Cross-Border Healthcare

Modernisation of the Cross-Border Healthcare Directive Back on the Political Agenda

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More than 15 years after the entry into force of the Cross-Border Healthcare Directive (Directive 2011/24/EU), cross-border healthcare is once again attracting political attention. The Directive establishes the European legal framework for patients to receive healthcare in other Member States and regulates, among other things, the reimbursement of healthcare costs as well as cooperation between national health systems, including in the areas of the European Reference Networks (ERNs), eHealth services, and the mutual recognition of prescriptions. Against the backdrop of the ongoing digitalisation of healthcare, new European legislation such as the European Health Data Space (EHDS), and more than a decade of practical experience with the Directive, a targeted revision of the legal framework is now under discussion.

Draft Report in the European Parliament

The European Parliament is advancing the debate on the modernisation of the Directive through an own-initiative report. On 14 July, the rapporteur of the Committee on Public Health (SANT), Giorgos Georgiou (The Left, Cyprus), presented a draft report calling on the European Commission to submit a legislative proposal to revise the Directive by the end of 2027. The aim is to facilitate access to cross-border healthcare, reduce obstacles related to reimbursement and administrative procedures, and adapt the Directive to developments over recent years. On 2 September, Georgiou will officially present and explain his proposals in the SANT Committee.

Simpler and More Digital Procedures

The draft report contains numerous proposals to facilitate cross-border healthcare and adapt the Directive to current needs. These include more transparent prior authorisation and reimbursement procedures, a stronger role for the National Contact Points, and greater use of digital tools, in particular the EHDS and the MyHealth@EU infrastructure. In addition, Georgiou advocates sustainable funding and stronger integration of the European Reference Networks into national healthcare systems. Particular attention is given to improving access to highly specialised cross-border care for people with rare diseases, chronic conditions, and children.

Scientific Analysis Highlights the Need for Reform

At the same time as the publication of the draft report, the SANT Committee released a scientific analysis on the future of the Cross-Border Healthcare Directive. The analysis considers the Directive an important pillar of European health law but concludes that its potential has not yet been fully realised. It finds that the cross-border use of healthcare services remains limited and does not pose a threat to the sustainability of national healthcare systems. At the same time, it criticises the fact that patients continue to face significant practical barriers.

Modernisation Aims to Remove Existing Barriers

According to the authors, the main challenges include insufficient information for patients, complex prior authorisation and reimbursement procedures, shortcomings in digital interoperability, and the still inadequate integration of the European Reference Networks. The analysis therefore recommends strengthening the National Contact Points, simplifying administrative procedures, introducing clearer rules for telemedicine, and ensuring closer alignment with the European Health Data Space. Many of these recommendations are also reflected in Giorgos Georgiou’s draft report and are expected to shape the forthcoming parliamentary discussions. Members of the European Parliament may submit amendments to the draft report until 10 September.

Background

Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare entered into force on 24 April 2011 and has applied in all Member States since October 2013. It lays down the conditions under which insured persons may receive planned healthcare in another EU Member State and obtain reimbursement of the treatment costs from their statutory health insurance fund. The Directive complements the existing provisions of Regulation (EC) No 883/2004 on the coordination of social security systems.

For the statutory health insurance funds, the Directive primarily means assessing applications for reimbursement and prior authorisation in accordance with harmonised European rules and informing insured persons about their options for receiving treatment in another EU Member State. To this end, National Contact Points have been established in all Member States. In Germany, this role is performed by the German Liaison Agency for Health Insurance – International (DVKA), which is part of the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband). The DVKA provides information to insured persons and healthcare providers on the conditions for cross-border healthcare and cooperates with the National Contact Points in the other Member States.

OECD Trust Survey 2026

Good governance strengthens trust.

Overall, trust in governments remains at a comparatively low level across OECD member countries. At the same time, the 2026 Trust Survey, published by the OECD on 29 June, shows that positive experiences with public services can significantly strengthen trust in state institutions. The survey highlights that the quality of public administration is a key factor in the acceptance of state institutions.

Since 2021, the OECD has been regularly examining how citizens perceive various public institutions in their country and the extent to which they trust their government. In addition to general trust, the survey analyses the factors that influence this trust – ranging from everyday experiences with public services to the assessment of political decisions in complex policy areas.

Trust in governments varies across the EU

Across the OECD, general trust in national governments has remained broadly stable at around 40 per cent. In Germany, the figure stands at 35 per cent. Within the European Union (EU), citizens in the Nordic countries, as well as in Belgium, Ireland, Portugal and Spain, report comparatively high level of trust in public institutions. By contrast, trust is particularly low in France, Greece and Slovakia. Overall, public administration enjoy greater trust than political institutions. Across the OECD, 46 per cent of the population trust the public service, which also includes social security providers. In Germany, the figure is slightly higher at 49 per cent.

