State of play, main conclusions, outlook

The Directive on patient rights in cross-border healthcare (Directive 2011/24/EU) aims to facilitate access to safe and high quality healthcare in another EU country. Thanks to the Directive, patients can claim reimbursement from their national health system or their health insurance provider. Prescriptions for medicinal products and medical devices are recognised anywhere in the EU in line with national dispensing rules. National Contact Points (NCPs) have been set up in each EU country to provide information to patients on their rights to cross-border healthcare. More than 200 000 patients a year take advantage of the systems put in place under this Directive to receive healthcare in another EU country.

The Directive has also triggered European cooperation in healthcare creating the European Reference Networks (ERNs) for rare and low prevalence complex diseases, promoting European e-health initiatives leading to the planned European Health Data Space and fostering health technology assessments within the EU. The COVID-19 pandemic has reinforced the importance of cross-border cooperation in healthcare illustrating also the benefits for health systems when capacities can be made available across borders in the EU.

The Commission has finalised the evaluation of the Directive in May 2022

The evaluation considered assessments by the European Parliament, the Council, the European Committee of the Regions and the European Court of Auditors, and Court of Justice case law interpreting certain provisions of the Directive. It takes also the Fit for Future Platform opinion on patients’ rights into consideration.

The evaluation concluded that the Directive is still relevant to address current patients’ needs, and has enshrined important patient rights, such as equal treatment of EU and domestic patients. The evaluation also pointed to the 24 European Reference Networks for rare, low prevalence and complex diseases as a major achievement for cross-border healthcare cooperation. Moreover, key achievements have been underlined on the role of the Directive to deepen cooperation in the area of e-Health, leading to the proposal for a Regulation of the European Health Data Space, and in the area of health technology assessment, leading to the adoption of Regulation (EU) 2021/2282.

However, the Directive’s potential for improving access to cross-border healthcare continues to be hampered by some issues. These include, in particular: the low level of awareness of patients’ rights to cross-border healthcare; inadequate patient information; disproportionate administrative burdens; and uncertainty over healthcare costs abroad and reimbursement.

The Commission supports the exchange of good practices to remove barriers, for example through the digitalisation of healthcare and to ensure better information on cross-border healthcare.

The Commission is implementing key actions identified during the evaluation exercise as listed in the Action Plan annex of the evaluation report.

Fit for Future Platform

The Fit for Future Platform included the Directive in its 2021 work programme. In its opinion adopted on 10 December, the Platform underlines that:

- the opportunities created by the Directive are not sufficiently well known by the European citizens and their health providers;

- the provisions of the Directive do not provide seamless access to information on care options abroad;

- prior authorisation could be transformed from a hurdle to an enabler to care abroad;

- billing remains an obstacle and could be simplified;

- access to information on applicable fees needs improving.

The Platform made a series of suggestions in particular to redesign National Contact Points, tie prior authorisation with direct billing, introduce a common EU cross-border health bill template, create a network of regional "Healthcare abroad" points in all EU border regions, complement the triennial implementation report with a Cross-border healthcare Conference for regional authorities, make the use of European electronic health record (EHR) exchange format mandatory for Member States in cross-border healthcare, enable truly cross-border emergency care and transport and improve information on applicable tariffs.

Based on the evaluation findings, the Commission committed to strengthen cooperation with the national contact points and organise knowledge and capacity-building workshops, the first to take place in February 2023.

It will also organise new bilateral dialogues with Member States regarding prior authorisation and will help Member States share good practice on price transparency for cross-border patients and the estimated level of reimbursement.

The Commission will also help the Member States share knowledge on streamlining procedures for accessing cross-border healthcare through digitisation. In addition, the Commission will support awareness events in the Member States organised in cooperation with the NCPs and attended by regional healthcare projects as well as relevant stakeholders, as suggested by the Platform.