Health Brief: Cross-border healthcare rights are (still) unknown

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After ten years with the cross-border health directive, hardly anyone in the EU is aware of their rights to be treated in another county, the European Commission’s new evaluation of the directive has revealed. Just as plenty of evaluations before them have.

If you are like most people in the EU, you probably do not know what your options are for cross-border health care even though it could prove useful.

Maybe you live in a border area and the neighbouring country’s hospital is closer than one in your own country. Or maybe your country lacks the specialised treatment that you need. You can go to a specialised place somewhere else.

That sounds handy, does it not?

Well, if only it was so easy. Knowing your rights is good but there are plenty of issues with making the concept function smoothly.

The directive governing these rules has been evaluated by the Commission in its tenth year. According to them, it has done a lot of good and boosted access to treatments, but the “potential for improving access to cross-border healthcare continues to be hampered by some issues,” said the evaluation, published last Thursday (12 May).

“These include, in particular: the low level of awareness over patients’ rights to cross-border healthcare, inadequate patient information, disproportionate administrative burdens and uncertainty over healthcare costs abroad and reimbursement,” it added.

The evaluation blames these problems on uneven implementation of the directive by EU countries, cumbersome administrative procedures, and overly complex information on the best cross-border healthcare options available.

The EU’s Health Commissioner Stella Kyriakides is generally positive about the findings, which confirm the directive has brought about more equal treatment of EU patients when they are treated in another country and ensured full or partial reimbursement of the costs.

“The COVID-19 pandemic has shown the importance of European cross-border solidarity in times of crisis. It is encouraging that EU legislation is fulfilling its purpose of facilitating equal treatment and access to safe and quality healthcare for EU patients across the Union,” Kyriakides commented.

“We will now take steps to address the remaining challenges and ensure that all patients can make full use of their healthcare rights under EU law. Ensuring strong European cooperation on cross-border healthcare is an important part of our work to build a strong European Health Union for all patients,” she added.

The evaluation briefly acknowledged the criticism of patient organisations, who have long been complaining that patients receiving treatment abroad have to pay upfront and get reimbursed later. This is said to create inequalities in access to healthcare.

But that will not be the first thing to change as paying upfront is considered “the only viable way to empower the patient to choose public or private healthcare in another EU country without prior approval, while also giving the patient the right to reimbursement of costs, up to a certain level, by their health insurer”.

Old news

This is not entirely new. Others have evaluated the directive before the Commission and come to similar conclusions.

Back in 2019, the European Parliament approved a resolution on the implementation of the Cross-Border Healthcare Directive where the MEPs expressed disappointment that “a significant number of member states have not effectively implemented the requirements for guaranteeing patients’ rights.”

They also wanted cross-border healthcare to be a stand-alone programme in the multiannual financial framework (MFF) (2021-2027), to give citizens better informed about their rights and to invest in and promote National Contact Points (NCPs) and eHealth platforms for patients to provide accessible information.

Amongst other issues, they also encouraged the Commission to support the setting up of specialised centres for rare diseases in the EU.

This last point was highlighted again in 2022 when the European Parliament approved a report about the use of cohesion policy to reduce healthcare inequalities and enhance cross-border health cooperation.

“In my country, Croatia, there are a lot of diseases, especially rare diseases, [where we lack] expertise or equipment to treat patients. Why not establish centres of excellence for certain types of rare diseases that will cover more regions for different member states,” rapporteur Tomislav Sokol (EPP) told EURACTIV in an interview in March 2022.

He also highlighted the lack of knowledge among citizens about their rights to cross-border healthcare.

The directive has also been reviewed by others, such as the European Court of Auditors in 2019 and the Committee of Regions in 2020.

So very well assessed indeed.

Can we move on from evaluations?

In its reaction to the evaluation, EuropaBio, the European Association for bioindustries, called for a revision of the directive “to address the shortcomings highlighted by the evaluation.”

“It is necessary to address persisting barriers, such as long approval times, fragmented payment and reimbursement processes, difficult access to clinical trials, and disjointed implementation that hinders patients’ access to the excellence of care and innovative therapies,” they wrote.

EuropaBio also said the Commission should hold structured dialogue with EU countries and stakeholders with the goal to make the directive’s implementation function better.

For the Commission, a revision of the directive is not on the table right now. They conclude that they would rather “maximise the potential of the Directive and strengthen cooperation between member states in cross-border healthcare.”

This is based on the evidence of inconsistent implementation across EU countries, as the European Parliament evaluation also touched upon.

There are plenty of things to work on (according to point six in the evaluation), including countries complying with obligations to provide data on patient mobility in order to be able the monitor whether the directive is actually working and for the NCPs to deepen their work with spreading information.

Given the newfound interest in more coordination in the field of health expressed by citizens and new proposals such as the European Health Data Space, time will tell if that is enough.

By Amalie Holmgaard Mersh

Subscribe to EURACTIV’s Health Brief, where you’ll find the latest roundup of news covering health from across Europe. The Health Brief is brought to you by EURACTIV’s Health Team Giedrė Peseckytė, Clara Bauer-Babef, Amalie Holmgaard Mersh, Gerardo Fortuna, and Natasha Foote.


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Upcoming events

16-20 May – European public health week.

18 May – European Cancer Nursing Day

18 May – Maximise EHDS impact on better health data sharing

19 May – Monitoring national action plans on antimicrobial resistance at country level – joint webinar by FAO, OIE, WHO, and UNEP

19 May – Improving cancer screening in the European Union

19 May – Faster, more equitable access to medicines across Europe, webinar organised by EFPIA and hosted by the Financial Times

20 May – Healthcare provision in times of armed conflict: what have we learned from the last European conflict in ex-Yugoslavia?

20 May – Transforming health systems for resilience: access, workforce and digital

20 May – Healthcare provision in times of armed conflict – What have we learned from the last European conflict in ex-Yugoslavia?

22-28 May – Seventy-fifth world health assembly.

23 May – Public hearing at the EESC on the Health Workforce and Care Strategy for the future of Europe

24 May – Institutional meeting of chief nursing officers

24 May – Institutional meeting of chief dental officiers

24 May – Parent Decision-Making around Child Health Protection: The Impact of COVID-19 and the HPV virus. 

24-25 May – EIT Health Summit in Stockholm, Sweden.

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