Healthcare across EU borders: a safe framework - European Union Committee Contents


EU Sub-Committee G (Social Policy and Consumer Affairs) is conducting an inquiry into the issues raised by the European Commission's proposal for a directive on the application of patients' rights in cross-border healthcare. This was published on 2 July 2008. The relevant Commission document COM(2008) 414 final, together with an associated Impact assessment and other relevant documents, is accessible on the Commission website.[55]

The Commission makes clear that the proposed directive would not undermine the existing rights of EU citizens to emergency medical treatment which may become necessary during a stay in another Member State or the existing rights to go to another European Economic Area (EEA) country for planned treatment, subject to prior approval by a local commissioner. These rights are currently established under EC Regulation 1408/71 on the co-ordination of social security schemes. In the UK, since January 2006, access to this entitlement has been made available through possession of a European Health Insurance Card (EHIC)[56], which replaced the previous E111 form.

The Commission recognises that the vast majority of EU patients prefer to receive healthcare in their own country but that, in certain circumstances, some patients may seek healthcare in another EU Member State. It reports that, in recent years, citizens have brought a series of cases to the European Court of Justice (ECJ) seeking to assert rights to reimbursement for such cross-border healthcare. In its judgments on these cases since 1998, the Court has consistently ruled that patients have the right in certain circumstances to reimbursement for healthcare received abroad that they would have received at home.

The Commission states that the purpose of their proposed directive is to provide a framework which makes clear how the principles which have arisen in these specific ECJ cases should be applied in general. The objectives of this framework will be:

  • To provide sufficient clarity about rights to be reimbursed for healthcare provided in other Member States
  • To ensure that the necessary requirements for high-quality, safe and efficient healthcare are ensured for cross-border care.

In order to achieve the objectives set out above, the Commission proposes to establish a Community framework for cross-border healthcare through the introduction of a Community directive. Subject to the conditions laid down in the text of the directive relating to the arrangements for prior authorisation and cost limit, the new directive would allow patients to seek healthcare in another Member State and to be reimbursed for the cost of this by the Member State of their origin (see Article 6 on pages 36 & 37 of the draft directive accessible through the link above).

The Commission states that the Community framework for cross-border healthcare should reflect the common values and principles in EU health systems which were agreed by EU health ministers in June 2006[57]. These set out which Member State shall be responsible for ensuring the common principles for healthcare and what those responsibilities include, in order to ensure that there is clarity and confidence with regard to which authorities are setting and monitoring healthcare standards throughout the EU.

The Commission also states that the directive would establish a framework for European co-operation in areas such as: co-operation in border regions; recognition of prescriptions issued in other countries; European reference networks; health technology assessment; data collection; and quality and safety.

The Commission asserts that the legal basis for the proposed directive is provided by Articles 95 and 152 of the Treaty establishing the European Community (TEC)[58], which relate respectively to the establishment and functioning of the internal market, and to public health. The Commission states that the proposed directive fully respects the responsibilities of Member States for the organisation and delivery of health services and medical care.

The Commission goes on to argue that the directive respects the Community principle of subsidiarity[59] because both national government and individual citizens face challenges in this field that cannot be satisfactorily solved by Member States alone. It suggests that action by Member States alone, or lack of action at Community level, would significantly undermine the safe and efficient provision of cross-border healthcare, and would leave Member States without a clear capacity to manage and steer their health systems as a whole. It states, moreover, that the directive conforms to the Community principle of proportionality[60] because it leaves a wide margin for implementation by the Member States according to their national, regional or local circumstances and, hence, does not go beyond what is necessary in order to achieve its objectives.

Particular questions raised by the Commission's draft directive to which we invite you to respond are as follows:

  • What do you see as the general advantages and disadvantages of patients having the right to obtain healthcare in Member States other than that where they reside? In what circumstances might patients seek to exercise any such right?
  • What problems do you think have arisen as a result of the present uncertainty in respect of EU citizens' rights to obtain such cross-border healthcare and to have the costs of this reimbursed by the Member State where they reside?
  • What need do you see for EU level action in this field and, if you do see such a need, what objectives should such action have?
  • What is your view of the extent to which the Commission's proposed directive will meet the objectives, if any, that you judge action at Community level should have?
  • What conditions, if any, do you feel that Member States should be allowed to impose on citizens' rights to seek healthcare in another EU country—and to what extent do you think the draft directive satisfactorily makes provision for these conditions?
  • What limits, if any, do you think there should be to the level of costs which Member States should be obliged to reimburse to citizens who obtain cross-border healthcare—and to what extent do you think the draft directive satisfactorily makes provision for these conditions?
  • What is your view of the likely practical impact of the proposals and of how they would affect day-to-day healthcare provision in the UK? For example, could language difficulties present an obstacle?—Who should be responsible for after care (out-patient and in-patient)?
  • What is your view of the need to limit the medical conditions for which treatment could be sought in this manner?
  • How important do you feel it is to ensure that opportunities to benefit from rights to cross-border healthcare are, in practice, made equally available to all citizens and are not confined to just the wealthy or well-educated who may have the knowledge and ability to take advantage of their rights?
  • How do you think the aim of such equality of access should be achieved and to what extent do you feel that the draft directive is satisfactory in this respect? To what extent, for example, are the provisions on the availability of information sufficiently robust?
  • What are your views on the provisions set out in the draft directive for
    co-operation between Member States, including: the mutual recognition of prescriptions; the establishment of European reference networks of healthcare providers; e-health; and the management of new health technologies?

We also would welcome your views on any other aspect of the Commission's draft directive.

Interested parties are invited to submit a concise statement of written evidence to this inquiry by Friday, 26 September 2008.

55 Back

56   See the EHIC Information Service website- Back

57   Council conclusions on common values and principles in EU Health Systems-Outcome of proceedings, Brussels, 5 June 2006 Back

58   See Articles 95 (p.79) and 152 (p.114) of the Consolidated Treaties document in the link: 

59   See Article 5 on page 46 of the Consolidated Treaties document in the link at footnote 4 Back

60   See Article 5 on page 46 of the Consolidated Treaties document in the link at footnote 4. Back

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