The European Commission (EC) states that the Patient Directive doesn´t meet the objectives.

UM – 03/2022

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

Directive 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 health care.

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.