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

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.