European Commission proposes rules for cross border health care

BMJ 2008; 337 doi: (Published 03 July 2008) Cite this as: BMJ 2008;337:a676
  1. Rory Watson
  1. 1Brussels

    The European Commission has tabled draft legislation setting out rules whereby patients who choose to receive medical treatment in another European Union country would be reimbursed by their national health authority.

    The proposal follows several judgments over the past decade by the European Court of Justice confirming that individuals have the right to be reimbursed for health care they receive abroad, subject to certain conditions. However, uncertainty over the exact way the right should be exercised and the effects that an increase in demand would have on countries’ health services have prompted governments to ask for clear pan-European legislation on the issue.

    As the EU’s health commissioner, Androulla Vassiliou, explained when presenting the proposal on 2 July: “This aims to clarify how patients can exercise their rights to cross border health care, while at the same time providing legal certainty for member states and healthcare providers.”

    The commission insists that the draft legislation, which must be approved by the governments of EU countries and the European parliament before becoming law, is not designed to harmonise national health systems. These will continue to remain the sole responsibility of national authorities. “This is not a takeover bid to run health services in Europe,” said one official.

    Under the proposal patients would be able to receive reimbursable medical care in another EU country from doctors, dentists, opticians, and other medical professionals outside hospitals without needing prior authorisation from their home authorities. However, if the treatment involves a stay in hospital, governments would be able to insist on such authorisation, largely because of the potential costs.

    In either case patients would have to cover the costs themselves and would be refunded the amount it would have cost to have had similar treatment in their own country. The proposal also stipulates that it is the health service providing the care that is responsible for ensuring that proper quality and safety standards are in place and that would be liable in the event of any dispute.

    In addition to expanding patients’ choice of treatment the commission is hoping that the legislation will encourage governments to provide the public with clear information on the opportunities available and the procedures that patients must follow to avail themselves of them.

    The extent to which patients will make use of the possibility of reimbursable medical treatment is likely to be limited. A European survey showed that only 4% of respondents said they had received health care in another country, and the commission estimates that cross border movement of patients accounts for just 1% (about €10bn (£8bn; $16bn)) of total healthcare expenditure in the 27 EU member states.


    Cite this as: BMJ 2008;337:a676


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