Everyday experiences shape trust

Expectations and perceptions regarding public services as well as day-to-day interactions with public authorities play a much greater role in shaping trust in the public service and local government than in national government. Germany performs better than the OECD average in several areas. These include access to social benefits such as pension payments or unemployment benefits, tolerance for errors in benefit applications, and the fair assessment of benefit claims. Among those who have recently used such services, 65 per cent across the OECD as a whole and 52 per cent in Germany are satisfied with administrative services – an important factor for trust in public institutions at all levels.

Government performance is viewed more critically

Whilst many people view their interactions with public authorities positively, their assessment of government performance on complex and long-term policy issues is significantly more critical. Government action is viewed particularly positively when policy decisions are transparent, based on scientific evidence, responsive to public preferences and balance the interests of present and future generations. These factors are very similar across all OECD member countries.

Majority remains sceptical about AI in the public sector

For the first time, the Trust Survey provides insights into public awareness of artificial intelligence (AI) and citizens' expectations regarding its potential benefits in the public sector. Overall, 60 per cent of respondents across the OECD and 55 per cent in Germany remain sceptical about the use of AI by government institutions and social security organisations. Nevertheless, people in Germany – as in most EU member states – are more positive about the potential use of AI by public authorities in all areas surveyed than the OECD average.

Ireland’s Agenda for Europe

Irish Presidency of the Council aims to create opportunities and protect people.

Under the motto “Strength through Unity” (“Ní neart go cur le chéile”), Ireland will assume the Presidency of the Council of the European Union (EU) in the second half of 2026, succeeding Cyprus. It will be Ireland’s first Presidency since Irish became one of the official working languages of the European Union in January 2022. Through its Presidency, Ireland intends to underline the Union’s commitment to linguistic diversity and integrate the Irish language into the work of the Council, official communication and cultural events.

Strengthening Europe’s capacity to act: Priorities of the Irish Council Presidency

At a time of economic transformation and geopolitical uncertainty, the Irish Presidency presents itself in its programme as a consensus-oriented and moderating force. The Council is to be strengthened as a forum for joint decision-making and Europe’s strategic resilience. Accordingly, the focus is less on launching new initiatives and more on advancing viable compromises and delivering tangible progress on existing legislative files. Ireland’s objective is to strengthen Europe’s capacity to act in times of global uncertainty through implementation, reliability and unity.

This also includes supporting common security efforts, such as enhancing the EU’s foreign policy capacity, strengthening cooperation in addressing hybrid threats and reinforcing critical infrastructure. Existing international partnerships are likewise to be deepened. Through its Presidency, Ireland also aims to advance the resilience of European value chains and further develop the Capital Markets Union in order to secure the EU’s long-term economic competitiveness. Reducing regulatory barriers and improving the business environment are intended to go hand in hand with the digital and green transitions.

Within the framework of the Employment, Social Policy, Health and Consumer Affairs Council (EPSCO), the Presidency seeks to strengthen quality of life and living standards across Europe, promote equal rights and social inclusion, and combine sustainable growth with competitiveness.

Ireland explicitly presents European social and health policy as part of a shared European social and economic model based on resilience, cohesion and equality.

Employment and a modern labour market

Employment policy will focus on how to create and secure high-quality jobs in a changing European labour market. The Irish Presidency intends to advance discussions on how employees and employers can succeed both within and beyond the Single Market. It also aims to promote safer, healthier and more productive workplaces.

As part of the FairLabour Mobility Package, which is expected to be published during the Irish Presidency, Ireland intends to prioritise two initiatives:

• The development of the European Social Security Pass (ESSPASS), designed to make it easier for citizens to prove and exercise their social security entitlements when living or working in another EU Member State;
  

• Strengthening the mandate of the European Labour Authority (ELA) to improve the implementation and enforcement of fair working conditions across the EU.
  

These initiatives aim to reinforce the EU’s social safety net, strengthen the protection of workers’ rights and promote high employment standards across all Member States.

Social policy, equality and inclusion

Another priority is the further development of the European equality and social model.The Irish Presidency emphasises that equal rights, non-discrimination and social participation are key prerequisites for economic development and democratic stability.

Within the framework of the new European Gender Equality Strategy 2026–2030, particular attention will be paid to the care economy, the impact of technological change on labour markets and participation in political and economic decision-making processes.

The Presidency underlines that social investment not only helps combat poverty and exclusion but can also foster innovation, skills development and economic growth.

Health as a prerequisite for competitiveness

In health policy, Ireland highlights the connection between strong health systems, innovation and economic performance. Access to high-quality healthcare is understood both as an expression of European values and as a prerequisite for social and economic resilience.

