European Commission draws up measures on seeking health care abroadBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7568.568-d (Published 14 September 2006) Cite this as: BMJ 2006;333:568
The European Commission is facing the challenge of drawing up a package of measures to ensure that different national health systems are compatible with European Union rules.
Last week it launched wide ranging consultations that will run until the end of the year. After assessing the input it will table concrete proposals during the first half of next year. These would then have to be approved by EU governments and the European parliament.
The commission stresses that the aim is not to harmonise national health systems; the benefits and services they provide remain national responsibilities. Instead the aim is to guarantee legal certainty for patients seeking treatment abroad and for health services managing and financing these services.
The complex issue is on the EU's agenda because of a series of judgments from the European Court of Justice, the first of which was in 1998. This judgment established the right for patients, under certain conditions, to travel to another EU member state for medical attention and have the costs reimbursed. The judges reasoned that as medical treatment is paid for, it must be treated as a service, albeit one with its own distinct features. As a result, EU rules on the freedom to offer and receive services apply.
Subsequent legal rulings have developed this principle, but the absence of legislation or clear guidelines is creating confusion among health services and individuals alike. Instead of allowing particular issues to be addressed on a case by case basis through the courts, there is growing pressure, not least from national governments and the European parliament, for a wider and clearer political solution.
The ability to use health care in different countries, known as patient mobility, already raises several questions. How much information is a patient entitled to receive? What compensation exists if an operation goes wrong? What flexibility do health services have to manage their own systems without breaking EU rules on freedom of movement? These and other questions all require unambiguous answers.
But patient mobility, which triggered the current debate and has attracted the most media interest, currently accounts for just 1% of all medical treatment and is not the only transnational issue on the table. Three others are also covered by the EU's internal market rules.
Firstly, services such as telemedicine, remote diagnosis, and laboratory facilities may be based in one country and provided to another. Secondly, large healthcare providers may decide to establish a local clinic in another member state. Thirdly, health professionals, especially specialists, may temporarily work abroad. The commission believes these issues too need greater legal certainty on where they stand in relation to EU law.
Some form of legislation appears inevitable, but the commission sees the cross border package as an opportunity to provide practical help to national health systems. This could include the creation of a network of centres of reference that would agree criteria to assess new health technologies or develop comparable data.
Despite political sensitivities, the commission's overall aim is to propose a balanced package of benefits to all concerned: patients, national authorities, and healthcare professionals, insurers, and organisations.