EPRSauthor By / April 15, 2014

European patients’ rights in cross-border healthcare

Directive 2011/24/EU on patients’ rights in cross-border healthcare is an important achievement of the ‘patient empowerment’ policy of the EC…

© mipan /Fotolia

Directive 2011/24/EU on patients’ rights in cross-border healthcare is an important achievement of the ‘patient empowerment’ policy of the EC and an essential requirement enabling European citizens to benefit from cross-border healthcare services. It is a natural extension of the fundamental freedoms enshrined into the EU Treaties.

European patients' rights in cross-border healthcare
© mipan /Fotolia

In its landmark pronouncements in the Kohll and Decker cases in 1998, the European Court of Justice stated that European citizens have the right to benefit from healthcare services in a different Member State. These principles however created an uncertain legal situation during their application. This was because of the diversity of health care systems, especially regarding the reimbursement aspects and the delivery of health-care services. For these reasons the EC Directorate-General for Health and Consumer Protection launched in 2006 a public consultation on this issue, with its final report concluding on the need establish a general legal framework.

The European Parliament adopted its position at second reading the 19th of January 2011.

The Directive provides a detailed legal framework focused on three main areas:

  • rules concerning the reimbursement of costs of cross-border healthcare
  • responsibilities of the Member States with regard to cross-border healthcare
  • cooperation between healthcare systems

With cooperation between healthcare systems being one of the main reasons for legal uncertainties, the Directive foresees the development of National Contact Points (NCPs) and European Reference Networks (ERN). Acting as information desks, the NCPs should support patients in their reimbursement procedures or enable them to make well-informed choices among the possible solutions offered by other Member States healthcare systems. The ERNs aim to facilitate access to diagnosis and healthcare services in case of highly specialized medical treatment, especially for patients affected by rare diseases.

EU countries had until 25 October 2013 to pass their own laws implementing the Directive.

As identified in some recent Parliamentary questions, many uncertainties still exist for cross-border patients. The European Commission is currently monitoring the correct implementation measures of the directive in the Member States. The European Commission will submit a specific report on this to the European Parliament and the Council before the end of 2015.


Policy on Cross-border care / European Commission, DG Health & Consumers The dedicated official web-page of DG SANCO provides a general overview of the policy, recent adopted actions and future challenges.

EU Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare: Legislation Guidance of Patient Organizations/ European Patients’ Forum (EPF), August 2012, 16 pages. This Document provides a clear summary of the legal framework on patients’ rights in cross-border health and highlights the provisions related to the EU patients’ empowerment.

Patient choice beyond borders – Implications of the EU Directive on cross-border healthcare for NHS commissioners and providers / Briefing by the NHS European Office, May 2011, Issue 7, 8 pages. This briefing gives a synthetic and clear overview of the Directive 2001/24/EU, with the particularity to highlight the practical implications for health-care providers and commissioners.

Cross-Border Healthcare Directive 2008/0142(COD) / EuroHealthNet, 2011, 4 pages This policy brief provides a short summary of the EU Cross Border Healthcare Directive. It highlights key aspects of the directive and identifies some potential implications.


Cross-border healthcare in the European Union. Mapping and analysing practices and policies/ Matthias Wismar, Willy Palm, Joseph Figueras, Kelly Ernst, Ewout van Ginneken; World Health Organization, on behalf of the European Observatory on Health Systems and Policies, 2011, 396 pages. This document gives a comprehensive analysis about policy-relevant aspects of cross-border healthcare. Its structure is based on an inductive approach, focusing several faces of the topic whose analysis is developed along the legislative development, the implementation procedures by Member States and the new challenges for the European Union.

Building European Reference Networks in healthcare. Exploring concepts and national practices in the European Union / Willy Palm, Irene A. Glinos, Bernd Rechel, Pascal Garel, Reinhard Busse, Joseph Figueras; European Observatory on Health systems and Polices, 2013, 83 pages. This source provides a recent analysis about the ways in which European Reference Networks have been developed giving a broad overview about their establishment under several points of view: the typologies of medical conditions requested, the regulatory and administrative process involved and the financial arrangements needed. One of the main peculiarities of this study is to outline the key-policy implications and challenges framing the concept of reference networks at national EU-level in implementing the Directive 2011/24/EU.