The priorities of the Irish Presidency therefore include advancing key health files, in particular negotiations on the EU Biotech Act as well as revisions to the Medical Devices Regulation (MDR) and the In Vitro Diagnostic Medical Devices Regulation (IVDR). A particular focus will be placed on women’s health. Ireland explicitly refers to previously underserved health areas – including conditions such as endometriosis – and highlights their impact on labour market participation, healthcare outcomes and social equality. 

Through this approach, the Presidency aims to anchor health policy more firmly as an integral component of a future-oriented European economic and social agenda. 

A Social Europe as a competitive advantage

Overall, Ireland links its EPSCO priorities to the idea that European values – including equality, the rule of law, solidarity and non-discrimination – are not only guiding societal principles but also a source of economic competitiveness. The Presidency therefore sees social investment, high-quality employment and resilient health systems as essential conditions for strengthening Europe’s attractiveness as a place to live and work in the long term.

Biotech Act Draft Report

SPC extension retained – further strengthening of the industrial policy approach.

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On 15 June, rapporteurs Vytenis Andriukaitis (S&D, SANT) and Wouter Beke (EPP, ITRE) presented their joint draft report on the European Biotech Act. In the explanatory statement, the rapporteurs argue that Europe is losing ground to the United States and China in global competition and must do more to translate its scientific excellence into innovation, manufacturing and economic value creation. In their view, the Biotech Act should therefore go beyond a narrowly defined sectoral instrument and establish a "European biotechnology ecosystem" that combines competitiveness, strategic autonomy and tangible benefits for patients.

Overall, the draft report closely follows the Commission proposal presented in December but introduces additional industrial policy instruments, regulatory incentives and further measures to accelerate regulatory procedures.

Expansion of strategic projects and new industrial policy instruments

A central element of the draft report is the further development of the strategic projects already proposed by the European Commission. These projects are intended to support particularly important biotechnology medicines and technologies that are considered strategically relevant for innovation, manufacturing and security of supply. They would benefit from accelerated authorisation procedures as well as facilitated access to public support and financing.

The rapporteurs propose additional categories for projects of particular strategic importance and the creation of "EU Biotech Flagship Zones" to promote European biotechnology hubs across the entire value chain. They also introduce an "Advanced Biomanufacturing Technology (ABT) Designation" as a new regulatory incentive for innovative manufacturing technologies. At the same time, authorisation procedures for projects of exceptional strategic importance would be further accelerated: for so-called "High-Impact Projects", the maximum authorisation period would be reduced to four months instead of the ten months proposed by the Commission.

Further acceleration of clinical trials

While the European Commission had already proposed shorter timelines for clinical trials, the rapporteurs go a step further by proposing additional deadline reductions and new dedicated procedures for multinational clinical trials. They propose amending the Clinical Trials Regulation (Regulation (EU) No 536/2014) by introducing a specific procedure for multinational clinical trials. The aim is to further centralise and harmonise procedures while reducing approval timelines. In addition, dedicated fast-track procedures are proposed for rare diseases, rare cancers, advanced therapy medicinal products (ATMPs), critical medicines and cross-border health threats. The rapporteurs also call for closer integration of the European Reference Networks (ERNs), registries, biobanks and research infrastructures.

SPC extension remains unchanged

The rapporteurs do not propose any changes to the European Commission's proposal for a one-off twelve-month extension of the Supplementary Protection Certificate (SPC). As a result, one of the most controversial elements of the Biotech Act remains unchanged in the draft report. While the opinion-giving ENVI and JURI Committees recommended deleting the provision entirely, the lead committees SANT and ITRE maintain the principle of granting additional exclusivity rights.

In its statement, the German Social Insurance European Representation (DSV) strongly opposes the proposed SPC extension. According to DSV calculations, the measure could generate additional annual costs of around €585 million for Germany's statutory health insurance system and approximately €1.7 billion per year across the European Union. During the EPSCO Council meeting on 16 June, Poland, Estonia and Malta likewise warned of negative effects on competition, delayed biosimilar market entry, higher healthcare expenditure and reduced affordability of medicines.

A stronger industrial and innovation policy approach

Overall, the rapporteurs pursue a clearly industry- and innovation-oriented approach. In addition to maintaining the SPC extension, they propose new support instruments, privileged project categories and further accelerated procedures. At the same time, they seek to strengthen links between European research, data and healthcare infrastructures, particularly in the field of rare diseases. The draft report therefore reinforces the broader trend of increasingly linking health policy objectives with industrial and competitiveness objectives.

Outlook

Amendments to the draft report may be tabled in the lead ITRE and SANT Committees until 7 July. The committee vote is currently scheduled for 1 December. The opinions already adopted by the associated committees will also feed into the negotiations. The European Parliament is expected to adopt its position in plenary in early 2027. The Council likewise aims to reach its General Approach around the same time.

Cloud and AI Development Act

Commission proposes regulation to strengthen European cloud and AI infrastructures.

