EU Corner: Patient mobility: Reality or myth?

Issue: September 2015

Adopted in 2011, the Cross-Border Healthcare Directive is a flagship initiative of the EU which allows patients to travel throughout the 28 member block for medical treatment and seek reimbursement at home. The Directive entered into force in October 2013. Nearly 2 years later, the EU legislation empowered patients to use their cross-border health care rights.

Speaking at a conference organized by the European Patients’ Forum on 2 July, EU Health Commissioner Vytenis Andriukaitis said that on a whole most Member States had done a good job in transposing the Directive, but efforts were uneven, as some countries had raised serious concerns with elaborate systems of prior authorization, lower reimbursement tariffs or complex administrative requirements. All this leads to low patient use of their cross-borders rights. Only 5% of Europeans received treatment in another EU country in 2014 and 2% had actually planned to have treatment abroad.

These remarks are backed by a recent study published by the European Commission, which analyzes the barriers for the uptake of the legislation. The study identified three main challenges: the reimbursement of cross-border health care, the quality and safety of cross-border health care and undue delay of treatments.

An EU survey conducted in all 28 Member States and published by the Commission in May, further reveals that the Directive is mostly being used by people living in Luxembourg and Italy, followed closely by Hungary and Romania. The reason these countries are leading is the lower cost of treatment outside their home countries, with the exception of the Luxembourgians who are mostly from other EU countries and go home for treatment. Besides those two reasons, 71% of respondents stated the reason to get treatment abroad was to receive treatment not available in their home country while 51% of respondents listed better quality of care.

Lack of awareness of these cross-border health care rights is another key to these numbers. A number of disparities exist with the information provided by the National Contact Points and health insurance providers regarding procedures; doctors are also, in some countries, reluctant to allow patients to travel abroad for treatment. There are certainly dangers in travelling after major surgery and follow-up arrangements are usually very clear, but Member States should work across sectors to allow patients to stay in the host country for rehabilitation and support parents to accompany their children.

Despite these challenges, the EU Directive on cross-border health care also holds promises to modernize EU healthcare systems by improving cooperation between Member States on interoperable eHealth tools, the use of health technology assessment and the pooling of rare expertise with the creation of European Reference Networks.

The Commission now plans to work with the incoming Luxembourg Presidency to try and make the EU public better aware of their rights under this Directive through increased awareness efforts and making its provisions more accessible by decreasing the number of hurdles people are faced with when trying to use it. The Commission will also publish in the autumn its implementation report, which should give a clearer picture as to whether Member States have properly transposed the Directive and what needs to be done to improve patient mobility in the EU.

In light of the increased ageing population and cuts in health care budgets, the cross-border directive will no doubt have an impact on orthopaedic surgeries, as they are the most common elective surgical procedures. EFORT European Curriculum in Orthopaedics and Trauma adopted in March 2015, aims to respond to the challenges of the free movement of both patients and healthcare professionals by ensuring that treatment received in any country within Europe is of a similar high standard and delivered by professionals with similar levels of training and expertise.