APPENDIX 3: CALL FOR EVIDENCE |
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.
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),
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
- To ensure that the necessary requirements for
high-quality, safe and efficient healthcare are ensured for cross-border
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.
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),
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
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
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
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
- 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
- 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 countryand to what extent do you
think the draft directive satisfactorily makes provision for these
- 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 healthcareand
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
- 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
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
55 http://ec.europa.eu/health/ph_overview/co_operation/healthcare/cross-border_healthcare_en.htm Back
See the EHIC Information Service website-http://www.ehic.co.uk Back
Council conclusions on common values and principles in EU Health
Systems-Outcome of proceedings, Brussels, 5 June 2006 http://ec.europa.eu/health/ph_overview/co_operation/high_level/keydo_062006.pdf Back
See Articles 95 (p.79) and 152 (p.114) of the Consolidated
Treaties document in the link:
See Article 5 on page 46 of the Consolidated Treaties document
in the link at footnote 4 Back
See Article 5 on page 46 of the Consolidated Treaties document
in the link at footnote 4. Back