Intended for healthcare professionals


How can quality of health care be safeguarded across the European Union?

BMJ 2008; 336 doi: (Published 24 April 2008) Cite this as: BMJ 2008;336:920
  1. Helena Legido-Quigley, research fellow1,
  2. Martin McKee, professor of European public health1,
  3. Kieran Walshe, professor of health policy and management2,
  4. Rosa Suñol, director3,
  5. Ellen Nolte, senior lecturer1,
  6. Niek Klazinga, professor of social medicine4
  1. 1London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. 2University of Manchester
  3. 3Institut Universitari Avedis Donabedian Universitat Autónoma de Barcelona, CIBER Epidemilogía y Salud Pública (CIBERESP), Barcelona, Spain
  4. 4Academic Medical Centre, University of Amsterdam, Netherlands
  1. Correspondence to: M McKee martin.mckee{at}
  • Accepted 10 February 2008

Can Europeans be confident about the quality of care received in another EU country? Helena Legido-Quigley and colleagues discuss the various mechanisms at work across Europe to ensure quality and safety

The European Union (EU) is built on the concept of free movement of goods, services, people, and capital. Laws enacted to implement and protect these freedoms impact on the healthcare sector. For example, to facilitate professional mobility, qualifications obtained in one country are automatically recognised in others. Citizens can travel freely within Europe, reassured that they will have access to health care should an emergency arise.1 The licensing of new drugs and medical devices is harmonised across Europe. But can Europe’s citizens be confident that any care received in another EU country will be safe and of high quality?

We discuss why healthcare professionals and patients in the European Union should take an interest in this subject, and we describe the current status of some of the elements of a high quality health system, who is in charge, and how things might change.

Why is this becoming an issue now?

In the EU, delivery of health care is a responsibility of individual countries. The assumption that health services provided according to national regulations in any EU country will be of adequate quality is confirmed by the European Court of Justice, which has applied the principle of mutual recognition in its rulings.2 Yet within Europe the approach to quality in different countries varies, often for historical reasons, such as whether doctors have been state employees, subject to oversight of their work—or whether they view themselves as a liberal profession, demanding professional autonomy.3 These differences are becoming increasingly important for two reasons.

Firstly, the number of health professionals moving within the EU is increasing rapidly.4 These professionals need information on the structures and processes …

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