That oversight will cost him 15,000 Kč ($620).

"This system is not very well thought out," said Pfeiffer. "She did not submit one paper and now we have to pay crazy money."

Health insurance coverage while working abroad was thrown into the spotlight when the Czech Republic joined the European Union last May and Czechs, attracted by higher salaries, flocked to work in other EU countries.

"We get about 20 phone calls a day from people who are going to work abroad and are trying to figure out their health insurance situation," said Václav Janalík, spokesman for the Center for International Reimbursement, which deals with interstate issues related to health insurance.

In line with EU regulations, an EU citizen migrating for work or business to another union state must contribute to the health care system of the country where his or her employer or business is based, and receive covered treatment in that country.

In the Czech Republic, health insurance is compulsory for all citizens. Mandatory monthly premiums are deducted from paychecks entitling workers to free treatment. Czechs who leave the country for work are required to cancel that insurance and show proof that they have insurance in the country where they are working or doing business within eight days of signing a contract with an employer. Offenders face fines of up to 20,000 Kč.

People who work or do business in more than one EU country must contribute to the health care system in the country where they and their dependents actually live.

"In this case, a person should have health insurance in the country where he or she actually lives, and premiums from all his or her income in both countries should be paid in the country of residence," Janalík said.

Not very flexible

Health care rules vary, however, in different EU member states. Not all countries allow citizens of another state to carry their insurance home when they go there to work or visit.

For example, Czechs who work in Germany and pay into that country's health care system can also be treated back home. The situation is quite different for EU citizens working in the United Kingdom.

"The British government is trying to protect its health care system and avoid situations where foreign workers would go home for a holiday and receive medical treatment that would be covered by British insurance companies. They want to prevent business being taken away from British doctors," Janalík said.

Pfeiffer, who went to work in West Sussex in November as a psychiatrist and consultant for an assertive outreach team, continues to do contract work in the Czech Republic, where his family lives. Although he contributes to the British health care system, it will not cover him when he is visiting or working in the Czech Republic.

"I go home up to two or three times a month because I still have work to do. Sometimes I would come for a week," said Pfeiffer, pointing out that it is not unusual for someone to prefer to have some health problems treated at home.