Parliament backs EU cross-border healthcare plans


The European Parliament has passed a landmark directive which would allow Europeans seek healthcare abroad more easily and be reimbursed for the cost of doing so. However, EU member states are still working to iron out a range of practical difficulties before the plan can be formally adopted.

The controversial report was backed by MEPs by 297 votes to 120, amid 152 abstentions, and has been the subject of criticism from political groups and the Committee of the Regions (CoR), which represents local government at EU level. 

Under the proposal, patients are to be reimbursed up to the level they would have received in their home country. Member states can also opt to cover other related costs, such as therapeutic treatment, accommodation and travel costs. 

The directive includes a system requiring prior authorisation for the reimbursement of hospital costs in order to preserve the financial stability of member states’ social security systems. 

EU countries wrangling with practicalities 

The proposal will now be discussed by EU ambassadors early next month (6 May) as member states continue to wrangle over the practicalities of enhanced patient mobility. The plan has been discussed several times at meetings of EU governments this year, but Brussels insiders warn there is still much work to do before agreement is reached. 

Among the outstanding issues to be resolved are how much power member states will have to control the flow of patients to their health services from outside their jurisdiction. 

It is believed that the Czech EU Presidency is now suggesting that countries should have greater freedom when demanding prior authorisation for treatment, particularly for “specialised and cost-intensive” care. The presidency is hoping for political agreement at a meeting in Luxembourg on 8 June, so as to progress the issue before the end of its six-month term. 

Cooperation by member states on health issues is a thorny issue as healthcare is a matter for individual countries, and there are significant differences in funding models of health and social insurance systems across the EU. 

Socialists and radical left in political row 

A political spat between the Socialist group and the more radical GUE/NGL leftist group unfolded on the sidelines of the debate, with the Nordic Greens accusing the Socialists of being internally divided. 

The Socialist group abstained from the vote, and was the only major group not to issue a statement after the result. A spokesperson told EURACTIV that its concerns over prior authorisation and the legal basis for the directive had not been met. 

Dutch MEP Kartika Liotard (GUE/NGL) said the proposed directive “opens the door to market forces in healthcare,” and accused the Socialists of indirectly putting economic concerns ahead of patients’ interests by abstaining rather than voting down the dossier. 

When UK Conservative MEP John Bowis’s report was approved by the European Parliament’s committee on environment and public health at the end of March, the Socialist group opted to abstain at the last minute amid concerns over the wording of a number of amendments. 

The EPP-ED and ALDE groups backed the plan, ensuring that it passed at first reading. 

Ahead of the vote, the Committee of the Regions had expressed fears that the directive would lead to unequal access to healthcare services across Europe. Karsten Uno Petersen of the South Denmark Regional Council, who was the CoR's rapporteur on the issue, said prior authorisation was essential if equal access and patient safety were to be guaranteed. 

CPME, the standing group of European doctors, congratulated the European Parliament on passing the proposal for a directive at first reading. "CPME welcomes the European Parliament's call for clearer rules on EU citizens' access to treatment elsewhere in the EU. The vote on this report is the first step in the right direction for establishing a level playing field in cross-border healthcare," the committee said in a statement. 

Kartika Liotard MEP (GUE/NGL; Netherlands) had requested that the report be sent back to the parliamentary committee responsible for these issues, the Committee on Environment and Public Health, because the proposal is based on article 95 of the Treaty. 

"Article 95 is the infamous 'harmonisation of the internal market' article and is based solely on economic interests. This article has nothing whatsoever to do with public health, which is covered by Article 152 of the Treaty," Liotard said in a statement. 

"The behaviour of members of the PES was interesting to say the least. They are as fickle as the weather. In the debate this morning, they claimed that they would not vote in favour of the proposal if it was not also based on Article 152. At the final vote however, they abstained from voting and therefore indirectly approved that economic interests are more important than patients' interests. One good thing is that, because of this, the proposal was backed by just a fraction of the majority," she concluded. 

UK Liberal Democrat MEP Liz Lynne said the legislation paves the way for European patients to access healthcare across the EU irrespective of income. 

"Why should a patient have to lose their sight waiting for a cataract operation, or spend months in agony waiting for a hip replacement when they could get treatment sooner in another member state, sometimes at a lesser cost to the country of origin? If a clinician advises treatment and this cannot be provided at home, then we need a legal framework to ensure that they can seek it elsewhere," she said. 

Greens/EFA MEP Margrete Auken (Denmark) said the Greens had voted against the proposal because it had no legal basis beyond the internal market. She warned that the current wording risks allowing a neo-liberal, free market view of healthcare. 

"We are of course very much in favour of defending patients' rights, but this directive offers precious little towards that goal. It risks putting medical tourism before universal access to quality domestic healthcare. We must not jeopardise the rights of the huge majority of Europeans who prefer to receive good quality healthcare close to their homes. This system risks benefiting only a small number of well-off patients who can shop around for treatments, at the expense of a large majority who may experience deteriorating quality of their hospitals," she said. 

Conservative UK MEP Philip Bushill-Matthews, who spoke in place of his colleague John Bowis, the author of the report, said people who are let down by their national health services should be able to seek treatment elsewhere in the EU. 

"At a time when patients may already face great uncertainty it is important they do not worry about battling through the courts to receive care they are entitled to under the EU's treaties. These plans provide greater clarity on the rights and responsibilities of patients and healthcare providers, so that all sides have certainty. All patients should be able to access healthcare according to their needs and not their means," he said. 

Irish MEP Colm Burke (EPP-ED) welcomed the vote, having himself had major surgery in the UK in the past. "I am a beneficiary of cross-border healthcare. I was lucky enough to be able to afford to pay. Now, I want those who were not as lucky as I was to be able to benefit from the right to travel to receive healthcare without having to worry about costs, fully informed as to their rights and as to the quality of care they can expect to receive," he said. 

The European commissioner with responsibility for health, Androulla Vassiliou, welcomed the European Parliament's vote. "I am convinced that this will lead to greater confidence and knowledge for all citizens about the healthcare they receive. These are initiatives that really bring the European Union closer to its citizens," she said. 

The European Public Health Alliance has broadly supported the proposed Directive since it was first drafted by the European Commission in July 2008 but has lobbied to ensure it meets the needs of all patients. In a statement, it said the public health community is satisfied that this proposed Directive has made it through a first reading and that the Parliament "has shown such a strong lead on it". 

"We hope that the member states will show a similar commitment to European patients within the Council proceedings,"said Monika Kosinska, Secretary General of EPHA. 

However, the Alliance expressed some reservation at what is sees as a lack of ambition to further facilitate access to cross-border healthcare for under-privileged patients. 


A series of rulings by the European Court of Justice, beginning in 1998, found that healthcare could be sought in any member state, with patients entitled to have their costs covered by their own health systems. 

This prompted the European Commission to adopt a communication in 2006 which began a consultation process on cross-border access to healthcare. This culminated in the publication of a proposal for a directive in July 2008 (EURACTIV 18/07/08). 

The proposals would allow citizens to seek treatment anywhere in the EU and claim reimbursement in their home countries under certain circumstances. Patients can seek non-hospital care, such as dental treatment and medical consultations, without prior authorisation. 

However, prior authorisation is required for in-patient procedures, such as surgery. The final report, drafted by UK Conservative MEP John Bowis (EPP-ED), excludes organ transplantation and long-term care from the scope of the directive. 

  • May 6: EU Ambassadors to discussed proposed directive 
  • June 8: Czech Presidency to seek political agreement at meeting between member states at meeting in Luxembourg 

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