The EC published a study February 24 about
improving the Cross-Border Healthcare Directive. According to the EC, it
currently falls short of expectations for many patients.
Pioneers were Kohll and Decker
2011/24/EU of March 9, 2011 about patients' rights in
cross-border healthcare was introduced at the time to provide a reliable legal
framework for interests following cross-border medical treatment or the
procurement of healthcare products. This was preceded by legal disputes between
health insurers and their policyholders before the European Court of Justice.
The pioneering judgements were those on Decker (C-120/95)
and Kohll (C-158/96)
given in 1998, which denied the necessity of prior authorisation for procuring
glasses and orthodontic treatment in other EU countries by the respective
health insurance company.
The Patient Directive is now eleven years old
The "Patient Directive"
regulations were included in German law in 2013, so that prior authorisation is
only needed in the event of inpatient hospital treatment. The directive became
eleven years old in March. But there has not been a run on healthcare services
in other EU countries. The EC, which is presently reviewing the current version
of the directive, blames this on hurdles in practically applying the directive.
Criticised: Prior authorisations
Most countries would have adopted a process
that required prior authorisation by the national health care provider or
insurer, which the directive does not mandate. These procedures would vary
widely. There is also a lack of information for patients about how to obtain
prior authorisation. The NCPs (National Contact Points) used here do not always
fulfil their role as intermediaries for interested parties seeking cross-border
Cooperation with National Contact Points
There would also be shortfalls in the
collaboration between the NCPs and patient groups, health care providers and
health insurers. Only a limited number of member states have implemented
consultation arrangements between NCPs and patient associations, health
insurance agencies and health care providers. This does not happen at all in
some countries. The image this presents is as heterogeneous as the systems and
the distribution of competencies within the individual member states.
The study commissioned by the EC was intended to
appraise and analyse the practical implementation of the Patient Directive in
the EU’s 27 member states and the EEA/EFTA countries. Options for improving
traceability and transparency when applying the regulatory framework should
also be formulated and the control indicators for future directive evaluations
should be subjected to a critical review. The “toolbox”, a collection of
comprehensive, specific target group information and working tools (see
here) can also be used as a form of "immediate help". It contains
helpful information, but is not well known by the relevant stakeholders.
The study (Study
on Enhancing implementation of the Cross-Border Healthcare Directive 2011/24/EU
to ensure patient rights in the EU) was conducted on behalf of the EC by
Ecorys Nederland, Technopolis Group and Spark Legal Network.