Analysis of the EU Cross-Border Healthcare Directive

The purpose of this cross-border healthcare directive was to offer greater clarity on the rules governing patients travelling abroad to receive treatment, and in some ways was achieved on the 19th of January when the second reading of the cross-border healthcare directive was finally approved. National governments now have 30 months to integrate the measures set out into national legislation.

In a nutshell, the newly adopted EU cross-border healthcare directive clarifies patients' right to access safe and good quality treatment across the EU border, allowing member state healthcare systems and patients to benefit from it in a number of ways:

Patients will be reimbursed for accessing safe and good quality treatment across the European border Patient will enjoy equal treatment with citizens of the country in which they are treated National health authorities will have to work closer together and ensure that continuous improvement in the quality and safety of their infrastructure is being met; benefiting both foreign and domestic citizens Health experts across Europe will be able to share best practices on healthcare and provide standards of excellence. In addition to this, communication between providers will be important. This is addressed through provisions on e-Health and by giving patients the right to access their medical records in both their home state and where they receive treatment. Patients who are seeking for diagnosis and/or specialised treatment for rare diseases, not provided in their home country, can now access such care across the border Patients have more freedom in their choice of healthcare provider and where to receive their treatment. Establishment of national contact points where information on healthcare providers, including assessment, registration status and restrictions on practice, patient's rights, procedures for reimbursement, and complaint and redress mechanisms. Each healthcare provider must supply patients with information on availability, quality, and safety of care, clear invoices and information on prices. This process with ultimately increase the transparency of healthcare systems and is likely to stimulate the improvement of care.

What are the bigger implications behind the EU cross-border healthcare directive?

Despite the directive being an important step', there are many loopholes. A number of restrictions' or better yet, challenges are faced within the EU cross-border healthcare directive and as a result the actual benefit that will be experienced remains a question.

1. Prior Authorisation

The European court has clearly set out a frame in which prior authorisation will be justified given the risk to the health system in terms of cost and distribution of major capital investments

National authorities can introduce a system of prior authorization' in three distinct cases:

(a) For healthcare which involves overnight hospital stay of at least one night

(b) Highly specialized and cost-intensive healthcare

(c) In serious and specific cases relating to the quality or safety of the care provided abroad.

What this ultimately means is that national health authorities can refuse authorisation of the treatment in question, thereby refusing reimbursement. Refusal can be made if the treatment or the healthcare provider presents a risk for the patient or in cases where appropriate healthcare can be provided on its territory within a time-limit which is medically justifiable. The question that arises from this is what will stop countries from taking advantage of the vagueness of the criteria to increase their scope to refuse prior authorisation?'

2. Inequalities

Initially it had been stated that within the process of prior authorization, the response to any patients request should take place within 15 days. However the final version of the cross-border healthcare directive allows countries to "set out reasonable time limits'. The vagueness in this time frame could result in many inequalities between countries and ultimately force health ministries to define what "reasonable" actually means. In a time where economic crisis is present, it remains only logical that countries financially burdened will not want to commit to paying for cross-border treatment and as a result could easily use such loopholes to prevent overseas care.

3. Reimbursement

Patients will be reimbursed the amount it would cost them if they would have received the same type of healthcare in their own country. Any remaining cost will be paid out of pocket. This was placed within the cross-border healthcare directive as a means to discourage health tourism. Another minor hurdle within the reimbursement scheme is the fact that the patient may need to pay upfront and then hope to be reimbursed quickly, again bringing further inequalities between the member states and most importantly, inequalities between patients.

4. People retiring to other countries

The cross-border healthcare directive specifies that:

The Directive should not apply to those long-term care services deemed necessary in order to enable the person in need of care to live as full and self-determined a life as possible. Thus this Directive should not apply, for example, to long-term care services provided by home care services in assisted living facilities and in residential homes or housing (nursing homes)'.

The problem with this proposal however is the fact that the current market is largely characterized by an increase in baby boomers, whereby it is estimated that until the year 2030 the percentage of the population belonging to the 60 and over age segment will represent nearly one half of the European population. With this increase will come the need for greater provision of specialized intermediate healthcare services. However in countries such as the UK where such care homes are already saturated, assuming the rate of provision does not increase, it is expected that there will be a shortage of 62,500 units in the UK alone. To top this up, the actual cost that is associated with entering such care homes is extremely high in comparison to other EU countries such as Spain. So the question here is: how can you refuse patients the freedom to seek out living facilities in other neighbouring countries and receive some proportion of reimbursement?


The EU cross-border healthcare directive is in the right direction and is a step forward towards allowing patients the freedom to seek healthcare in other EU member states - whether for economic reasons, due to the quality, or the specialised and rare form of treatment that can be found outside their border. However there is a great need to ensure that all member states join forces together and guarantee that by the year 2013 all national laws and systems will have been implemented. Even if one country opts to break the deadline will consequently hamper the progress of the EU cross-border healthcare directive and its impact within the medical tourism industry.

It is true that the new rules of this directive have not been designed to encourage health tourism, as stated by UK MEP Liz Lynne. However what we should hope for is that with the proper implementation, the full impact on patients will become clear in the course of the coming years. As results are observed, changes can be adopted in order to ensure that this cross-border healthcare directive fulfils its aim in allowing patients to benefit when it comes to their healthcare needs.

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