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On 3 June, the European Commission presented its proposal for a Cloud and AI Development Act (CADA). The Regulation forms part of a broader package aimed at strengthening Europe’s technological sovereignty, which also includes the Chips Act 2.0 and the EU Open Source Strategy. Its objective is to enhance Europe’s competitiveness in cloud computing and artificial intelligence (AI), expand European computing and cloud capacities, and reduce dependencies on non-European providers.

Framework for cloud and AI

The proposed Regulation seeks to accelerate the deployment of European cloud and AI capacities, promote the uptake of these technologies and strengthen Europe’s technological sovereignty. Among other measures, it envisages so-called Cloud and AI Leadership Initiatives to support the research, development and deployment of European cloud and AI technologies. At the same time, it aims to facilitate the expansion of sustainable data centres and establish a common European framework for assessing sovereign cloud services. This Union Cloud Computing Sovereignty Framework would introduce different sovereignty levels against which cloud services could be assessed and recognised.

Public sector in focus

Alongside businesses, the public sector plays a central role in the proposal. Through the envisaged Cloud and AI Leadership Initiatives, the development and deployment of AI models and AI systems in the public sector are to be promoted. According to the proposal, these systems should help simplify administrative procedures, support decision-making and reduce administrative burdens. Critical public sectors such as healthcare are explicitly highlighted. In addition, the quality of public-sector data is to be improved, while the sharing and reuse of training data and AI models across the EU public sector are to be encouraged.

Sovereignty in public procurement

Another key element concerns the public procurement of cloud services. According to the Commission, significant dependencies on non-European cloud providers persist and cannot be adequately addressed under the existing public procurement framework. Public authorities would therefore be required to assess the level of sovereignty needed for specific public activities. Based on that assessment, cloud services should in principle only be procured if they meet at least the lowest European sovereignty level. In addition, procurement procedures should increasingly take into account considerations such as digital sovereignty, resilience and dependencies on third countries.

EuroCloud Federation and open source

The proposal also provides for the establishment of a European Public-Sector Cloud Federation (EuroCloud Federation). Its purpose is to connect national and European cloud initiatives and facilitate the shared use of highly trusted and secure cloud capacities across the public sector. In parallel, Union institutions and public authorities would be encouraged to promote the use of open-source solutions and make software developed by or for public authorities more easily reusable.

Relevance for social security

For social security institutions, the initiative is particularly relevant in view of the processing of sensitive data. Social security institutions handle large volumes of personal and other highly sensitive data and increasingly rely on robust digital infrastructures. At the same time, requirements relating to cybersecurity and resilience continue to grow. The proposed Regulation could therefore influence which cloud services public authorities may use in the future, what requirements will apply regarding their digital sovereignty, and how public institutions manage sensitive data in cloud-based environments.

Extreme weather conditions

Does Europe need clearer rules on heat at work?

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As workers across many European cities struggled to cope with the first major heatwave of the year at the end of June, experts gathered at several events in Brussels to discuss the impact of climate change on occupational safety and health (OSH). In addition to agriculture, discussions focused on sectors such as construction and fisheries, where workers are also particularly exposed to heat-related risks.

A dangerous combination of risks

Figures by the International Labour Organization (ILO) show the growing number of workers worldwide affected by heat and extreme weather events. While already alarming, the ILO considers these figures likely to underestimate the true scale of the problem. Workers, particularly those employed outdoors, are no longer exposed to high temperatures only during heatwaves. Increasingly, persistently elevated temperatures outside heatwave periods are also affecting their safety and health at work.

The risks extend well beyond traditional climate-related hazards such as extreme heat and ultraviolet radiation. Workers are also increasingly exposed to a broader range of hazards, including agricultural chemicals, vector-borne diseases and air pollution.

Gaps in occupational safety and health legislation

Although the EU Framework Directive on Occupational Safety and Health already indirectly requires employers to take heat-related risks in the workplace into account, workers' representatives argue that these provisions are insufficient. The sector-specific directives for construction and fisheries also fall short, as they contain no explicit references to heat or extreme weather conditions.

Technical guidance remains voluntary, whereas binding legal requirements create the necessary incentives for employers to implement measures to protect workers from heat-related risks. This is also confirmed by recent findings from the European Survey of Enterprises on New and Emerging Risks (ESENER), which show that legal requirements remain the strongest driver of preventive action within companies. In principle, the Framework Directive would provide a legal basis for introducing a dedicated directive on occupational heat stress. Such legislation could follow the model of existing technical OSH directives, for example, those on the protection of workers from noise.

