Final vote paves way for EU cross-border health care

After the vote, EU Health Commissioner John Dalli said "this directive [...] will help patients who need specialised treatment, for example those who are seeking a diagnosis or treatment for a rare disease".

"It will bring about closer and improved health cooperation, including the recognition of prescriptions between member states," Dalli added.

Dutch MEP Kartika Liotard (GUE/NGL) denounced the EU vision of health care as a market product.

"The new EU directive will mean that insurers drive patients abroad in search of cheaper treatment. But patients - especially if they are seriously ill - just need care in their region, close to their family and a doctor who speaks their language," Liotard said. 

"Patients from rich countries will be able to travel to less expensive, poorer, countries where there is a threat that care standards for locals will deteriorate to make room for profitable health tourism," she added. 

Monique Goyens, director-general of European consumer organisation BEUC, hailed the adoption of the directive, but cautioned, "although we understand the necessity of prior authorisation to safeguard national health systems, this should not become an obstacle".

"We are bewildered by the vagueness of some provisions of the legislation. If, for instance, a German patient needs a hip replacement in Belgium, he will have to wait for a 'reasonable' time before his home authorities give him the authorisation to be reimbursed for this treatment abroad. How long is reasonable? On top of that, he may need to pay upfront and then hope to be reimbursed quickly. Clearly, this could bring inequalities between EU patients," Goyens said. 

European medical technology industry association Eucomed supports the directive, but has reservations about provisions for Health Technology Assessment coooperation between member states (Article 14): "Transparency in both the objectives and work of the HTA network, as well as an open dialogue with all stakeholders, are key elements to develop adequate policies and methodologies for HTA, and it is now up to member states to implement these principles."

"The medical technology industry favours strong stakeholder participation in HTA and very much looks forward to providing extensive relevant expertise," said John Wilkinson, chief executive of Eucomed.

Liberal MEP Parvanova Antonyia (ALDE; Bulgaria), an advocate for the directive, said, "now it is important to monitor the proper implementation of this directive and ensure that it delivers concrete public health benefits for patients right across Europe". 

Dutch Green MEP Bas Eickhout said: "The Greens believe the final compromise adopted today strikes the right balance between guaranteeing patients' rights to cross-border health care and safeguarding the provision of quality health services at national level."

German MEP Dagmar Roth-Behrendt, vice-president of the Socialists & Democrats group, said: "Our group achieved a good balance between the right of EU patients to seek the best treatment and the protection of the financial sustainability of national social security systems."

"The new rules are not designed to encourage health tourism," said UK Liberal Democrat MEP Liz Lynne.

"Patients are only entitled to reimbursement for treatment that their home health authority would normally provide. Travel or hotel costs cannot be claimed back. Patients from other member states travelling to the UK specifically for healthcare will have to pay the full NHS cost of treatment," Lynne said. 

French Socialists & Democrats (S&D) MEP Bernadette Vergnaud, who is vice-president of the European Parliament's internal market committee, welcomed the fact that the vote had allowed the EU to avoid establishing a European health system at different speeds.

Fellow French S&D member Gilles Pargneaux agreed that health was not a commodity like any other. According to him, this directive will make sure it will not be treated as such.

He regretted that the directive had failed to tackle inequalities among the EU's 27 health systems. This issue will have to be addressed in the future, he said.

The Pharmaceutical Group of Europe also expressed concern: "Pharmacists need to assess, authenticate and validate prescriptions from other member states, as they do in the case of national prescriptions. When authenticating a prescription, it is essential not only to identify the patient but also be able to verify and be able to contact the prescriber in order to prevent medication errors occurring." 

"Sometimes, if patient safety is to be ensured, prescriptions need to be adjusted in cooperation with the prescriber. This presents particular difficulties when the prescriber is from a different country. PGEU therefore welcomes the principle established in the directive that pharmacists should be able to refuse to dispense such prescriptions in cases of doubt, or due to ethical concerns, and the proposal in the Directive to facilitate pharmacist/prescriber contact," the group said. 

And though the United Kingdom supported the proposal, Nigel Farage, leader of the UK Independence Party, said the rules would turn the country's health system into a "bureaucratic nightmare". Extra staff, he said, would be needed to "chase up getting the money we are owed from countries such as Romania". 

But other British MEPs supported the directive, including Conservative MEP Marina Yannakoudakis. "Cross-border health care can be a very useful tool in patient care, giving choice to the patient and taking pressure off [national health systems] in areas where a backlog exists."

European Parliament President Jerzy Buzek called the directive a "solid legal basis for dealing with cross-border healthcare in the EU that was hitherto in a legal grey zone. We unified the different standards set by the European Court of Justice and we created thus a clear and objective system of references."

The European Patients' Forum welcomed the Directive on Cross-border Health Care adopted by the European Parliament. They said that although the compromise adopted fell short of their vision, many aspects of the directive could be built upon "to achieve better quality care for all patients".

On eHealth, the organisation regretted that cooperation is only voluntary and standards are not as high as in non-electronic health services.

It said: "Much now depends on the way the directive is implemented by member states; its full impact on patients and all the other involved parties will only become clear in the course of the coming years."