Bakgrunn (fra Kommisjonens meddelelse, engelsk utgave)

The vast majority of EU patients receive healthcare in their own country and prefer to do so. But in certain circumstances patients may seek for some forms of healthcare to be provided abroad. Examples include highly specialised care, or in frontier areas where the nearest appropriate facility is on the other side of the border. In recent years, citizens have brought a series of cases to the European Court of Justice seeking to assert rights to reimbursement for healthcare provided in other Member States. In its judgements on these cases since 1998, the Court has consistently ruled that patients have the right to have reimbursement for healthcare received abroad that they would have received at home. It is necessary to clarify how the principles established on these specific cases should be applied in general. Community rules about how quality and safety of cross-border healthcare should be ensured more generally are therefore necessary. For this purpose, the Commission is planning to propose in 2008 a Communication and a Council Recommendation on Patient Safety and Quality of Health Services as well as a Council recommendation on health care associated infections.

Based on this case-law, this initiative aims at ensuring a clear and transparent framework for the provision of cross-border healthcare within the EU, for those occasions where the care patients seek is provided in another Member State than in their home country. When this happens, there should be no unjustified obstacles. The care should be safe and of good quality. The procedures for reimbursement of costs should be clear and transparent. While respecting principles of universality, access to quality care, equity and solidarity, the objectives of this framework will therefore be to:

– provide sufficient clarity about rights to be reimbursed for healthcare provided in other Member States;
– and ensure that the necessary requirements for high-quality, safe and efficient healthcare are ensured for cross-border care.

Member States are responsible for the organisation and delivery of health services and medical care. They are in particular responsible for determining which rules will apply to the reimbursement of patients and to the provision of health care. This proposal changes nothing in this respect. It is important to underline that this initiative does not alter the Member States' choice of the rules which will be applicable to a specific case. Instead, this framework is designed to facilitate European cooperation on healthcare, such as for European networks of centres of reference; sharing assessments of new health technologies; or using information and communication technology to provide more efficient healthcare ("e-health"). By doing so, this will provide additional support to the Member States in achieving their overall objectives of universal access to high-quality healthcare on the basis of equity and solidarity, which will benefit all patients, whether they move countries or not.

These issues have been discussed on several occasions between the Commission and the responsible authorities of all Member States, representatives of the European Parliament as well as the health care community and the other stakeholders. Prior to bringing forward these proposals, the Commission also held a public consultation regarding Community action on health services, the results of which have provided a solid basis for developing and shaping this proposed framework1 Both the Ministers in the Council and the European Parliament have also requested action on health services and their specific character has been confirmed by the exclusion of these services from the general services directive.

This proposal is based on Article 95 of the EC Treaty on the establishment and functioning of the internal market. It is also consistent with the provisions of Article 152 of the EC Treaty on public health and respects the responsibilities of the Member States for the organisation and delivery of health services and medical care as interpreted by the Court of Justice. The provisions of the Reform Treaty will not affect the legal basis.