Future initiatives

Finnish Member of the European Parliament Maria Ohisalo (Greens/EFA) is expected to begin drafting an own-initiative report for the Committee on Employment and Social Affairs (EMPL) during the summer. While emphasising the importance of guidance and additional support measures, she also advocates binding legislative rules to protect workers from heat exposure. At the end of June, the European Commission likewise announced that it intends to give greater consideration to climate change-related challenges in the preparation of the forthcoming Quality Jobs Act and the revision of the Workplace Directive.

Urban Wastewater Treatment Directive

Parliament calls for a "Stop-the-Clock" on Extended Producer Responsibility.

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The implementation of the Urban Wastewater Treatment Directive (UWWTD) remains politically dynamic. The revised Directive sits at the intersection of environmental, industrial and health policy, raising increasingly important questions about how environmental objectives can be reconciled with security of supply and industrial competitiveness. At its core lies the question of who should bear the costs of enhanced wastewater treatment in the future and what implications this may have for medicine prices, the supply of generic medicines and, potentially, statutory health insurance systems.

Background: The Polluter Pays Principle and the Fourth Treatment Stage

The original Directive, adopted in 1991, was comprehensively revised between 2022 and 2024 to improve the protection of water bodies from micropollutants. Since entering into force on 1 January 2025, it provides for the gradual introduction of a quaternary treatment stage at larger municipal wastewater treatment plants to remove pharmaceutical residues, hormones, antibiotics and microplastics. Implementation will take place progressively until around 2045.

For the first time, the Directive introduces Extended Producer Responsibility (EPR). Pharmaceutical and cosmetics companies will be required to finance at least 80 per cent of the costs of removing product-related micropollutants. This is based on the European polluter pays principle. According to the European Commission, pharmaceutical and cosmetic products account for around 92 per cent of the relevant micropollutants found in urban wastewater. The industry's financial contribution is scheduled to apply by the end of 2028.

Parliament Increases Political Pressure

On 18 June, the European Parliament adopted a resolution in Strasbourg on the implementation of the Urban Wastewater Treatment Directive, calling for a temporary suspension ("Stop-the-Clock") of the implementation of the Extended Producer Responsibility provisions. The proposal is driven by concerns that requiring the pharmaceutical and cosmetics industries to finance the fourth treatment stage could affect the availability and affordability of medicines. The resolution was adopted by a narrow margin, with 294 votes in favour, 245 against and 28 abstentions. Amendments tabled by the EPP and ECR groups strengthened the text compared with the original draft. Parliament now calls on the European Commission to present a new independent study on the costs of removing micropollutants and on the allocation of producer responsibility. Until this assessment has been completed, Parliament proposes suspending the industry's payment obligations.

The resolution is not legally binding. However, the Commissioner for Environment responsible for the Directive, Jessika Roswall, announced that the Commission would continue to work closely with Parliament, the Member States and stakeholders to ensure the smooth implementation of the Directive.

The Debate Reaches Health Ministers

The Directive was also discussed by the Employment, Social Policy, Health and Consumer Affairs Council (EPSCO) on 16 June at Germany's initiative. German Federal Minister of Health Nina Warken argued that the European Commission's supplementary study did not sufficiently assess the potential impact on the supply of medicines and on healthcare systems. Several Member States voiced similar concerns, particularly regarding possible consequences for generic medicines and critical medicines. Greece and Bulgaria explicitly called for a postponement of implementation. Commissioner for Health and Animal Welfare Olivér Várhelyi acknowledged these concerns but reaffirmed the objectives of the Directive, while encouraging Member States to closely monitor any potential effects on the supply of medicines.

Directive in Force – Impacts Should Be Closely Monitored

In its assessment of the implementation of the Urban Wastewater Treatment Directive, the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) emphasised the need to consider environmental protection and public health together, to uphold the polluter pays principle, and to closely monitor any potential effects on the supply of medicines. As the Directive has already entered into force, there are strong arguments for a measured approach. Planning certainty for municipalities, wastewater operators and industry is just as important as carefully monitoring any effects on the availability and affordability of medicines. Based on the evidence currently available, a suspension of the Directive does not appear to be justified. Instead, the review and adjustment mechanisms already provided for in the legislation should be used.

EU Tobacco Regulation

European Commission announces revision of tobacco product and advertising rules.

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The planned revision of the EU rules on tobacco products and tobacco advertising marks the beginning of the next major reform of European tobacco policy. In the fourth quarter of 2026, the European Commission intends to present proposals to revise both the Tobacco Products Directive (2014/40/EU) and the Tobacco Advertising Directive (2003/33/EC). This will be the first comprehensive reform of the EU regulatory framework for tobacco and nicotine products in more than a decade.

Stalled negotiations on tobacco taxation

At the same time, negotiations on the revision of the Tobacco Excise Directive (2011/64/EU) are continuing. The Directive establishes harmonised minimum excise duty rates for manufactured tobacco products while allowing Member States to apply higher national excise taxes. With its proposal presented in July 2025, the Commission sought to bring new tobacco and nicotine products within the scope of the excise framework and close existing regulatory gaps.

