The advice for Britons in Luxembourg is that should a withdrawal agreement be approved, the current rights to access healthcare will remain the same and comparable to that of a Luxembourger.  Shutterstock

The advice for Britons in Luxembourg is that should a withdrawal agreement be approved, the current rights to access healthcare will remain the same and comparable to that of a Luxembourger.  Shutterstock

To quote the doctor turned comedian Adam Kay, “From the most insignificant of actions can come the most serious of consequences.” What holds true in medicine will hold true for health care as a whole across the EU27 as Brexit becomes a reality.

Currently 5,786 UK nationals living in Luxembourg fall under the umbrella of permanent EU residents or “posted-workers”. With tunnel negotiations underway, the likelihood of a “somewhat-deal Brexit” is certain. 

A plethora of resources exist regarding the eventuality of a deal or no-deal Brexit which makes it harder to separate the wheat from the chaff. For simplicity, let’s divide the two probable scenarios: a hard no-deal and a Brexit with a withdrawal agreement (ignoring the third likely option of Boris leaving the country along with Brexit, while invoking yet another referendum). 

The European Health Insurance Card (EHIC) card allows European citizens to access state-provided healthcare in all EU member states including state-provided emergency and maternity care. It also accounts for pre-existing medical conditions. If one permanently resides in Luxembourg whilst being a UK citizen this card currently is also required to access the NHS free of charge. In the worst-case scenario EHIC access will cease, and rights will no longer be protected in a no-deal scenario, according to the UK government’s policy. Maternity and emergency healthcare will thankfully always be free of charge in the NHS.

Alarm bells ring

In the eventuality of a clear no deal exit, the UK government’s policy advises that one “be ready for possible changes” in accessing healthcare. Even as a medical professional, I am not sure how to prepare for changes in access to healthcare. Does this mean stockpiling medication as the NHS is currently doing? Or does it subtly hint at digging up European ancestry for the sake of a passport should you wish to remain an EU resident? Alarm bells ring. 

The Department for Exiting the European Union has highlighted their input on the withdrawal agreement, which anticipates the protection reciprocal healthcare arrangements in a no-deal scenario with member states. The year-old healthcare bill, established as a legal foundation to fund these particular schemes, shows promise for agreements with the EU as a whole or with individual states. 

Furthermore, as the UK government hopes to continue the reciprocal care scheme until December 31, 2020, it has pledged to pay healthcare costs for UK residents residing in the EU.

Britons in the grand duchy

The advice for Britons in Luxembourg is that should a withdrawal agreement be approved, the current rights to access healthcare will remain the same and comparable to that of a Luxembourger. If UK residents living in Luxembourg have a UK EHIC card they may use the NHS services in England, Scotland and Wales freely, and this will not change in Brexit. “Living in” guidelines on the UK government’s website are updated for all member states.

Until recently, the EU Commission held a different stance. Stating that if the withdrawal agreement were not ratified, EU rules on social security coordination will no longer apply to the UK. 

As of August 2019, however, plans have shifted towards individual member states outlining their social security contingency plans in a no-deal Brexit. Luxembourg favours reciprocity of healthcare. UK-insured residents in Luxembourg will receive equal healthcare as EU citizens,  provided they have joined Luxembourg’s national healthcare scheme. In terms of whether UK nationals residing in Luxembourg will enjoy social security benefits post withdrawal, the response is overall positive. 

Although subject to change, prescriptions obtained from within the EU are recognised in the UK; however, following Brexit, a list of approved countries will be issued from which the UK will recognise and approve prescriptions. The ultimate decision of dispensing lies with the dispenser, and these prescriptions will come at no cost to the NHS and fall under the bracket of private prescriptions. 

For further guidance, visit the gouvernement.lu and gov.uk websites. 

Dr Lilani Abeywickrama is a Luxembourgish ophthalmologist currently based in Milan. Her main interest is advocating healthy living and precision technology within her specialty and is pursuing her interests in the field of healthcare management.