Patients rights in EU cross border healthcare

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Patients' rights in EU cross border healthcareIn future it will be easier for patients to seek healthcare abroad and be properly reimbursed for its cost, said the Environment and Public Health committee, backing the general aim of a proposal on patient rights in cross-border healthcare. MEPs also want patients to be properly informed about their rights when treated outside their home Member States.

The proposed directive on cross-border healthcare aims to ensure that there are no obstacles to patients seeking care in a Member State other than their home one. It also clarifies the right to be reimbursed after a treatment in another Member State. These rights have been confirmed in European Court of Justice judgements, but are not yet included in EU legislation. At the same time, the directive aims to ensure high-quality, safe and efficient healthcare and to establish health care co-operation mechanisms among Member States.

Directive for patients – national competences and existing rights are respected

MEPs underline that the proposal is about patients and their mobility within the EU, not about the free movement of service providers. They also stress that the directive fully respects the national competences in organising and delivering healthcare and that it does not oblige health care providers in a Member State to provide health care to a person from another Member State. The Committee points out that the new directive will not affect current patient rights, which are already codified under another EU regulation, or the regulations on the co-ordination of social security systems.

Prior authorisation for hospital treatments

The draft directive states that patients have the right to seek health care abroad, but Member States may nonetheless chose to introduce a system of a prior authorisation for the reimbursement of the costs of hospital care. Such a system may be introduced under certain conditions, for example if the financial balance of the Member State’s social security system could otherwise be seriously undermined.

The committee agrees with this principle, but wants Member States to define what hospital care is and not the Commission, as originally proposed. It also underlines that the prior authorization requirement must not create an obstacle to the freedom of movement of patients.

Reimbursement of costs to be made easier

On the reimbursement of medical costs incurred, MEPs agree with the general rule that patients are to be reimbursed up to the level they would have received in their home country. They add that Member States may decide to cover other related costs, such as therapeutic treatment and accommodation and travel costs.

Since the proposed rules would in practice mean that patients need to pay beforehand and get reimbursed only later, MEPs added a provision that Member States may offer their patients a system of voluntary prior notification. In return, reimbursement would be made directly by the Member State to the hospital of treatment. MEPs say Member States must ensure that patients having received prior authorization, will only be required to make direct payments, to the extent that this would be required at home. The Commission is to examine whether a clearing house should be established to facilitate the reimbursement of costs.

Exceptions for patients with rare diseases or disabilities

The committee added special rules for patients with rare diseases and disabilities that might need special treatment. Patients affected by rare diseases should have the right to reimbursement even if the treatment in question is not provided for by the legislation of their Member State. Special costs for persons with disabilities must also be reimbursed under certain conditions. Furthermore, all information must be published in formats accessible to people with disabilities.

Information to patients and their rights to complain at the European Patients Ombudsman

To improve patient’s confidence in cross-border health care, they must receive appropriate information on all important aspects of cross border health care, such as the level of reimbursement or the right of redress in the event of harm caused. MEPs therefore agree with a proposal that national contact points shall be established. MEPs also propose establishment of a European Patients Ombudsman, to deal with patients’ complaints with regard to prior authorization, reimbursement of costs or harm once all complaint options within the relevant Member State have been explored.

Long term care and organ transplantation excluded from the directive

According to MEPs the directive shall not apply to long-term care and to organ transplantation.


Health care was excluded from the Services Directive. Parliament and Council had asked the Commission to address issues relating to cross-border healthcare in a separate instrument. The regulations on the co-ordination of social security systems provide for persons for whom a medical treatment becomes necessary during a stay in the territory of another Member State to enjoy the same benefits as patients ensured in the host Member State, using the European Health Insurance Card.

The regulation also provides for patients to be able to seek health care in another EU country, subject to prior authorization which has to be given if the care cannot be provided within a medically justifiable time.In addition, since 1998, the European Court of Justice has ruled in several judgements that patients have the right to be reimbursed for health care received in another Member States that they would have received at home.

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