However, under the Cypriot Council Presidency, Member States failed to reach an agreement, meaning negotiations will now continue under the Irish Presidency. Deliberations in the European Parliament also proved controversial. On 17 June, Parliament rejected the proposal to recast the Directive on the structure and rates of excise duty applied to tobacco and tobacco-related products and called on the Commission to withdraw it. Socialists, Liberals, Greens and the Left welcomed the rejection and called for a more ambitious reform. By contrast, Patriots for Europe (PfE), the European Conservatives and Reformists (ECR), and parts of the European People's Party (EPP) had advocated a much more cautious approach. Although Parliament has only a consultative role in the field of tobacco taxation, the vote sends an important political signal for the ongoing negotiations in the Council.

A new reform round for tobacco and nicotine products

While progress on tobacco taxation has stalled, the Commission is already preparing the revision of the EU's product and advertising legislation. According to the Commission, the emergence of new products and diverging national regulations have increasingly fragmented the internal market. In recent years, several Member States have introduced their own rules on issues such as flavours in e-cigarettes, disposable e-cigarettes, heated tobacco products, nicotine pouches and plain packaging. At the same time, novel nicotine products have gained market significance despite being only partially covered by the existing EU framework. The Commission is also placing particular emphasis on marketing through social media and influencers, which is especially effective in reaching young people.

Stricter rules for new products and advertising

The Commission's initiative pursues a dual objective. On the one hand, it aims to harmonise divergent national rules and thereby improve the functioning of the internal market. On the other, it seeks to update the public health framework in light of changing patterns of nicotine consumption and contribute to the implementation of Europe's Beating Cancer Plan. Current indications suggest that the Commission will pursue an ambitious approach. Expected measures include stricter rules on flavours, packaging and labelling, the inclusion of novel products such as nicotine pouches, and significantly tighter regulation of advertising and marketing in digital media.

DSV supports ambitious European rules

In its feedback to the Commission's public consultation, the German Social Insurance (DSV) welcomes the planned revision of the EU tobacco legislation. From the DSV's perspective, harmonised and ambitious European rules offer an important opportunity to prevent young people in particular from taking up nicotine use and to close existing regulatory gaps. The DSV therefore supports, among other measures, a ban on flavoured tobacco and nicotine products. It also calls for a comprehensive EU-wide ban on advertising and promotion, including on social media and at the point of sale, as well as the introduction of standardised plain packaging for all tobacco and nicotine products.

Outlook

The experience with the Tobacco Excise Directive demonstrates that EU tobacco legislation remains politically sensitive. It therefore remains to be seen when and in what form the Commission will ultimately table its proposals, and how political majorities in the Council and the European Parliament will evolve thereafter. What is already clear, however, is that the regulation of tobacco and nicotine products will remain a key issue on the European public health agenda in the years ahead.

Coordination of Social Security

After one reform comes the next.

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On 29 April, the trilogue negotiations on the revision of Regulations (EC) No 883/2004 and No 987/2009 on the coordination of social security systems were successfully concluded (see DSV News 04/2026). The German Social Insurance (DSV) expressly welcomes the compromise as an important step towards modernising the coordination framework. The agreement will also allow provisions of particular importance for social security institutions to enter into force, including the coordination of long-term care benefits. Formal adoption by the European Parliament and the Council will follow the legal-linguistic revision.

However, the revision of the coordination regulations does not mark the end of the further development of EU coordination law. Preparations are currently underway for the digitalisation of social security, in particular the introduction of the European Social Security Pass (ESSPASS). German social security institutions are actively contributing to this work. The European Commission intends to present a legislative proposal as part of the Fair Labour Mobility Package in the third quarter of this year. At the same time, discussions on the technical implementation are already progressing.

Further legislative action is needed beyond digitalisation

While digitalisation is an important priority, there remains scope to further improve the coordination regulations themselves. The DSV has therefore examined at an early stage how the coordination framework could be further developed beyond the recently agreed revision in a practical and future-oriented manner. Its proposals focus on two key areas: the rules on applicable legislation and the system for inter-state reimbursement of costs.

The applicable legislation should reflect economic reality

One objective of the DSV proposals is to ensure that the rules better reflect today's cross-border patterns of employment and self-employment. For example, the legislation of the Member State in which a person pursuing activities in two or more Member States carries out the main part of their economic activity should, as a general rule, apply. Under the current rules, priority is generally given to employed activity, irrespective of its actual scale. This approach no longer reflects today's labour market realities. Moreover, it creates opportunities for economically self-employed persons who also pursue only marginal employed activity in another Member State to influence the determination of the applicable legislation in ways that are not justified by the actual substance of their economic activity.

