Despite opposition, plans to let Europeans seek medical treatment in other countries in the 27-countries of the EU moved forward in late December when EU countries gave their stamp of approval at ambassador level. This paves the way for a vote in Parliament on 19 January and increases the chances that the cross-border healthcare directive could be in force as early as 2013.
Françoise Grossetête (European People's Party) and rapporteur on the draft bill comments,” Negotiations have been tricky, since many member states were reluctant for a proposal for a directive. Patients will benefit from clearer rules when they decide to go to another EU member state to receive healthcare treatment.”
The new rules will 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 in December including
• Prior authorization will 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 must be established in an efficient and transparent way and 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 can refuse a request for prior authorization.
• Patients with rare diseases are those with a prevalence of under 5 per 10,000, that it is serious, chronic and often life threatening.
In all there were an additional 106 amendments, but final negotiations still have to deal with some key problem areas on e-health objectives and health technology assessments.
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. Health services were excluded from the general Services Directive in 2006 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 decided to establish an EU framework to ensure cross-border access to healthcare services. 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 delayed on the deal and unsuccessfully tried to frustrate and obstruct the will of the Council and MEPs with private agreements that would have made the directive unworkable.
The latest agreement on the long-contested patients' rights directive is an important step for EU health policy, although the draft is still narrower in scope than that originally envisioned by the European Commission. Crucially, the law will require patients to get advance permission from national authorities before going abroad if their treatment involves a hospital stay of more than one night, hi-tech equipment, is risky, or raises quality or safety concerns. National authorities can also refuse patients permission to go abroad if the treatment would expose the patient or others to risks (e.g. infectious diseases), or if the standard of healthcare in the other country raises safety concerns. Governments may also turn down requests to go abroad if they can justify the waiting time on medical grounds.
As the agreement was made just before the Christmas recess, the full paperwork has been delayed so full details of the agreements are not available. The European Parliament lost a bid to require national governments to reimburse patients their travel expenses and hotel costs. Instead, the draft simply states that governments may decide to do this. Member states also weakened provisions on European co-operation on e-health and safety standards, although they did not succeed in removing them altogether from the draft.
The draft still has to pass two formal hurdles – a vote in the European Parliament, expected in January, and approval by EU ministers, expected in February or March. This will pave the way for the law to come into force in 2011, although governments will have 30 months to write it into domestic law. 2013 is still optimistic as even if the Directive is in place it will have to be implemented in the member states, some of who are infamous for enacting EU legislation years after the deadline. Bearing in mind that at every stage and in every discussion so far, a host of amendments have been made, there is still plenty of scope for MEPs and ministers to make changes or even go back on what are assumed to be agreed deals, in a climate where several EU economies (Spain, Greece, Portugal, Ireland) are still on the brink of disaster.
* 19 Jan 2011: European Parliamentary vote.