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.

EU NEWS

The first meeting of the European Parliament’s new COVID-19 committee (COVI) on Thursday (12 May) did not bring about any concrete results but revealed the broad range of topics MEPs wish to address in the quest to collect lessons learnt from the pandemic.

Hepatitis

Mysterious hepatitis cases are continuing to grow. As of the 15th of May, there were over 420 probable cases of acute hepatitis of unknown origin reported from 22 countries. At least 6 children died, 26 needed transplantation, and overall many needed hospitalisation.

Hepatitis forms from A to E have largely been excluded as a cause of this outbreak.

“Key working hypothesis remained the links to adenovirus and also COVID-19, and importantly, now have these two infections by maybe working together as cofactors, either by enhancing susceptibility or creating an abnormal response,” Philippa Easterbrook, a senior scientist in the global hepatitis programme at the World Health Organisation (WHO), told a press briefing on Tuesday (17 May).

COVID-19

The Commission might terminate APA with Valneva. A manufacturer of one of the four COVID-19 vaccines currently under rolling review by the European Medicines Agency (EMA) received notice from the European Commission that the advance purchase agreement of over 24 million doses might be terminated.

Long COVID. A follow-up study found that two years after being hospitalised with COVID-19 in China, over half still have at least one symptom.

First COVID-19 outbreak in North Korea. North Korea has announced their first outbreak of COVID 19 through their state media, with more than 1.4 million suspected cases since late April. 

Tedros Adhanom Ghebreyesus, WHO’s director-general, told a press briefing on Tuesday (17 May that “WHO is deeply concerned at the risk of further spread of COVID 19 in the country, particularly because the population is unvaccinated and in many have underlying conditions putting them at risk of severe disease and death”. 

The WHO’s emergency director Mike Ryan also highlighted that tools for fighting the pandemic are available “and they’re ready to be used”. 

“As such, who stands ready to support both North Korea […] but beyond that, WHO has no special powers to intervene in a sovereign state”, he said adding that “WHO bears no particular power and would not and cannot intervene in a sovereign state without the expressed wish and intent and invitation of that state”.

Disabilities

Almost one billion children and adults with disabilities, as well as older persons, do not have access to the assistive technology they need, warned a new report by the World Health Organisation, whose chief urged all the countries to make this issue a priority.

AMR

European lawmakers are still not impressed by the EU executive’s strong defence of its stance on the disputed antimicrobial colistin, as disagreements surrounding the list of antimicrobials to be reserved for human use continue.

Ukraine

The areas in Ukraine suffering from water and sanitation infrastructure damage are at risk of a potential cholera outbreak, the World Health Organisation warned on Tuesday (17 May), adding it was already deploying cholera kits on the ground.

Monkeypox in the UK

Four additional cases of monkeypox were detected in the UK among men who have sex with men leading to concerns about the virus spreading in the community. 

The Capitals

PARIS

Masks no longer required on French transport. Facemasks no longer need to be worn on public transport in France from Monday, meaning the country is getting closer to dropping all COVID-19 restrictions. By Nelly Moussu | EURACTIV.fr

MADRID

Spain to make abortion a public health right, end parental consent for over 16s. Spain is finalising the details of a draft law that would guarantee the right to seek an abortion in the country’s free public healthcare system and scrap the requirement for 16-year-olds and above to obtain parental consent. By Fernando Heller | EuroEFE.EURACTIV.es

Spain to become first European nation offering menstrual leave. Spain could become Europe’s first country to introduce medical leave for women suffering from menstrual pain with the government and parliament set approve a draft bill amending the country’s abortion law to this effect. By Fernando Heller | EuroEFE.EURACTIV.es

BELGRADE 

COVID-19 jabs still necessary, says Serbian epidemiologist. An increase in the number of new COVID-19 cases was not registered during the Labour Day and Easter holidays but everyone should be careful, and vaccinations are still necessary, said Serbian epidemiologist Predrag Kon on Tuesday. EURACTIV.rs | betabriefing.com

ZAGREB

Croats protest after no-abortion scandal. Thousands of Croats marched in protest rallies in nine Croatian towns on Thursday, demanding “an end to the destruction of public health and the neglect of women’s health.” By Zoran Radosavljevic | EURACTIV.com

VIENNA

Austria lifts COVID-19 entry requirements. Entering Austria no longer requires proof of vaccination, recovery passes, or testing after all COVID-19-related entry requirements were dropped from Monday. By Laura Kabelka | EURACTIV.de

THE HAGUE

Dutch could face autumn lockdown as government unprepared. The Dutch may have to lockdown again in autumn as the government has not prepared an effective strategy in case another COVID-19 wave hits the country, Dutch media NOS reports. By Sofia Stuart Leeson | EURACTIV.com

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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