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BMJ. 2008 January 5; 336(7634): 15.
PMCID: PMC2174773

Plans for cross border care costs to be met by home country are halted

Plans to clarify European Union rules for patients to receive reimbursable health care in countries other than their own have unexpectedly been put on hold after several EU commissioners strongly criticised them. The plans were due to have been presented on 19 December.

At least half a dozen of the 27 commissioners have lodged forceful objections to the proposal, which had been drafted by Markos Kyprianou, the health commissioner, and his advisers.

Some of the objections are openly political, given the sensitivity of healthcare issues and the fact that health care is the responsibility of national, not European, authorities. Margot Wallström, senior vice president of the European Commission, has expressed her “fundamental reservation” over the proposal and questioned its political advisability.

One of her concerns is that the EU should not be seen to be doing anything remotely controversial at a time when governments are ratifying the new Lisbon Treaty, which, after the failed EU constitution, is a final attempt to reform EU institutions so that they can function effectively with 27 or more member states.

Opponents also point to practical problems that they believe are not fully dealt with in the current text. These include the cross border recognition of prescriptions and the question of a doctor’s or hospital’s liability if treatment goes wrong once a patient has returned home. In addition, the proposal is facing opposition in countries with a national health service, such as the United Kingdom, and those, such as in Scandinavia, that have a high level of public funding.

The decision to remove the proposal at the last minute from the commission’s final agenda before Christmas—ostensibly for lack of time—is a severe setback for Mr Kyprianou. EU officials say that the plan might now be examined again at the end of January or early February.

However, a few weeks are unlikely to overcome the political objections. To be fair to the commission, it only agreed to draft an EU framework for cross border health care after national health ministers had explicitly asked it to do so a year ago. They had argued that such a framework was needed to ensure clarity of the rules and procedures that would apply rather than relying on successive rulings from the European Court of Justice. It was the Luxembourg based judges who had first confirmed that EU rules allow for reimbursable cross border health care, under certain conditions, by pronouncing on individual cases that had been referred to them.

The commission estimates that on average 1% of EU states’ public health budgets—roughly €10bn (£7.2bn; $14.4bn)—is spent on cross border health care each year. The practice is most common in small countries (the first successful case was brought by a Luxembourger), in border regions, in areas that attract lots of tourists, and when patients have rare diseases.


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