Reimbursement procedures should become more efficient

The DSV also proposes streamlining the system for inter-state reimbursement by introducing shorter deadlines and harmonised procedural standards. In the DSV's view, this is now entirely feasible. Communication between social security institutions is today largely carried out electronically through the Electronic Exchange of Social Security Information (EESSI), making exchanges significantly faster. In addition, reimbursement procedures are based on standardised Business Use Cases, which already address many issues automatically that previously required lengthy bilateral clarification. These developments justify shorter deadlines both for payments and for contesting reimbursement claims.

An end to reimbursement on the basis of lump-sum amounts

A particular priority for the DSV is the abolition of reimbursement on the basis of lump-sum amounts. Such arrangements do not necessarily reflect the actual costs incurred by health insurance institutions when providing benefits in kind on behalf of insured persons from other EU Member States. The abolition of flat-rate reimbursement was already discussed during the negotiations on Regulation (EC) No 883/2004 but ultimately failed due to opposition from the Member States applying such arrangements, notably Spain and Portugal. A future revision of the coordination rules should revisit this objective. In the DSV's view, an appropriate transitional period would allow the Member States that still rely on flat-rate reimbursement to move towards reimbursement based on the actual costs incurred.

European Semester Spring Package

The European Commission issues country-specific recommendations.

On 3 June 2026, the European Commission adopted the European Semester 2026 Spring Package. The policy guidance addressed to the Member States places a strong emphasis on enhancing the European Union’s competitiveness and strategic autonomy. In addition, it promotes economic and social resilience as well as European cohesion. Furthermore, the recommendations take due account of the need to ensure the long-term sustainability of public finances and the adequacy of social protection systems, while addressing the challenges arising from the current geopolitical environment.

Country-Specific Recommendations for Germany

A key focus of this year’s Country-Specific Recommendations for Germany is social investment. For the first time, policy guidance formulated at EU level on strengthening human capital has been translated into concrete country-specific recommendations for the Member States. In this context, the Commission places particular emphasis on investments in skills development and quality jobs. For Germany, the recommendations focus primarily on addressing labour shortages in the long-term care sector and on measures to increase the working hours of care workers. In addition, the Commission recommends improving the cost-effectiveness of long-term care services and enhancing the availability and quality of early childhood education and care, as well as all-day schooling.

As in the previous year, the Commission also criticises the high level of federal budget transfers to the statutory pension insurance scheme. It recommends limiting tax-financed transfers to the pension system and strengthening its long-term fiscal sustainability. As potential policy levers, it points to longer working lives as well as a broader uptake of occupational and private pension provision.

Within the framework of the Savings and Investments Union, additional funds from funded occupational and private pension schemes are expected to be made available to new and innovative companies in their start-up and growth phases. Further recommendations addressed to Germany include the time-bound design of measures to mitigate the impact of rising energy prices, the modernisation and digitalisation of public administration, and the reduction of dependence on fossil fuels.

Outlook on the Multiannual Financial Framework (MFF)

The European Commission, the European Parliament and the Council of the European Union are currently negotiating the next Multiannual Financial Framework (MFF) for the period 2028 to 2034. In the future, European funding is expected to be used in a more performance- and reform-oriented manner. This could mean that the reform proposals communicated now or in the future may become conditions for the disbursement of funds, for example under the European Social Fund.

Next steps

The Country-Specific Recommendations are now submitted to the Council of the European Union for adoption, with a decision expected by July. Subsequently, they are to be taken into account in the design of budgetary, economic, employment and social policies. Progress towards the objectives will be reviewed in the next European Semester cycle in 2027. It is already foreseeable, however, that long-term reform initiatives, for example in pension or long-term care policy, will not have been fully implemented by then. In order to support the implementation of the recommendations for Germany, the measures proposed by the Pension Commission could be helpful.

Supplementary pension provision as risk capital

The IORP II revision puts the future of pension provision in the spotlight.

On 22 and 23 June, Members of the European Parliament exchanged views on the proposed directive to strengthen the framework for occupational pensions (IORP II revision). Through the proposed revision, the European Commission aims to further develop the European framework for occupational pensions. The proposal forms part of a broader package of measures to strengthen supplementary pension provision, presented by the Commission in November 2025 as part of the Savings and Investments Union. From the Commission's perspective, occupational and personal pensions should in future not only contribute to providing adequate retirement income but also play a stronger role as a source of long-term capital for investment.

Discussions in the European Parliament

The European Commission’s plans have already met with criticism in the European Parliament. The Committee on Economic and Monetary Affairs (ECON) is the lead committee responsible for the IORP II revision; the Committee on Employment and Social Affairs (EMPL) is contributing an opinion. During a debate on the draft reports, MEPs from several political groups warned against encroaching on national competences and disrupting tried-and-tested occupational pension schemes. Representatives from the EPP, S&D, ECR and PfE also expressed concerns about a greater focus on directing pension assets towards industrial or economic policy objectives.

