The EU directive on cross border healthcare took many years to negotiate and has many complex and detailed rules and regulations. However, it is possible to summarise the rules for both you and your home country.
Rules for Citizens
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Residency: To be entitled to cross border healthcare, you must be a resident of a country within the European Economic Area (EEA). This includes EU citizens and also those in Norway, Lichenstein and Iceland. If you have lived outside the EEA for more than 3 months and are not registered with a general practitioner, then you may no longer be considered resident.
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Local provision: In order for cross border healthcare to be funded, it must be available in your home state as part of the standard healthcare package available to all citizens. Local commissioners will set out what treatment is covered under each state system.
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Undue delay: Cross border healthcare must be funded if there is undue delay in providing the same treatment locally. The European Court of Justice defined undue delay as a waiting time that "exceeds the period which is acceptable in the light of an objective medical assessment". This means that such judgements should be based on medical assessments, not just on arbitrary time based targets. The S2 route also applies here, and the Directive states that consideration should be given to the Regulations – (EC) 883/2004 initially – unless the patient does not wish to use this route.
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Reimbursement: The cost of cross border healthcare will only be reimbursed up to the cost of the treatment in the home state. States are not obliged to pay for costs in excess of the cost of treatment in the home state and you are not allowed to profit from having cheaper treatment in another state. The costs of travel and accommodation are not generally reimbursed.
Rules for States
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Prior authorization: Member states may introduce prior authorisation for any treatment that involves a hospital stay, expensive specialist equipment or staff, or in cases where there are doubts as to the quality or safety of treatment.
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Refusal of authorization: Authorisation may be refused if the treatment or healthcare provider represents a risk to your health. States may also refuse if appropriate care can be provided at home without undue delay. People with highly contagious or dangerous infections may be refused authorisation, as may those who require secure psychiatric care.
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Protecting home state services: Member states may also limit cross border healthcare approval if this presents a risk to their own healthcare provision. For example, where highly specialised, low volume departments would be threatened by even a small downturn in patient numbers.
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Refusal of treatment: Member states have the right to refuse treatment to a visiting citizen if this would compromise their ability to serve their home citizens. This applies where waiting lists are long or capacity is limited. Cross border healthcare cannot be used to jump the queue of another state and visitors must be treated exactly the same as home citizens.
Exceptions
There are exceptions to these rules, and the Directive on cross border healthcare allows for exceptional circumstances. For example, where specialist treatment for a rare disease is only available in certain countries, then cross border treatment can be funded, even though this treatment is not available in the home state. However this is not an absolute right: decisions are made on a case by case basis, usually by a nationally appointed body.
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