Cross-border healthcare directive has had too little impact according to EU auditors

The 2011 Cross‐border Healthcare Directive seeks to ensure EU patients’ rights to access safe and high‐quality healthcare, including across national borders within the EU. Although EU actions improve collaboration between EU countries, the benefits for patients are limited.

Very few patients ask for reimbursements for treatment abroad under the Directive, as not many of them are aware of their right to seek such care. Relevant information is difficult to access in some areas. Only 200,000 claims are filed per year, whereas 17 million citizens live in other EU countries and about one million and a half are active cross-border workers. It’s not much compared with two million citizens making use of their right to claim reimbursement under the European Health Insurance Card, the system which preceded the Directive and now complements it.

However, the issue is more than a lack of information. The intrinsic elements of the Directive seem to be a burden as well. Auditors found in their surveys that the requirement to pay upfront for the medical treatments abroad is a challenge for patients. The differences in treatment costs in respective countries are also an obstacle.

The Commission’s strategic planning and project management also showed weaknesses. The auditors concluded that the Commission didn’t assess properly how cost-effective the EU-wide eHealth infrastructure will turn out to be. Overall, the Commission spent about € 50 million to set the project in motion.

That Commission expected that in 2018 a total of 12 member states would start exchanging patient data on a regular basis, something that had to evolve into an accepted practice of the national healthcare systems by 2019. In reality, the only exchanges of patients’ health data are between two northern member states. According to the report, six years after the Healthcare Directive entered into force, there is only one flow of e-prescriptions in the whole EU, from Finland to Estonia. When it comes to e-patient summaries, only two member states can receive electronic patient summaries at the moment, Luxemburg and the Czech Republic. Even so, there is little to no use of the system, as no country has developed their sending system yet.

In reply to the report, the EU executives argued that they can’t do anything to push member states to participate since the cooperation on this matter is voluntary. Healthcare is a national competence, meaning that it is up to each member state to decide how to manage and organise their health systems and this might be the biggest burden.

Moreover, health data exchanges depend on technical readiness of each country and, at the moment, only 10 member states reported in 2017 to have e-prescription services in place. A member state should first have a national e-health system, in order to be able to join the EU-level portal, the report highlighted.

Auditors recommended in their report that the Commission assess the results achieved so far with the cross-border exchanges of health data. The Commission was also urged to support the National Contact Points and communicate better to patients the rights they have under different instruments. The Commission accepted the recommendations in an official reply.

The auditors will present their report to the European Parliament and the Council of the EU, and will reach out to national parliaments as well.

Read the full report

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