Analysis Health Systems Perspectives

Cross-border healthcare in the European Union: clarifying patients’ rights

BMJ 2011; 342 doi: (Published 17 January 2011) Cite this as: BMJ 2011;342:d296
  1. Helena Legido-Quigley, research fellow 1,
  2. Ilaria Passarani, senior policy officer2, scientific researcher 3,
  3. Cecile Knai, lecturer in European health policy 1,
  4. Reinhard Busse, professor of health care management4,
  5. Willy Palm, dissemination development officer5,
  6. Matthias Wismar, senior health policy analyst5,
  7. Martin McKee, professor of European public health1
  1. 1London School of Hygiene and Tropical Medicine, London, UK
  2. 2BEUC, The European Consumers’ Organization, Brussels, Belgium
  3. 3Department of Health Organisation, Policy and Economics, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Netherlands
  4. 4Technische Universität, Berlin, Germany
  5. 5European Observatory on Health Systems and Policies, Brussels, Belgium
  1. helena.legido-quigley{at}

The adoption of a new directive on cross-border healthcare in Europe could bring clarity for patients, health professionals, and policy makers, as well as raising awareness of how healthcare differs between EU member states, say Helena Legido-Quigley and colleagues

This paper is part of an occasional series prepared in conjunction with the European Observatory on Health Systems and Policies (

A proposal for a directive on patients’ rights in cross-border healthcare—defined as healthcare provided or prescribed in a member state other than that of affiliation—is currently being discussed by the European Parliament and the Council of Health Ministers.1 The Directive on the Application of Patients’ Rights in Cross-Border Healthcare ( could provide greater clarity on the rules governing patients travelling abroad to receive treatment. Moreover it could affect individual member states’ national health systems.

We should be concerned about how this issue is resolved. First, European citizens show a growing interest in travelling abroad to receive treatment.2 3 A recent survey in all member states found that 53% overall expressed a willingness to seek treatment in another country of the European Union (EU).2 This finding was supported by surveys among German patients enrolled with a nationwide health insurance fund. In 2003 only 7% had obtained non-urgent treatment in another EU country, but by 2008 the proportion had increased to 40%.2 Second, any solution may have implications for how domestic health systems are run. In this paper we describe who is affected by the directive, review the current proposals,1 and review the process that has given rise to the draft directive. We discuss its most contentious issues and examine its potential implications for patients, health professionals, and policy makers.

Who is affected by the directive

Mobile patients include temporary visitors abroad, people living in border regions, people sent abroad by their …

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