Spain revives plans for cross-border healthcare

Spain engineers a compromise text, but proposal falls far short of Commission hopes.

The European Union’s health ministers will next week breathe new life into a draft law aimed at making it easier for patients to get treatment wherever they are in the EU. 

Just six months ago, the proposal on cross-border healthcare seemed to have reached an impasse. Spain was among a group of countries that included Greece, Lithuania, Poland, Portugal and Romania opposing the proposal, and the European Commission was considering withdrawing it altogether.

But in a move that has surprised some officials, Spain, which now holds the rotating presidency of the Council of Ministers, has engineered a compromise text. Officials are optimistic that ministers will reach an agreement in principle when they meet in Luxembourg next week. “I cannot see anything that could jeopardise a political agreement on 8 June,” said one official.

The cross-border healthcare proposal aims to clarify patients’ rights to treatment in other EU countries and has been billed as a way to avoid costly legal cases, after a decade of rulings from the European Court of Justice.

The Commission published its proposal in mid-2008, but was under attack even before that from some national governments and trade unions, which argued that the proposal would undermine national control over healthcare and create inequalities between travelling and non-travelling patients.

Pensioner payments

Spain feared being saddled with the costs of healthcare for many northern Europeans living in retirement on the Spanish coasts. The text to be endorsed by health ministers next week contains a compromise about which country bears the healthcare costs of pensioners resident in another member state. Whereas usually the country of residence would pay, under the compromise if a German pensioner living in Spain returned to Germany for healthcare, Germany would be responsible for paying the final bill.

The picture is further complicated by an agreement between nine EU countries – Austria, Belgium, France, Germany, Greece, Italy, Luxembourg, Spain and Sweden – to give their pensioners more rights to healthcare from their home country under a 2004 regulation on social security.

Commission officials consider that the exemption from the principle that the host country pays risks making the law more confusing for patients, but is better than nothing. “It is the sign of a true compromise to a very difficult political question,” an official said.

The Commission also thinks that the Spanish proposal does not give enough clarity for patients, but is prepared to go along with it to get the legislation draft moving again.

An agreement by the ministers would clear the way for the Commission, the Council and the European Parliament to begin negotiations on a final version of the law in the autumn.

The text that ministers are set to agree falls far short of what the Commission wanted. One “painful point” for the Commission is that patients will be required to seek ‘prior authorisation’ from healthcare authorities if their treatment involves a hospital stay of more than one night, or “highly specialised” equipment – a term left undefined – or raises safety or quality concerns. When the three-way negotiations get under way, the Commission could side with the Parliament’s position on these points, where patients would face fewer restrictions.

The Commission is also unhappy with the compromise on electronic-health data, an area where it would have liked more EU co-ordination. But some countries think they have made a big concession just by allowing the Commission to draft guidelines on the patient data that can be shared across borders.

Only small numbers of patients seek treatment in another EU country, mostly those with rare conditions or living in border regions. EU countries spend on average 1% of their health budget paying for healthcare treatment in another member state.

According to a Commission estimate made in 2008, around 780,000 patients are expected to travel to another EU country for treatment.

Nicola Bedlington, director of the European Patients’ Forum (EPF), said more needed to be done to make the directive work for patients. The EPF wanted a system of up-front payments to ensure that patients were not out of pocket when they travel abroad for treatment.

She feared that the need to obtain prior authorisation could deter patients from going abroad.

“That lack of flexibility calls into question some of the basic reasons why the directive was put into place in the first place,” Bedlington said.

Patients’ groups “will fight hard for this directive, but not at all costs”, she said.