The proposal for a Directive on patients’ rights regarding cross-border healthcare was released on 2 July 2008. With the proposal, the Commission will try to create legal certainty on this issue and possibly avoid new court cases because the EU Treaty gives individual patients the right to seek healthcare in other Member States. In its meeting on 2 December 2009, the Council failed to reach an agreement on the Directive.
Building on the work done under the French and Czech presidencies, the Swedish Presidency has tabled four compromise texts on this file. The last one was examined by the Permanent Representatives Committee at their meeting on 25 November. In their note to the Council, the Permanent Representatives Committee pointed out that:"certain issues remain unresolved and the Council is, therefore, invited to examine the major outstanding questions, including the scope of the Directive and the definition of the Member State of affiliation, with a view to reaching a political agreement on a common position." To read the full note please click here
On 1 December, the EPSCO (Employment, Social Policy, Health and Consumer Affairs Council) discussed the file, but failed to reach an agreement.
At the European Parliament level, rapporteur Françoise Grossetęte MEP regretted that the negotiations failed at the Council level. Her statement in French is available here
The new Rapporteur  for the proposed Patients Rights Directive  has been announced. Francoise Grossetete MEP (EPP-France) will take over the dossier from John Bowis who retired from the European Parliament at the end of the previous term. This was publically stated in the Environment, Public Health and Food Saftey committee meeting on 2 September 2009.
Under the leadership of Mr Bowis, the Parliament completed its first reading and the Council of the European Union is currently considering its opinion in the EPSCO (Employment, Social Policy, Health and Consumer Affairs Council), working party on public health. The Swedish Presidency considers this file a priority in the health field and hope to have a compromise text before the end of their term.
The Patients Rights Directive compromise text shows a large swing towards subsidiarity and Member States (MS) were keen to ensure national competency in organising their health systems. MS also wanted to exclude long-term care from the Directive. MS were not satisfied with the fact that most of this Directive will be worked out in comitology and there was debate on the issue of the legal base and many MS called for article 152 (Public Health) to be made the legal base alongside article 95 (Internal Market). Commissioner Vassiliou agreed to examine the issue of long-term care and the legal base. To read the full provisional compromised text please click here
The European Parliament voted on 23 April 2009 to adopt the report on Patients’ Rights by Mr John Bowis. The Directive is now closer to realisation following adoption of the report by 297 votes for, 120 against and 152 abstention. The vote in plenary took in over 80 amendments including several from the GUE/NL, Greens and PES parties aimed at changing the legal base. The vote was fraught with interruptions and ended up with all of the PES abstaining as they where calling for a change of legal base and this was not accepted.
The European Public Health Alliance has broadly supported the proposed Directive since it was first drafted by the European Commission in July 2008. Nevertheless, EPHA has been carefully monitoring the developments, striving to ensure that the Directive answers the needs of all patients. EPHA supports the vision of rapporteur John Bowis MEP for a Directive that addresses patients with needs and not only patients with means.
"The public health community is satisfied that this proposed Directive has made it through a first reading and that the Parliament has shown such a strong lead on it. We hope that the Member States will show a similar commitment to European patients within the Council proceedings," said Monika Kosinska, Secretary General of EPHA. "Mr Bowis’ work has been commendable and EPHA, while harbouring a few reservations, is extremely happy with the efforts of the Parliament."
One of EPHA’s key reservations is the lack of ambition to further facilitate access to cross-border healthcare for under-privileged patients, noticeably better guarantees of reimbursement for healthcare.
To read the full report and an analysis of EPHA amendments please click here
In a vote taking one hour and a half, with over 800 amendments, the European Parliament Committee for Environment, Public Health and Food Safety (ENVI) finally adopted the Rapporteur’s, John Bowis (EPP-ED), Report on the proposed Directive on the application of patients’ rights in cross-border healthcare.
All 25 compromised amendments were carried, as were around 90 amendments. In a surprise turn at the final vote on the amended report the shadow rapporteur, Mrs Dagmar Roth-Behrendt of the PES, called for a five minute recess. After the recess, the Socialist group announced that they would have to abstain from the final vote.
The report was adopted 31 in favour, 3 against and 19 abstentions.
The full report by the Rapporteur, the opinions of all the Committees and an analysis of the adopted EPHA amendments can be found at the members only section
The proposed Directive on the application of patients’ rights in cross-border healthcare is currently in first reading in the European Parliament. The French Presidency has released its progress report and amended text and will it will be further discussed under the Czech Presidency.
The European Commission has no further role to play in the proposed Directive’s progress from now on. The Commission’s only role is to answer questions posed by the European Parliament and European Council. The Commission are particularly unhappy with the Council as they are trying to remove any mention of Quality and Safety standards and, as they see it, restrict free movement by ensuring prior authorisation across the board. The Commission have continued to stand by their original position and support the Directive in its entirety.
The European Parliament Committee on Environment, Public Health and Food Safety (ENVI) is the Committee responsible for the Directive. The Rapporteur, MEP John Bowis EPP-ED, presented his report on 1 December 2008 and amendments from the ENVI Committee have been submitted. The Committee discussed the amendments for the first time on 10 February 2009 with very little change in positions. Several other Committees have given or are to give opinions on the following dates:
FEMM: 11 February: opinion adopted
ITRE: 17 February: opinion adopted
EMPL: 02 March: opinion adopted
ECON: 10 March: opinion adopted
IMCO: 10 March: opinion adopted
The vote in ENVI has been postponed from 12 March until 31 March 2009. Mr Bowis took the decision to delay the vote with the shadow rapporteurs.
