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17/01/2011 |
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Cross-border healthcare: simplifying access to healthcare for Europeans abroad - when necessary
On Wednesday 19 January, the European Parliament will vote on a proposal for a directive on patients’ rights as regards cross-border healthcare. The negotiations between Council and Parliament have been tricky, since many Member States had reservations about this proposal for a Directive. An agreement was found nevertheless, thanks to the work of the Belgian Presidency and to the willingness of the European Parliament. The compromise clarifies the means of reimbursement and the definition of the treatments that patients will be able to benefit from when they decide to cross the border. The objective was to ensure the greatest legal certainty for the concrete use of patients' rights, as they have been repeatedly confirmed in the jurisprudence of the EU Court of Justice.
"Patients will benefit from clearer rules when they decide to go to another EU Member State to receive healthcare treatment," said Françoise Grossetête, who is Rapporteur on the dossier.
For Françoise Grossetête, patients’ access to healthcare is a major issue for all Europeans. An overwhelming majority of EU citizens receive healthcare in the Member State where they live, under the social security system to which they are affiliated. In certain circumstances, however, citizens from one Member State can need to go to another to receive medical treatment - citizens from smaller Member States, living in border regions or tourists travelling abroad who need urgent medical service, for example.
Although the European Union Court of Justice has repeatedly recognised patients’ rights on that matter, current European legislation does not deal specifically with this issue. The lack of a specific legal framework creates legal uncertainty for patients and Member States. The point of the directive is therefore threefold: to clarify and simplify the rules and procedures applicable to patients’ access to cross-border healthcare; to provide EU citizens with better information on their rights to cross-border healthcare; and to ensure an equal application of patients’ rights for all EU citizens. Rather than promoting cross-border healthcare as such, the aim is to make access to cross-border healthcare possible when it is necessary and useful for patients. Under this Directive, patients will benefit from complete and transparent information when they resort to healthcare abroad, through the implementation of a single point of contact in each Member State. The European Parliament wished to avoid any legal uncertainty for patients by identifying the cases where a Member State could refuse the right to the reimbursement of healthcare treatment. Patients with rare diseases will be able to benefit from cross-border expertise and diagnosis so long as treatment is unavailable in their Member State of origin. Furthermore, in order to prevent pre-payment by the patient of cross-border healthcare treatments, the European Parliament fought to avoid any discrimination based on the patient's financial means. Finally, the Directive includes a section to allow better cooperation between Member States. "European patients should, in the long run, be able to benefit from better treatments and better continuity of follow-up care thanks to the development of e-health," Françoise Grossetête concluded.
FAQ on Cross-Border Healthcare in the EU
Why healthcare abroad?
| Citizens usually prefer receiving healthcare close to where they live. However, in certain situations, it can be more efficient or bring them a greater benefit to get healthcare abroad. This can be the case, for example, for patients living in border regions where healthcare provided abroad is closer to their home. Sometimes there are better facilities or more expertise available in another Member State - for certain highly specialised treatments for example. Sometimes treatments can be delivered faster in another country due to the larger capacity of their healthcare providers. And for some Europeans, receiving healthcare treatments outside their country of origin is more convenient because their family and friends live in another Member State. The European Union already deals with workers’ and students’ mobility. It now needs to deal also with patients’ mobility and remove the legal uncertainty with which patients are currently faced. |
How often do patients receive cross-border healthcare?
| According to the European Commission, on average 1% of total public health budgets goes on cross-border healthcare every year. This represents about 10 billion euros annually. Cross-border healthcare is most often to be found in border regions, small Member States, tourist regions, or for the treatment of rare diseases. Even under those circumstances, cross-border healthcare represents only a very small share of total health expenses. |
What is the current legislation as regards cross-border healthcare?
| The only mechanism that allows reimbursement for healthcare treatments received in another EU country is the regulation on the coordination of social security systems (1408/71 that became 883/2004). It mainly covers students and tourists needing unavoidable or urgent treatments. But the European Court of Justice has re-affirmed patients’ rights to cross-border healthcare many times. |
If the EU Court of Justice has already answered this question, why make a new proposal?
We need legislation to ensure that cross-border healthcare rights are applied uniformly to all European patients.
In numerous fields, legal uncertainty persists, for example as regards:
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Progress on the debate within the European institutions
| The proposal for a directive on services in the internal market, which was presented by the Commission at the beginning of 2004, included some provisions codifying the Court’s rulings by applying the free-movement principle to healthcare. This approach was rejected by the European Parliament and Council, who underlined that the specifics of cross-border healthcare had not been sufficiently taken into account. Consequently, the European Commission started to examine the best way to develop a political initiative specifically dealing with cross-border healthcare as a distinct issue. Parliament adopted its first reading in April 2009. After lengthy negotiations, the Council reached a different agreement on this sensitive issue on September 13, under the Spanish Presidency. 23 Member States supported the agreement, three were against (Poland, Slovakia and Portugal) and one abstained (Romania). So now a revised version of the proposal is back in Parliament for a second vote in plenary. On October 27, members of the Environment, Public Health and Food Safety Committee already adopted the report with an overwhelming majority, auguring well for the vote in plenary. |
What are the main objectives of this directive?
This directive should enable all patients, not only the better-informed and richer ones, to benefit from a range of rights that have already been recognised by the European Court of Justice as regards healthcare and conditions for reimbursement. The organisation and management of national social security systems will remain firmly in the hands of the Member States. The purpose is not to foster cross-border healthcare as such but rather to make it possible, safe and of high-quality when it proves to be useful and necessary. The future European framework aims to help European patients benefit from improved information and more clarity on the rules that can be applied to a move to another Member State to benefit from healthcare. |
What are the main issues for patients?
This proposal for a directive clarifies patients’ rights to benefit from healthcare in another Member State and simplifies its application. Once transposed into national law it should offer numerous advantages for patients:
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Reimbursement
| The directive enshrines the following principles: citizens will be able to receive in another Member State, without prior authorisation, any non-hospital treatment to which they are entitled in their own Member State. They will be reimbursed up to the amount for reimbursement foreseen in their own social security system. It won't be possible for a patient to benefit financially from the reimbursement. If an unpredictable increase in the volume of cross-border healthcare treatments threatens to create sizeable difficulties, the proposal provides a specific safeguard clause. According to European Court of Justice case law, a Member State can establish a system for prior authorisation for hospital treatments, if required for the preservation of its system. In any case, Member States can apply to cross-border healthcare the same conditions as the ones applied at national level, such as the obligation to consult a general practitioner before consulting a specialist or receiving hospital treatments. This proposal does not challenge the right for Member States to define which medical services they choose to insure. If a Member State does not offer the right for patients to get a particular treatment at national level, this directive does not create any new right for patients to receive this treatment abroad and to get reimbursed, except for the specific case of rare diseases. |
REFERENCES
RELATED NEWS
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17/12/2010 | Cross-border healthcare: agreement in sight on the Directive |
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16/12/2010 | Three-way meeting reaches compromise, Europolitics, 16 December 2010 |
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27/10/2010 | Cross-border healthcare: guaranteeing patients' access to and reimbursement of healthcare treatments |
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08/06/2010 | Patients' rights in cross-border healthcare |
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01/12/2009 | Françoise Grossetête MEP regrets failure of negotiations in today's Health Council on cross-border healthcare. |
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01/09/2009 | Cross-border Healthcare Directive |
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23/04/2009 | Cross-Border Healthcare - new rules welcomed |
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22/04/2009 | Cross-border healthcare set to be backed by MEPs |
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