Medical Tourism: treatments, Markets and Health System Implications: A scoping review / Neil Lut, Richard Smith, Mark Exworty, Stephen T. Green, Daniel Horsfall and Russell Mannion, OECD report, September 2011, 55 pages. The main value of this source is its analysis about the concept of ‘medical tourism’. Structured with a deductive approach, this study provides a detailed overview of the recent globalization of health-care market, focusing the interaction of demand for, and supply of, medical tourism services, and the different organisations and groups involved in the industry. In light of this, the research outlines key-health policy aspects not only with a European perspective, but with a systematic overview of main global-level impacts of this ‘new concept’ of benefitting healthcare services.

Free Movement of Patients: Directive 2011/24 on the Application of Patient’s Rights in Cross-Border Healthcare/ Miek Peeters in European Journal of Health Law, 2012, Vol. 19, Issue 1, 33 pages This article provides a detailed juridical analysis of the Directive 2011/24, under several points of view as the ECJ judgments and its implications into the Member States legal systems or the Directive transposition and its legal impact for health-care public systems and private stakeholders.

Enabling patient mobility in the EU: between free movement and coordination / Willy Palm, Irene A. Glinos, WHO Regional Office for Europe, April 2011, 52 pages. This document provides a deep but clear step by step analysis on the enabling process of European patients in their cross-border rights. It focuses on the ‘conceptual construct’ of patient mobility analysed by the parallel development of the fundamental freedoms within the European single market.

The Directive on cross-border healthcare or the art of codifying complex case law/ Stephane De La Rosa In: Common Market Law Review, 2012, Vol. 49, Issue 1, 32 pages. The main objective of this article is to study the recent Directive on the application of patients’ right in cross-border healthcare by putting it into perspective with the case law that initiated it, together with the trade-offs that had to be taken into account.

Treatments of Low-priority and the Patient Mobility Directive 2011, and End of Legal Uncertainty for the English NHS? /Maria K. Sheppard in European Journal of Health Law, 2013, vol. 20, 20 pages.

Click on “see if we recognize you” to access the database This academic paper provides a valuable analysis about some specific impacts on the national legal systems created by the Directive 2011/24 implementation. Giving as case-study the implementation in UK, this source is focused on the still existing legal uncertainties related to cases of ‘prior authorization’ as condition to benefit cross-border rights. It is argued that major problems exist on the fixation of specific thresholds which should justify the decisions of the National Health Systems in order to grant the ‘prior authorization’ for cross-border treatments which are available only with certain clinical criteria. The value of this contribution is the enlightenment of two fundamental points of view: of National Health Systems operators within the establishment of this thresholds and of those patients who don’t have certainty if they should receive “low priority” treatments.

Stakeholders’ views

Public Consultation on the implementation of European Reference Network (ERN) / European Commission, DG Health & Consumers On this page you will find the final report of a public consultation launched in 2012 about the development of European Reference Networks, an indispensable tool to facilitate the implementation of the Directive 2011/24/EU. The main value of this source is the collection of many patients’ and health professionals’ associations points of view on EU cross-border healthcare implementation status.

Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare – EPF Recommendations for a patient-centred implementation / European Patients’ Forum, August 2012, 12 pages. This document contains a series of recommendations developed by the European Patients’ Forum addressed to authorities and bodies in the EU Member States tasked with the transposition and implementation of the Directive 2011/24/EU. The main value of this source is the outline several patients’ organizations points of view about how a Member State should implement specific article of the Directive.

EPF Regional Conference on the EU Directive on Cross-Border Healthcare / Conference report, Bruxelles, 9-11 December 2013, 42 pages. This document is the outcome of a recent conference organised by the European Patients Forum in order to analyse the current situation of cross-border healthcare rights, immediately after the deadline of the transposition timeline granted to the Member States. The report describes the point of view of several national patients’ organizations, comparing the level of development of cross-border healthcare before and after the practical implementation of the Directive 2011/24.

EPHA Briefing on Patients’ Rights in Crossborder Healthcare Directive / European Public Health Alliance (EPHA), November 2011, 9 pages EPHA’s position is that more rights and increased choice for patients to receive treatment abroad is a positive development. However, this is only valid as long as this does not disturb the project of creating inclusive and well-functioning health systems across Europe. EPHA believes that there is potential for the Directive to contribute to sustainability by sharing resources and increased cooperation, but in order for this to happen effectively, a lot of foresight and proactive decision-making will be required. The role of communication – between health systems and various categories of health professionals, but also to the public at large – cannot be underestimated.

Are EU Member States ready for cross-border healthcare? / News article, by the European Public Health Alliance (EPHA), 2013 The transposition period for the Cross-border Healthcare Directive came to an end on 25 October, however it has been reported that many Member States are not prepared and have not set up vital information and control resources.

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