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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 May 12; 334(7601): 974.
PMCID: PMC1867885

Europe is to legislate on cross border health care

The European Commission has decided to prepare a package of measures, including legislation, to clarify the conditions under which cross border health care may take place and be reimbursed.

The decision was taken after a wide ranging consultation of European governments and health organisations confirmed strong support for the move. The results of the 40 page survey were presented to European Union health ministers at their informal meeting in Aachen on 20 April, where, said one official, “there was a sense of urgency that something must be done.”

The absence of any clear legislative and political framework has led to a large degree of uncertainty and has left governments and national health services having to adjust their arrangements in the light of successive judgments from the European Court of Justice.

The European Commission will have to decide the issues that require legislation—which governments and the European parliament will have to approve before it can take effect—and those that can be treated through softer measures such as guidelines and basic principles.

The question of prior authorisation is one that is likely to need legislation, whereas a standard EU-wide discharge letter after treatment or minimum levels of information for patients would not.

The survey, which attracted almost 300 responses, also showed support for Europe-wide prescriptions and the development of mechanisms to exchange patients' data among countries and to arbitrate on possible compensation for any harm to patients being treated in a country other than their own.

Overall, cross border health is estimated to account for 1% of total healthcare expenses. In 2005 in the United Kingdom 281 requests for treatment abroad (the E112 procedure) were approved, and under a pilot scheme 917 orthopaedic patients were treated in France, Belgium, and Germany. However, in one Belgian hospital as many as 9.3% of surgery patients were from abroad.

The need for political action was underlined by another ruling from the European Court of Justice on the eve of the health ministers' meeting. The case involved a Greek national, Dimitrios Stamatelakis, who was treated privately in a London hospital in 1998 but subsequently died. The Greek authorities refused to reimburse the costs on the grounds that under Greek law treatment in private hospitals abroad is paid only for children aged under 14 years.

His widow, Aikaterini, opened legal proceedings, which ended up before the Luxembourg based judges. They ruled that the measures were discriminatory and should be changed, because the country's health insurance companies reimburse the costs of treatment for adults in private hospitals in Greece.


Summary Report of the Responses to the Consultation Regarding “Community Action on Health Services” is available at

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