Healthcare Services/social Security : Commission Launches Debate on Cross-Border Healthcare

Article excerpt

The European Commission is about to start a debate on the scope for EU action on healthcare services. A consultation is due to be launched in Strasbourg on 26 September. Following its debate on 5 September (see Europolitics 3143), the upcoming communication is likely to focus on two broad areas: the introduction of a secure legal basis and support for the member states. Comments are due before the end of January 2007, an extension ofa a month on the deadline that was initially proposed.


The Commission's communication covers four types of service: cross-border provision of services (telemedicine, distance diagnosis, laboratory analysis); use of services abroad (patients travelling to other member states for treatment); the permanent presence of a service provider (a clinic setting up in another member state); the temporary presence of professionals (doctors travelling between member states to treat patients).

The communication notes that the volume of patient mobility remains relatively low, accounting for about 1% of all public healthcare spending, but it nevertheless acknowledges that this is a very approximate figure since healthcare and social security bodies provide no accurate data on available movements.a

The Commission is considering several possible ways in which it it may take action. These range from a regulation or a directive (based for example on Article 95 of the EC Treaty (1)), a modern mechanism to coordinate social securitya systems by replacing Regulation 1408/71, a communication interpreting case law, improved cooperation (through the High-Level Group on health care services), the openamethod of coordination on healthcare to other non-legislative instruments (communications, recommendations, guidelines). a


Case law has clearly identified certain limits. For non-hospital care, patients can travel to another member state without the prior authorisation of their social security organisation and subsequently request reimbursement from that body. For hospital care, prior authorisation may be required under certain conditions, for example when "the system cannot provide treatment within a medically acceptable timeframe".

The Commission proposes to resolve some issues that have not yet been addressed or settled by the European Court of Justice. Examples are the values and principles on which citizens throughout the EU can count on; the margin for manoeuvre available to member states in regulating and planning their own systems in view of the principle of freedom of movement; reconciling greater individual freedom of choice and the financial sustainability of healthcare systems; compensation for cross-border health care provided by the host country; comparative information for patients and healthcare professionals on services provided; and liaison with social services and long-term care services.a


The cost of public healthcare systems has risen more quickly than inflation in recent years and "is expected to increase by one or two percent of GDP in the majority of member states by 2050", says the Commission. "The key to ensuring the sustainability of healthcare and social security services involves keeping a cap on costs and increasing efficiency." The Commission feels that a more formal framework than the current arrangements is needed in certain areas: European networks of reference centres, joint evaluation and information on innovation and new therapies, improving statistical data and indicators, and impact assessment on healthcare systems. …