EUROPA

SUMMARY

This Directive makes provision for the introduction of a general framework to:

• clarify patients’ rights with regard to accessing cross-border healthcare provision *;
• guarantee the safety, quality and efficiency of care that they will receive in another EU Member State;
• promote cooperation between Member State on healthcare matters.

This Directive does not concern:

• long-term care services;
• organ transplants;
• public vaccination programmes.

Member States’ responsibilities

Each Member State shall designate one or several national contact points for cross-border healthcare. These contact points shall consult with patient associations, healthcare providers and healthcare insurers. They are responsible for providing patients with information on their rights when they decide to take advantage of cross-border healthcare and with the contact details of the other contact points in the other Member States.

The Member State of treatment * organises and provides the healthcare. They are responsible for ensuring the quality and safety of the healthcare provided, in particular by implementing control mechanisms. They also ensure the protection of personal data and equal treatment for patients who are not nationals of their country. The national contact point in the Member State of treatment shall provide patients with the necessary information.

Following the provision of care, it is the Member State of affiliation * who takes care of the reimbursement of the insured person on the condition that the treatment received is provided for under reimbursable care in their national legislation.

Procedures for reimbursing cross-border care

The Member State of affiliation shall ensure that the costs incurred by an insured person who receives cross-border care shall be reimbursed, on the condition that the person has the right to the type of care received. The amount of the reimbursement is equivalent to the amount which could have been reimbursed by the statutory social security system if the care was provided in their country. It must not exceed the actual costs of the care.

The Member State of affiliation may reimburse related costs, such as accommodation and travel costs.

An insured person may also receive reimbursement for services provided through the means of telemedicine.

With regard to certain cross-border healthcare *, the State of affiliation can implement a system of prior authorisation in order to avoid the risk of undermining the planning and/or financing of their health system. It must provide this authorisation automatically if the patient has the right to the healthcare in question and when this healthcare cannot be provided on its territory within a time limit which is medically justifiable. However, the State of affiliation may refuse to grant prior authorisation to a patient in very specific cases (as detailed in the Directive *).

If a patient requests prior authorisation and the conditions are met, authorisation must be granted in accordance with the Regulation relating to the coordination of social security systems, except if the patient requests to be treated under the framework of this Directive.

Administrative procedures relating to the provision of healthcare must be necessary and proportional. They should be implemented in a transparent manner, within fixed deadlines and based on objective and non-discriminatory criteria. When processing a request for cross-border healthcare, Member States must take into account the patient’s medical condition and the urgency of the specific circumstances.

Cooperation on healthcare

Member States will cooperate on the implementation of the Directive. In particular, they will support the creation of European reference networks of healthcare providers, which aim to facilitate the mobility of expertise and access to highly specialised care through the concentration and joining up of available resources and expertise.

Member States shall recognise the validity of medical prescriptions issued in other Member States if those medicines are authorised in their country. Measures must be taken to help health professionals mutually recognise and verify the authenticity of prescriptions.

Member States are also encouraged to cooperate in the treatment of rare diseases through the development of diagnostic and treatments methods. The Orphanet database and European networks can be used in this respect.

E-health systems or services also enable the provision of cross-border care. This Directive provides for the establishment of a network of national authorities responsible for ‘e-health’ with the aim of improving the continuity of care and guaranteeing access to high quality healthcare.

Lastly, the creation of a network of authorities or bodies responsible for evaluating health technologies will facilitate cooperation between the national competent authorities in this field.

Context

This Directive is in line with the Court of Justice jurisprudence following the Kohll and Decker judgement delivered on 28 April 1998 and which established the right of patients to be reimbursed for medical treatment in a Member State other than their own. It does not bring into question the Regulation principles on the coordination of social security systems, in particular the principles regarding equality between resident and non-resident patients of a Member State and the European Health Insurance Card.