The role of supplementary pension provision

According to the Commission, occupational and personal pensions should in future serve as a key source of risk capital. To encourage wider participation, the Commission proposes, among other measures, automatic enrolment with an opt-out option, pension tracking services and a pension dashboard. It also seeks to remove potential barriers to investment in equities and venture capital. At the same time, the European framework for institutions for occupational retirement provision is to be modernised and strengthened.

Implications for pension provision in Germany

The proposed reforms would particularly affect Germany's collectively organised occupational pension system. The plans envisage greater harmonisation of products and governance structures, as well as rules that have so far been designed primarily with private financial products in mind. This could result in higher costs and additional capital requirements, with potential implications for well-established national pension arrangements.

With regard to the first pillar, the Commission emphasises that supplementary pension provision is intended to complement, rather than replace, the statutory pension scheme. Nevertheless, the greater mobilisation of private savings could reignite the debate on the relationship between statutory, occupational and private pension provision.

What happens next?

Members of the ECON Committee have until 16 July to table amendments to the draft report. On Friday, 26 June, the Permanent Representatives of the Member States to the European Union (Coreper) approved the EU Council’s general approach to the revision of the IORP II revision. This is likely to further heighten the debate on the role of occupational pension schemes within the framework of the Savings and Investments Union.

EU-OSH after 2027

European Parliament launches debate on new strategic framework.

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The European Parliament has launched a debate on the future of European occupational safety and health (OSH) policy. As the current EU Strategic Framework on Health and Safety at Work expires at the end of 2027, Members of the European Parliament, together with experts, assessed the implementation of the existing framework and set the course for its further development. Representatives of employers and workers, research institutions, as well as European and international organisations discussed the challenges of a changing world of work. Particular attention was given to the impact of the digital and green transitions on OSH.

Calls for a more binding framework

At the beginning of the debate, the question was raised as to whether the current strategic framework is sufficiently binding. Several participants suggested giving the future approach a stronger political foundation and further developing the key priorities of the current framework. These include, among other things, the continuous revision of the Directive on carcinogens, mutagens and reprotoxic substances (CMRD), as well as the effective enforcement of existing legislation.

It was also proposed that rules on algorithmic management should not be limited to specific sectors but should apply across all occupations. Workers' representatives identified psychosocial risks, musculoskeletal disorders, and the impact of extreme weather events as key priorities for the new framework. They emphasised that voluntary guidelines and other soft law instruments alone may not be sufficient. Additional issues raised by the European Trade Union Confederation included a stronger gender-sensitive approach and more effective enforcement of OSH legislation through labour inspections.

Focusing on regulation and competitiveness

At the same time, the employers' representative pointed out that Europe's political and economic priorities have changed. Future OSH requirements must therefore also be aligned with industrial policy initiatives, such as the Industrial Accelerator Act and the Critical Raw Materials Act, as well as with increasing defence investments. Against this background, BusinessEurope advocated for more efficient and practical regulatory approaches. Not every regulatory detail, it argued, needs to be determined at the European level.

In addition, several participants called for a stronger scientific basis for OSH policy and closer cooperation between occupational health research and public health research. Initial proposals from the Advisory Committee on Safety and Health at Work (see DSV News 01/2026) indicate that the existing European OSH framework is robust and adaptable. It was therefore questioned whether additional regulatory measures are necessarily required.

Continuity in the key trends

Regardless of differing views on regulatory measures, there was broad agreement on the developments that will shape the future world of work. The key trends of recent years are expected to continue influencing OSH. Digitalisation, demographic change, and the green transition remain the main drivers shaping the workplace. Psychosocial risks and musculoskeletal disorders are regarded as particularly significant, with various studies, including those by the European Agency for Safety and Health at Work (EU-OSHA), identifying them as having the greatest impact. In particular, there is now a substantial body of scientific evidence on psychosocial risks from which a need for action can be derived. Occupational diseases were also identified as an area that will become increasingly important for future OSH policy.

Parallel developments

Although the official stakeholder consultation has not yet begun, initial position papers are already being published to influence ongoing political initiatives, such as the planned Quality Jobs Act. In mid-June, employer and business organisations issued a joint statement on psychosocial risks in the workplace, opposing their regulation through a standalone directive. At the same time, the Committee on Employment and Social Affairs (EMPL) is preparing an own-initiative report on the impact of extreme temperatures on the world of work.

Developments in OSH can also be observed at the national level. In the German Bundesrat, a motion for a resolution on reducing bureaucracy and modernising administration in the field of OSH has once again been introduced. The motion calls on the Federal Government to comprehensively review, modernise, simplify, and reduce unnecessary administrative burdens in national OSH legislation as part of the federal modernisation agenda.