Medical treatment in EU countries easier, but with fixed upper limits

Patients will find it easier in future to obtain reimbursements for the costs of medical treatment in other EU countries. Refunds will be limited, however, to the costs of such treatment in the patient's own country.

Internal market for health services - more competition, mobility and choice

The European Commission is planning to submit a proposal in November 2007 in a renewed attempt to establish a uniform directive for health services. The aim is to encourage competition between the different national health systems in the 27 EU Member States and to offer patients and service providers alike more mobility and choice, thereby creating an internal market for health services. The new attempt is being pioneered by the Cypriot Commissioner for Health Markos Kyprianou.

An earlier attempt by the European Commission failed because of resistance by EU governments, whose energetic criticism resulted in health services being removed from the latest service directive. Several Member States claimed that their health systems were a purely domestic matter, fearing a flood of foreign patients and further strain on their health budgets if they opened up their systems any further.

Guiding decisions by the European Court of Justice - but refund arrangements complicated

The European Court of Justice has passed down a number of decisions entitling claimants to refunds for medical treatment. In practice, however, the patients have often had difficulty in asserting these rights with their domestic health insurance companies. Commissioner for Health and Consumer Protection Markos Kyprianou is now endeavouring to establish a uniform regulation for the first time. According to his office, cross-border health care accounts for only 1 per cent of the total health spending in the EU and does not therefore pose a financial threat for the national social security systems.

Hospital treatment in EU countries subject to approval but with a time limit

According to Kyprianou's plans, patients will be entitled to the same hospital care in other EU countries as they have in their country of origin. They will require approval for such treatment from their domestic health authorities (usually health insurance companies), but this approval may not be refused if the treatment is "appropriate" to the patient's condition. The Commission also wants to set time limits for the granting of such approval, with a decision normally being made within two weeks or even earlier in urgent cases.

Out-patient treatment without red tape - but with reimbursement only at the rates applicable in the patient's own country

According to the new directive, patients seeking out-patient care in any of the EU countries will not require approval from their domestic health insurance company but will be reimbursed only at the rate applicable there - be it for short-term out-patient treatment or longer hospitalisation. Any amounts in addition to those reimbursed at home must be covered by the patient or supplementary health insurance.

Damages for malpractice - claim assistance - recognition of prescriptions

Patients will be entitled to claim for damages in the event of medical complications or malpractice in other EU countries. An office is to be set up in every Member States offering patients information about their rights and assisting them in asserting claims. Kyprianou also suggests that prescriptions issued in other EU countries be recognised in the patient's own country, and is even proposing that a special EU prescription form be designed for that purpose. The EU countries should also cooperate more effectively in border regions and in the treatment of rare diseases.

Critics fear loss of rights

These proposals have given rise to considerable discussion in Brussels. Critics claim that Member States still have too much scope to limit patients' mobility within the EU. The meaning of "appropriate" treatment is also unclear, they say. The directive could result in the curtailing of those rights that patients have already achieved through decisions by the European Court of Justice. It remains to be seen, they continue, whether this directive brings any benefits. At all events, it has to be approved not only by the 27 Member States but also by the European Parliament.

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EU Commissioner of Health and Consumer Protection Markos Kyprianou Austrian social insurance Financial Times, Germany