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The EU Directive: How will EU cross-border healthcare develop?

Health and medical tourism

Ian Youngman from IMTJ looks at some of the challenges facing the implementation of the EU Directive on Cross Border Healthcare, and whether governments and health services will invest the time on setting up the required systems and organization to make it work.


The EU Citizenship Report 2010 published by the European Commission identifies 25 obstacles which EU citizens face in exercising their rights across borders and suggests measures to tackle them.

On health, it highlights that European citizens are not fully benefiting from cross border healthcare and e-health technology as patients do not have basic information about their rights to seek treatment in another EU member state, including essential information about reimbursement. E-health technologies can improve access and continuity of care, yet access to e-health technologies is hampered by legal and organizational barriers including fragmentation of protection of personal data laws, differing reimbursement schemes, and lack of pan European interoperability.

To tackle these problems the Commission is developing pilot actions to give patients secure on line access to their medical health data by 2015 and to achieve widespread deployment of tele-medicine services by 2020. Plans are also underway to recommend a minimum common set of patient data to make it easier to transfer patient records. These records should be accessible or able to be exchanged electronically across EU member States by 2012. This work is being undertaken as part of the Digital Europe Agenda, and it is also being discussed within the legislative context of the Commission’s Cross Border Health proposals.

After years of political wrangling, the European Union has finally agreed the EU Directive on Cross-Border Healthcare. There will be clear rules at European level concerning the possibilities of patients to travel to other EU countries to get medical treatment. The question of how to lay down more precise rights for patients to seek healthcare in another member state and be properly reimbursed caused the most discussions between the European Parliament and European governments. Cross-border health care is very difficult today because many patients do not know if they are reimbursed and how that may happen when they come back home after medical treatment in another member state. The new rules should be in place by 2013.

According to the directive, patients will be allowed to receive treatment in another EU country only if this form of treatment is covered by their national healthcare system. They will also be reimbursed up to the level that they would have received in their home country. Each reimbursement system is evaluated very differently, and some health officials are concerned about managing their finances. As healthcare systems and levels of welfare are very different in each country, the benefits that citizens will be able to receive from cross-border health care will depend on how rich the country is that they live in. Several of the poorer countries argue that medical treatment prices differ greatly among different EU countries.

In the directive, although patients will be able to seek medical care in another country without prior authorization, for hospital and certain forms of highly specialised care EU countries are allowed to (and most probably will) introduce a system requiring prior authorisation. There are other limitations built into the final wording of the directive to prevent some countries becoming overburdened that are very vague and open to differing interpretations. According to the directive, all member states have an opportunity to take advantages of cross-border health care, however the patients’ mobility is being disturbed not only by different national health systems but also citizens from highly developed European countries may not trust the medical care of less developed countries, although there are many qualified specialists.

Although the directive has been passed, the economic crisis in several EU countries could mean that even governments happy to support the directive in principle, will try to find ways that their own already stretched health budgets will not have money to commit to an open cheque for cross-border treatment, either for outbound or inbound patients. Some are already said to be looking for loopholes, such as the one that allows each country to determine deadlines for responding to patient requests for overseas care.

In forecasting what may happen in 2011, Swiss Re's chief economist Kurt Karl says, "Developed and emerging markets have parted ways on growth, with emerging markets booming while developed economies are growing at a more modest pace – a situation that is set to continue in 2011 and 2012. Certain EU economies face fiscal crises. A risk remains that the economic recovery will be derailed by renewed financial market turmoil, resulting in part from a potential widening of the Euro zone debt crisis. Although the recovery is nearly 18 months old and broadening, investor trust in its continuation is still weak. Instability continues in several important markets including the US, Ireland and Spain. Despite the support received from the International Monetary Fund and the European Union, there are still concerns as to whether Greece and Ireland can cope with the problems they face."

Even with the adoption of the Directive by the EU parliament, governments who are dramatically cutting public spending will be loath to spend money on setting up the required systems and organization to make it work. Also, although in theory governments have to amend national laws and systems by 2013, some countries regularly break deadlines- from anything from a year to three years after the supposed final deadline. One of the worst repeat offenders on delays is Spain, one of the fiercest opponents of the directive, which has consistently tried to delay, derail or water down the original intent. I expect Spain to delay implementing this directive while it seeks to limit the implementation of the law. One area it is already investigating is a loophole where if a country can show that the directive would affect the ability to offer healthcare to its own people it can ask for certain exemptions; expect stories in the Spanish press anytime now about “ --how all these foreigners and retired expatriates are abusing the Spanish health system in resort areas, and threatening its financial collapse.” The EU system for dealing with countries delaying implementation is very cumbersome as it involves other European institutions, and if an EU member state drags its heels and promise a timeline of implementation, all the rest can do is wait. Some member countries will stick to the 2013 deadline and the spirit of the directive, but expect some creative ways from others of nullifying the impact.

For full details of the Second Reading and how it differs from the previous European Council position see this report.


Profile of the author

Ian Youngman

Ian Youngman is a writer and researcher specialising in insurance and health. He writes regularly for a variety of magazines, newsletters, and on-line services. He also publishes a range of insurance reports and undertakes research for companies. An ACII, with an honours degree in Economics from the University of Liverpool, Ian was a co-founder of The General Insurance Market Research Association. He also has widespread experience within the insurance industry at management level, working for brokers, a bank and an insurance company.  

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