Commission still has room to improve.

TH – 07/2019

According to a special report released by the European Court of Auditors (ECA) in June 2019, patients in the EU have difficulty taking advantage of the measures provided for in the EU Directive on cross-border healthcare. Only a small percentage of patients are aware of their right to receive healthcare abroad. The auditors also identified problems and delays in the electronic exchange of patient data between Member States. In addition, measures to facilitate access to healthcare for rare disease patients need to be improved.

What was it about?

The 2011 Directive aims to ensure safe, high-quality cross-border healthcare in the EU and the right to reimbursement of costs abroad under the same conditions as at home. Patients in the EU who receive healthcare in another Member State, such as planned hospital treatment or the purchase of medicines, are entitled to relevant information on treatment standards, reimbursement rules and the best legal pathway to use.


The audit examined whether the European Commission had monitored the implementation of the EU Directive on cross-border healthcare and assisted Member States in informing patients of their rights. The report also looked at the results of the cross-border exchange of health data and the key EU actions initiated for rare diseases.

Varying results

The ECA noted that the Commission had closely monitored the transposition of the Directive into national law and its transposition by the Member States.  Support for Member States in improving information on patients’ rights to cross-border healthcare was also satisfactory, but there was also some room for improvement.


For example, the Commission underestimated the difficulties in setting up an EU-wide eHealth infrastructure. At the time of the audit (November 2018), Member States were only just about to implement the electronic exchange of patient data; therefore, it was not possible to determine any benefits for cross-border patients. In addition, the Commission has not adequately assessed the potential use or cost-effectiveness of the exchange of cross-border health data.


Furthermore, the European Reference Networks for rare diseases, an ambitious innovation widely supported by doctors, healthcare providers and patients, face major challenges to ensure that they are financially sustainable and able to operate effectively in national health systems. 

What still needs to be done?

The auditors recommend the Commission to do the following:


  • improve support for National Contact Points with providing information on patients’ rights to cross-border healthcare;
  • improve support for the implementation of the cross-border exchange of health data;
  • improve support and management of the European Reference Networks to facilitate access to healthcare for rare disease patients.


The special report is available here.