Spain and Portugal are firmly opposed to the principle of the directive, which could have an impact on how services are planned and funded, EurActiv has learned.
In addition, Hungary, Poland and Italy also have reservations about what is proposed and may seek to impose limitations on the kinds of treatment that will be reimbursed under the new system.
Among the ideas currently being floated is exempting private hospitals and clinics from the directive in certain cases. But several member states are concerned that this runs contrary to the case law upon which the new legislation is built.
Despite this, a lot of progress has been made on the issue, with the UK, France and Germany believed to be reaching broad agreement on what the final text could look like, according to diplomatic sources.
The major obstacle will be the circumstances under which countries can refuse to pay for treatment for citizens who have suffered from "undue delays". The definition of this term and the question of who will decide whether a patient has waited too long are yet to be thrashed out.
Some smaller member states have consistently expressed concerns that the directive could have a negative impact on their health systems if there is a large outflow of patients or medical specialists to other countries.
Behind-the-scenes discussions on this subject have centred on finding ways to limit the potential negative impacts on health systems, and may lead to additional protection for border regions.
A debate on whether member states can refuse to reimburse specialist procedures on the grounds that they affect the integrity of the national health system is also likely.
Information to patients
Ministers will also discuss the European Commission's pharmaceutical package, which contains three major directives: on pharmacovigilance, counterfeit medicines and information patients. The Information to Patients Directive is expected to be blocked, as previously reported, while the other two are seen as less problematic (EurActiv 25/5/09).
The technical details of the legislation on counterfeit drugs and drug safety will be worked through, but there are no major stumbling blocks to their adoption.
The issue of allowing pharmaceutical companies to provide controlled information to patients caused controversy when ministers met in December, and attitudes have hardened further since then.
A large group is fundamentally opposed to the plan, launched last year by Commission Vice-President Günter Verheugen, while a smaller number of member states will suggest discussing access to quality information on medicines in another setting, possibly the successor to the pharmaceutical forum.
H1N1 influenza
A discussion on the H1N1 influenza outbreak – commonly referred to as 'swine flu' – is scheduled for lunchtime, but is unlikely to be a source of major controversy.
The EU's health security committee has been meeting daily since the World Health Organisation raised the pandemic threat level to stage five of a six-point scale, and health ministers are broadly happy with coordination to date.
However, speculation has grown that the WHO is close to declaring swine flu a global pandemic as the number of cases mounts.
Information and disease surveillance measures are in place, say sources close to next week's talks, and the issue of managing vaccine stockpiles is a national competence.
