Presentation John Rowan on Cross-border healthcare

Cross-border healthcare
Directive: latest news
John Rowan
First Secretary (Health and Pharmaceuticals),
Permanent Representation of the United
Kingdom to the European Union
Why do we have a Directive?
ECJ cases from 1998 onwards
established certain rights for patients;
confusion over interaction of these
rights and existing legal instruments for:
referral of patients abroad; tourists;
pensioners etc.;
exclusion of healthcare from the
Services Directive.
The ECJ has established the following
patients have a right to receive healthcare
abroad they would be entitled to at home;
they should be reimbursed the cost – but only
up to the cost of that treatment in their home
Member States may limit this right in order to
manage impact of patient outflow on their
but: large number of unanswered questions.
Commission’s original proposal: 3
Common principles in EU health care
systems (attempt to have minimal
requirements of quality and safety);
Rules for accessing cross-border healthcare
(reimbursement, prior authorisation and so
EU co-operation on healthcare (eHealth;
European Reference Networks; Health
Technology Assessments).
European Parliament’s first reading
essentially supported the Commission on quality and
some useful clarifications on the reimbursement rules
(e.g. gatekeeping); but some very unhelpful additions
(e.g. rare diseases; disabilities);
introduction of ‘direct payments’ concept;
duty on regulators to pro-actively exchange
information on professionals;
greater stakeholder engagement in areas of cooperation.
Council’s first reading text
did not agree with Cion / EP on quality and safety
– although agreed to transparency about
much more restrictive text on patient’s rights –
greater use of prior authorisation; more reasons
to refuse authorisation;
importantly: ability to refuse because of quality
and safety concerns;
some important points added e.g. patient inflow;
clarity that co-operation does not equal
harmonisation; limited role for secondary
So what happens now?
now in second reading phase –
vote in the ENVI Committee next
 final plenary vote in January;
 three months to reconcile EP and
Council position…
 …or we’re in conciliation.
 EP
Main outstanding issues
and safety – reasons for
 rare diseases;
 direct payments;
 prior authorisation;
 eHealth.
 quality
If we ever get there: what will happen?
Impact on numbers of patients travelling:
large, small, or negligible?
mechanisms for determining healthcare
entitlements will need to become more
transparent [NB Elchinov];
problems of planning capacity? greater
impact on poorer MS?
greater impact (probably) for certain
treatments and certain geographic regions;
greater competition and choice (including
from private providers in other MS)
Implications for supervising
depends on the text on quality and safety…
…but my guess is that there will be a
requirement for each MS to publish a list of
those organisations it considers to meet
quality and safety standards…
…and for providers outside any accreditation
schemes to be given opportunity to show they
meet those standards.
More information:
UK Permanent Representation to the EU
Avenue d’Auderghem 10, B-1040 Brussels
Tel: 0032 2 287 8270
Fax: 0032 2 287 8397