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Cross-border health care deal moves EU bill forward

Published: 22 December 2010

Despite opposition behind the scenes, plans to let Europeans seek medical treatment in other countries in the 27-country bloc surged forward Tuesday (21 December) when EU countries gave their stamp of approval.

BACKGROUND

Health systems are primarily the responsibility of the member states, but in some cases, as confirmed by several European Court of Justice (ECJ) rulings since 1998, EU citizens may seek health care in other member states, with the cost covered by their own health systems.

This can occur in instances where health care is better provided in another member state, for example, for rare conditions or specialised treatment. It may also be the case in border regions, where the nearest appropriate facility may be situated in another country.

However, health services remained excluded from the general Services Directive in spring 2006 (the so-called 'Bolkestein Directive'), despite the many ECJ rulings showing that they are to be considered as an economic activity and that Community law applies to them.

To provide clarity and legal certainty on the issue as well as support for co-operation between national health systems, the European Commission has decided to establish an EU framework to ensure cross-border access to healthcare services.

According to the EU executive, the current scale of cross-border mobility amounts to 1% (€10 billion) of overall EU-27 public health spending (€1,000 billion).

The European Parliament adopted the cross-border directive in April 2009, but it has been stalled ever since at the European Council, where health ministers have struggled to pass the deal.

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The deal, reached at ambassador level (Coreper), paves the way for a vote in Parliament on 19 January and increases the chances the cross-border healthcare directive could be in force as early as 2013.

"Negotiations have been tricky, since many member states were reluctant for a proposal for a directive," said French Member of Parliament Françoise Grossetête (European People's Party) and rapporteur on the draft bill.

The new rules would especially help retirees living abroad, people with rare diseases and those living near borders to get the best health care. Currently, only about 1%, or €10 billion, of public health budgets are spent on cross-border health care yearly, although that figure could rise with standardised rules for authorisation and reimbursement.

The Parliament, Council and Commission agreed to some significant compromises last week, according to a draft obtained by EurActiv. Among them:

• Prior authorisation shall be restricted to what is necessary and proportionate, and may not constitute a means of arbitrary discrimination or an unjustified obstacle to the free movement of patients.
• National contact points should be established in an efficient and transparent way and should be able to consult with patient organisations, health care insurers and health care providers.
• If cross-border treatment exposes the patient or the general public to a risk that overrides the interest of the patient, the member state should be able to refuse a request for prior authorization.
• For patients with rare diseases, that is defined as a prevalence of not more than 5 per 10,000, that it is serious, chronic and often life threatening.

But despite the additional 106 amendments, future negotiations will still have to address some thorny issues, including interoperability for e-health objectives, and what constitutes "appropriate" consultations of stakeholders when it comes to health technology assessments.

Nevertheless, Grossetête is determined: "Patients will benefit from clearer rules when they decide to go to another EU member state to receive healthcare treatment."

NEXT STEPS

• 19 Jan 2011: Parliamentary vote.