Overview of the European Union Directive on cross border healthcare

The new EU Directive on the application of patients’ rights in cross border healthcare does not, in itself, give you any new rights. However, it does formalise the way in which you can take advantage of those rights, incorporating the case law established in the European Court of Justice, to make the system more transparent and easier to access.

What does the Directive cover?

The new Directive covers planned healthcare in EU member states. It does not affect emergency treatment, which is generally covered, in state healthcare systems by the European Health Insurance Card (EHIC).

The Directive has two main purposes:

To clarify the rights of patients to obtain certain planned healthcare in any EU member state and establish the limits of those rights
To clarify the position of the member states regarding their legal obligations and assist them in managing the system effectively

The Directive and EU citizens

The Directive and EU member states

The Directive clarifies your rights to planned healthcare in any EU member state and establishes the circumstances in which these rights can be exercised.

The Directive also sets out clear procedures to access these rights, including detailed explanations of what the home state is and is not obliged to reimburse you for.

The Directive clarifies the member state’s obligations under EU law and details the circumstances under which it must fund planned healthcare treatment for its own citizens in other member states.

The Directive sets out criteria under which states are obliged to accept citizens from other EU states, and explains the rules for refusing such treatment.

The Directive also sets out the systems that a state must provide to allow its own citizens to access their rights to cross border healthcare, as well as the information they are required to provide for citizens considering coming to their country.

What are the limits of the directive?

Under the Directive, no member state is obliged to accept a patient for treatment, but they must be able to explain their decision to refuse to arrange treatment. A patient arriving for treatment from another EEA Member State cannot receive treatment in preference to a patient already within the home state healthcare system.

Example

Mr L, a 28-year old German accountant normally resident in Lundberg, whose sister is now a permanent resident of the UK, applied to come to the UK for surgery on two of his vertebral discs. His back pain was causing him significant mobility problems and although a local hospital in Germany had agreed to carry out the operation within 3 months, Mr L wanted to have the surgery in Bristol, so that he could spend three weeks living with his sister, a qualified physiotherapist.

Mr L asked for authorisation in Germany, which was granted, but then requested that his treatment within the NHS was carried out within the 3 month period. The NHS refused to accept Mr L as a patient under these terms. They agreed to do the operation, but within the normal waiting time of 6 months.

The implications of this decision

To put Mr L ahead of patients who had already been on the waiting list for the operation that he needed was ruled to be unfair to patients in the home state.

Furthermore, no member state is obliged to fund treatment in another country if that same treatment is available at home within a medically justifiable period, or if that treatment is not normally funded by the local heath service of the home state (except in exceptional circumstances).

Example

Mrs J, a 62-year old widow living in Somerset has been blind since the age of 10 but still now lives a successful and independent life in her own home. Over the last two years her osteoarthritis in her right knee has become progressively worse and she now needs a knee replacement to prevent her becoming disabled. She initially wanted to get treatment within the NHS and was prepared to go to the hospital in her nearest city, 12 miles away. Through her GP she made a request for a private room and extended physiotherapy. Her reasons for this, fully supported by her GP, were:

She needed a private room so that she could start moving around and exercising her knee in an environment where her lack of sight would not put her at risk. In a busy ward, there would be a high probability that she would risk an accident due to items left around by visitors, other patients or staff. A private room could be kept clear, and she could learn the layout more easily.
She needed additional physiotherapy to ensure she was fully mobile before she returned home so that she could remain independent despite being blind.

The hospital said that it was unable to meet either of these conditions. Mrs J, with the help of a family member, found a hospital in Germany that could provide a private room and an extra week of physiotherapy, and that could carry out the knee replacement within a month, 12 weeks earlier than her local hospital.

When Mrs J applied for permission from her primary care trust to do this through the Directive Route to cross border healthcare (see Section 2), she was refused. Her case was taken up by a local healthcare commissioner, who approached an exceptional funding panel that then reversed this decision and approved her authorisation for treatment in Berlin.

The implications of this decision

If Mrs J had not been blind, there would have been no exceptional circumstances and the request for additional treatments and facilities, over and above what is normally provided for patients having a knee replacement in the NHS, would have not been considered grounds for authorising cross border medical treatment through the Directive route.

When did the Directive come into force?

The Directive became EU law in April 2011 and must be implemented by all states within 30 months – so that’s by October 2013.

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In this guide

Download the guide to the European Directive on Cross Border Healthcare
The EU Directive on patient rights in cross border healthcare provides the framework by which EU citizens can travel to other countries for treatment. Our guide to EU treatment explains patient rights from a UK patient's perspective.
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