Flashing lights for the free movement of patients in Europe

Although Directive 2011/24/EU does not comprehend radical changes, it reinforces the patients legal rights in cross-border healthcare. The Directive supplements the rights that patients already had at EU level through Regulation 883/2004 and the constant case law of the ECJ, while preserving their right to organise their own healthcare system. There are however good reasons to temper the first enthusiasm. Firstly, the fact that the member states are losing control over their social security system under EU-law can lead to adverse effects. Due to the financial crisis member states can be inclined to adopt stricter provisions in the terms of the entitlements of all patients under each system, not at least to avoid the reimbursement of costs of more innovative and expensive treatment abroad. Furthermore, the absence in most member states of a set of transparent tariffs of reimbursement that reflect real costs of procedures and the reluctance to elaborate European DRGs potentially give rise to discrimination and complaints about illegal state aid to the benefit of domestic hospitals. A second flashing light relates to the gap between patients legal entitlements and their factual situation. Practical considerations, budget constraints and insufficient or unclear information may still pose significant obstacles for seeking healthcare abroad. Thirdly, the assumption that an equal standard of health care exists across the EU is a false one. Quality and safety of health care differ from one member state to another. The directive touches upon these issues, but does not contain clear and unequivocal obligations to adopt common quality and safety rules. However, non-binding methods of governance could lead to convergence and even harmonisation in the long term.status: publishe