Analysis

Patient mobility in the European Union

BMJ 2007; 334 doi: 10.1136/bmj.39086.497639.68 (Published 25 January 2007)
Cite this as: BMJ 2007;334:188

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  1. Helena Legido-Quigley, research fellow1,
  2. Irene Glinos, research fellow2,
  3. Rita Baeten, senior policy analyst2,
  4. Martin McKee, professor of European public health1
  1. 1London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. 2Observatoire Sociale Européen, Brussels, Belgium
  1. Correspondence to: H Legido-QuigleyHelena.legido-quigley{at}lshtm.ac.uk
  • Accepted 22 December 2006

Getting healthcare in another European country should be straightforward, but it often creates problems for both patients and healthcare systems

In September 2006 the European Commission launched a consultation on health services, focusing mainly on movement of patients across borders.1 The longstanding view that health care was the preserve of national governments has been rendered untenable by the European Court of Justice. Its judgments place health services firmly on the European agenda, upholding the right of individuals to obtain care abroad paid for by their home health system in specific circumstances (box). We discuss why patients seek care abroad, examine the medical and legal issues that this raises, and outline some possible responses.

European legal basis for patient mobility

The legal basis for patient mobility in Europe was established in 1971 through regulation 1408/712:

  • The E111 scheme enabled people temporarily abroad to get treatment if they became ill, with care being paid for by their home funder

  • People were also able to obtain care in another country with prior authorisation—for example, someone who had migrated but wanted to return home for treatment of a serious illness or someone who wanted to obtain care unavailable at home. Authorisation could not be refused if the care otherwise available was subject to “undue delay”

In 1998 two rulings by the European Court of Justice (the cases of Kohll3 and Decker) relating to spectacles and orthodontic treatment, established that individuals could obtain certain goods and medical service provided outside hospital and be reimbursed by their health funder without getting prior authorisation

A series of cases has since expanded the range of care that can be obtained without authorisation and clarified the principles—for example:

  • Patients are entitled to treatment for exacerbations of pre-existing illnesses that occur while abroad

  • Decisions to authorise treatment abroad must adhere to “international …

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