The French presidency presented a progress report and amended text from the Council WP at the EPSCO council meeting on 16 December 2008. The amended working document for the WP has removed much of the mention of quality and safety and has said that all patients travelling have to receive prior authorisation. The Czech Presidency will attempt to finish the reading.
EPHA has submitted and had adopted, many amendments in the Bowis report of December 2008, to read the full list of visible amendments please click here
Ahead of the COREPER 1 meeting on 10 December 2008, EPHA sent a letter to the members of COREPER 1 to highlight our main concerns regarding the possible alterations of the Patients Rights’ Directive at the EPSCO meeting on 16 December 2008.
Please find the proposed agenda for the EPSCO meeting here
The meeting of the Health Ministers on 16 December 2008 will be a deciding point in the future of this proposed Directive.
The draft Report by the French Presidency is proposing to remove any mention of increased transparency around quality and safety standards in healthcare.
The transparency about standards will help patients that are travelling to be informed of the quality of the healthcare they will be receiving and is therefore a necessary and important step.
The Council report will also include large changes to the proposed prior authorisation mechanism described by the Commission.
The letter was delivered to raise the concerns of the Patients in Europe and urged the Member States not to take a protectionist approach on such an important issue. EPHA also signed a joint statement in conjunction with EHMA, EFN, CPME, EPF and BEUC. This letter was sent at the same time and aimed to ensure the same principles where pushed forward.
The debate on the proposed Directive has now begun in both the European Parliament and the European Council.
In the Parliament- the Proposal has entered the first reading by the Committee on Environment, Public Health and Food safety (ENVI) with John Bowis MEP (PPE-ED) as Rapporteur. The Shadow Rapporteurs are: PSE - Dagmar Roth-Behrendt MEP; ALDE - Jules Maaten MEP; GUE - Kartika Tamara Liotard; IND/DEM - Kathy Sinnott. There is an ambition amongst the Rapporteurs to have a draft report out before the end of the Year.
In the Council- the Proposal has entered the first reading with the Council of Health Ministers. The views of the council are divided. There will be a progress report on 16 December 2008.
With the opportunity of addressing the large majority of European citizens
- impact on the patient: The proposal clearly states that it will secure the same access, equity and solidarity for all patients in the EU Member States. EPHA is concerned about the real practice of this directive, taking into account the existing differences concerning access to and quality of healthcare, both in and between Member States. With regards to healthcare tourism, it is already a reality for those who can afford it and all this directive will do is save this tiny percentage of the population some money.
- impact on the health professional: At first glance this proposal for a directive appears not to involve health professionals too heavily as it is aimed primarily at citizens and health services. However there are obvious effects on health professionals as any directive on health services would be bound to have. The ’Centres of Excellence’ proposed by the Commission could lead to pocketing of experts across Europe. The proposal for the increased use of so called ’e-health’ could be very useful to health professionals but details of the implementation need to be worked on.
- impact on Health Systems in Member States EPHA fears that with this proposal, the European Commission can not ensure the common values and principles in health systems agreed by member states in 2006. EPHA therefore stresses the need to respect the principles of the universality of health services, access to good quality care, equality and solidarity. EPHA is concerned that more people will now look for treatment in another Member State, especially if their national health service does not provide the same quality treatment, as in a neighbouring EU country. EPHA believes that the European Union should first focus on facilitating the same level of quality care throughout Member States.
- impact on socially excluded citizens’ The Alliance is concerned that this proposal would not support Member States in addressing existing inequalities within countries but even creating a bigger gap between and within the Member States. EU citizens coming from higher income groups would have greater access to healthcare services and could be favoured by this directive and leads to more health tourism for wealthy EU citizens.
To end with a positive note on this proposal citizens living close by EU border Regions and patients with rare diseases could find some more clarity and EPHA hopes that this Directive will, at least, initiate discussions at the highest political level on the access to and quality provided by, health care systems in Europe. Quality standards are left to each country and this could possibly raise discussions about different quality standards.
Could this be the beginning of a European benchmark for health care standards? EPHA believes there are plenty of questions still to be answered...
For further information
Please visit the Commission website, DG Sanco:
Health systems are primarily the responsibility of the Member States, but in some cases, as confirmed by several European Court of Justice (ECJ) rulings, EU citizens can seek healthcare in other member states with the cost being covered by their own health systems.
Health services were excluded from the Directive on services in internal market in Spring 2006, but the many ECJ rulings show that they are to be considered as an economic activity and that Community law applies to them.
The Commission stated that this Directive is necessary to clarify the role of the Member States as a result from the rulings established by the European Court of Justice (Watts Case, May 2006).
It is essential for the Member States to be clear what rules and limits are in order to meet their common objectives of universal access to high-quality healthcare on a financially sustainable basis. But the Commission acknowledges that this Directive aims to fill a ’hole’ made in the Services Directive and therefore the proposed legal basis is under the internal market article (article 95) of the Treaty.
For non-hospital treatments EU citizens can get treated and be reimbursed up to the cost of their national health service. Member States cannot insist that people get prior authorisation before going abroad.
For hospital treatment people need to apply to a national contact point and according to the Directive, patients should have a decision regarding the cross border healthcare within two weeks. For urgent cases, prior authorisation will not be needed.