIC) to identify social security tax payers and for the interoperability of different systems in 2002. In Hungary, the introduction of electronic healthcare card is also planned as the missing revenues from those who are not paying social security tax and the identification problems cause major concerns for the Hungarian social security system.

Travel insurance in the Union: E-111 card

Related to health insurance, the system of travel insurance also changed from 1 May 2004. After this date, if an insured tourist became sick in another EU member state or he/she had an accident, the healthcare service was provided by the member state he/she stayed in with same conditions like for its own citizens.

As the cost of healthcare service is paid by that health insurance company where the given person insurance, it is not necessary to advance the costs. Additionally, the insured person must have a so-called E-111 card which can be procured at the county directorates of the Hungarian National Health Insurance Fund (Országos Egészségbiztosítási Pénztár - OEP). The role of the card is to prove that the insurance company undertakes the cover of arising costs in advance. If the person who becomes sick or has an accident does not have an E-111 card, he/she must pay the cost of healthcare service on site, and he/she can claim a part of the costs when he/she returns home. That part can be claimed which would have been paid by the insurance company should he/she have had the card on site.

Advantages of the card
In order to withdraw the forms progressively that are difficult to use and that does not prove entitlement according to the requirements of the age, the European Council decided on the introduction of a European Health Insurance Card (EHIC) on 20 March 2002. The main goal of introducing the card was to develop such a document which meets the security requirements of our age, conforms to the relating standards, can be used by all EU citizens and ensures interoperability between the systems of member states.

The electronic health insurance card is suitable for creating an online connection among the different players of healthcare: the patient, the service providers and the insurance companies. The applied modern IT solutions including personal identification systems improve the quality and security of medical service and enhances the protection of personality rights.

With the help of the card, the social security can account for whatever healthcare transactions and in this way, it facilitates administration. At the same time, the patient's medical record is also accessible which helps to prevent repeated examinations. It is possible to check entitlement at healthcare providers with the patient's social security identification number which would simplify with the introduction of an electronic healthcare card.

The cards used in the health insurance system
One of the main elements of the health insurance system is the health professional card issued by the organization of healthcare service providers which is supplied with the photograph of the doctor or the pharmacist. This ID is a key factor in accessing the patient data stored in the card and in the healthcare system. Another function is the digital signature which can be used for signing the prescription digitally or to confirm the presence/examination.

The other element of the system, the patient card is issued by the health insurance fund. The plastic card works with a PIN code and is protected by cryptographic functions. Patients can give access permission to health professionals to their medical data stored on the card and in the electronic healthcare system.

The card's system of settlement

International situation

France
The Vitale eHealthcare system in France manages more than 80,000,000 claim forms every month, so far more than 60 million patient cards and 1 million health professional cards were issued and 60 thousand smart card readers were installed. The programme resulted in an annual cost reduction of around EUR 300 million for the state budget. Patients find the system easy to use and convenient.

Austria
The chip card system has been working in Austria since January 2008. The country has built a fast and effective system, and almost every citizen has a card half year after the introduction. The plastic with chip can be used as ID but does not contain the delicate personal healthcare data. It can be used for electronic signature and also functions as E111 insurance certificate.

Germany
Introduction of the German healthcare card took place in 2007 instead of 2006 which was previously planned. According to the announcement of the Ministry of Healthcare, every patient card cost less than EUR 2 for the healthcare insurance funds. Introduction of the healthcare card amounted to about EUR 1.5 billion. The electronic patient card replaced the former chip card of the health insurance funds and contains patient files, X-ray pictures and other data.

Slovenia
The aim of the Slovene eHealthcare initiative was to link the national healthcare and social systems and to ensure electronic services and transparent information flow for all concerned parties. The first electronic healthcare cards were issued at the beginning of 2008. In the future, they plan to issue such an electronic ID (e-ID) which carries healthcare functions.

EU standards

European Council, 20 March 2002
• Decision on developing a European Healthcare Insurance Card
• Technical specification, outlook and content of the card: Resolutions No. 2003/751/EC and 2003/752/EC of the European Commission

European Citizen Card Platform
• European Commission: CEN/TC224/WG15 standard
• Interoperable and secure e-ID chip card platform for internal and external use
• Reinforces that chip card technology is the best solution in the case of e-ID documents especially in healthcare

NETC@RDS project
• Testing the technology of Electronic European Health Insurance Card (EHIC)
• It is aimed at improving the access to different national health insurance systems for EU citizens with the help of chip card technology