Conclusions and recommendations
35. Ten years of case law on cross-border healthcare
have not provided the clarity needed by both patients and healthcare
providers. We therefore agree that the main rationale for the
Directive should be to clarify the application of treaty provisions
to health services.
36. Whilst we recognise the need for action on
these grounds, the response must strike a proportionate balance
between individual choice on the one hand and effective delivery
of public health provision, within limited budgets and reflecting
different national and sub-national practices, on the other.
Failure to strike a balance between these two objectives could
be detrimental for all patients.
37. We take the view that the fundamental
objective of the proposal should be to ensure that a framework
is in place to deliver the availability of healthcare across borders
but without excessive complexity and without harming the delivery
of national health systems at a local level, and taking particular
account of patient safety and redress.
38. We recall the set of overarching values underlying
the delivery of health services throughout the EU that were agreed
by EU Health Ministers in 2006 (see Box 2). This also finds expression
in recitals 11 and 12 of the Directive. We consider above all
that Member States must ensure that the principle of equity,
within the terms of Member States' own health systems, underpins
the negotiation and implementation of the Directive.
39. We note the argument that the introduction
of patient choice may force hospitals to become much more responsive
to patient needs and acknowledge that this may provoke adjustments
to the services offered by Member States through the mechanisms
and the incentives that choice creates. Choice is welcome if
it has a positive effect on the efficient delivery of health services
locally. In particular, we recognise that the proposal could have
a positive effect where there are particular specialities with
very long waiting lists. However, we recommend that effective
delivery at the local level must remain a key objective.
40. It is clear that it will not be possible
to identify the Directive's impact until it has been transposed.
We therefore conclude that the Directive should be reviewed within
three rather than five years after it comes into effect, in
order that Member States can learn lessons from the experiences
of cross-border healthcare sooner rather than later.
41. Given the importance of patient inflows and
outflows to the stable and secure delivery of healthcare in Member
States, we believe that the report produced by the Commission
should include information on patient inflows and outflows.