Commission pushes for internal health market

As public and private healthcare were excluded from the services directive, the Commission has decided to set up a specific EU health services framework to guarantee cross-border access to health care.

Regardless of the European Court of Justice (ECJ) rulings on patient mobility, patients, health professionals and actors of member states’ health systems are still uncertain about the practicalities and applicability of the Community law on health services. 

To provide clarity and legal certainty on the issue, the Commission has decided to establish an EU framework on healthcare services to ensure cross-border access to safe, high-quality and efficient care. The College of Commissioners held an orientation debate on the issue on 5 September 2006 and the Health and Consumer Protection Commissioner Markos Kyprianou will shortly draw up a Communication setting out ideas for such an EU framework. This Communication will then be subject to a public consultation, open, for example, to patients, health professionals, purchasers and providers of care, member states and the Parliament. 

This Commission initiative will, in particular, aim to provide legal clarity and certainty regarding the application of Treaty provisions on free movement to health services following the ECJ rulings and to support co-operation between health systems to enable economies of scale on some health-services areas. Development of European networks and centre of references will also be encouraged.²


Health Commissioner Markos Kyprianou believes that "the healthcare that patients need is sometimes best provided in another EU country". Therefore, he agues that a clear, practical framework is needed to "enable patients and those who pay for, provide and regulate health services to take advantage of cross-border healthcare where that is the best solution". He also adds that this will increase European cooperation and improve efficiency and effectiveness of all EU health systems, "whilst respecting national responsibility for their organisation and financing".  

MEP John Bowis argues that "it is time to bite the bullet and recognise that health is a cross-border issue. We as Parliamentarians must decide policy in this area and not leave it to the lawyers".


"A European strategy is needed to ensure that citizens can exercise their rights to seek care in other member states if they wish, and that European co-operation can help systems to work together to better meet the challenges they face," states the Commission in its communication on patient mobility (April 2004). 

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

Health services were excluded from the services directive in spring 2006, but the many rulings of the ECJ show that they are to be considered as an economic activity and that Community law applies to them.


  • Following the public consultation, specific Commission proposals are expected in 2007. 
  • The Health council agreed, in June 2006, on a statement on common values and principles that underpin Europe's health system.

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