People in Europe are increasingly finding work across national borders. But the demand for health services is low.

Cross-border work is on the rise in Europe. The basis for cross-border migratory movement for work reasons is provided by the Posting of Workers Directive, the Regulation on the Coordination of Social Security Systems No. 883/2004 and its implementing Regulation No. 987/2009. These regulations ensure that gainful employment within the European Union (EU) and the countries of the European Economic Area does not suffer due to social security issues beyond the border of the country of origin.

‘Applicable legislation’ differentiates between self-employed and non-self-employed persons (Article 12; EU No. 883/2004) and persons working in two or more Member States (Article 13; EU No. 883/2004). The European Commission’s Statistical Report from December 2019 uses the number of A1 certificates that have been issued to confirm social security coverage in the country of origin as an indicator for cross-border employment statistics. 

‘Multiple’ employment is rising disproportionately

Between 2007 and 2018, the number of A1 certificates issued continuously increased. They are distributed among 0.6% of the total labour force (measured in full-time equivalents).  However, the group covered by Article 13 continues to grow much faster than the group of persons covered by Article 12. Nevertheless, the latter represent the larger group in terms of numbers. However, the absolute volume of work performed by persons employed in two or more Member States is more than twice as high, as they work much longer periods abroad than posted workers covered by Article 12.

Country specific differences

The majority of A1 certificates were issued by Poland and Germany. These two countries issued just under 1.1 million certificates in 2018, accounting for about 36% of all certificates. Most A1 certificates from Poland are based on Article 13, whereas Germany issues mainly on the basis of Article 12. In France, the country with the fifth highest number of A1 certificates, the situation is the same as in Germany. In Spain it is almost 50/50.

Low use of healthcare services across borders

The Commission’s report also provides substantive information. The Coordination Regulations not only cover maternity and family benefits, unemployment benefits, invalidity and old-age pension benefits, and benefits in respect of accidents at work and occupational diseases, but also medical and nursing care benefits in the event of illness. Access to these are granted not not only by the Coordination Regulations but also from Patient Directive EU No. 2011/24/EU and thus from the fundamental freedoms. They are not considered in the Commission report. However, the budgetary impact amounts to only 0.4% of total healthcare expenditure related to benefits in kind; this equates to around €4 billion. The greatest demand comes from cross-border commuters and pensioners.