What does the EU Directive on cross border healthcare mean for you?

The new Directive on cross border healthcare means that exercising your rights should now be simpler and more straightforward. You should have a much clearer idea of what you are entitled to, and what restrictions your own country can put on these rights.

It is important to realize that the new Directive does not give European Union citizens any new rights to cross border healthcare. These rights already existed as part of the Maastricht and Lisbon Treaties.

In essence, you are entitled to obtain healthcare services in any EU state, as long as you are entitled to the same services in your own country, and as long as you are not able to obtain such services within a reasonable amount of time at home.

Example

Mr G developed carpal tunnel syndrome in his right hand, and was put on a waiting list in his local primary care trust. He expected to receive surgical treatment within 18 weeks, but various delays and an administrative error meant that he still did not have a definite date for his surgery 5 months later and his condition had worsened to such an extent that he was now on long-term sick leave.

He found a hospital in the Netherlands willing to do the surgery within 10 days and applied for authorisation to under the Directive route. His treatment was authorized because he had experienced an ‘undue delay’ according to the judgement of his GP.

Under the Directive, if your health service refuses to fund you treatment in another state, or if another state refuses to accept you for treatment, you must be given a full explanation as to why. The circumstances under which such refusals are allowed are clearly set out in the Directive. (See “Rules” later in this document).

Example

Mr S has been on the NHS waiting list for a hip replacement operation for osteoarthritis for 8 months. His condition worsens after he slips at home, dislocating his hip. Emergency treatment restores his joint, but he is in agony afterwards, needing prescribed painkillers. His GP refers him for an urgent appointment with his orthopaedic surgeon, who says Mr S needs a hip replacement within 4 weeks. The local primary care trust cannot organize the surgery within this time, but they are prepared to reimburse his treatment in Hungary, as a hospital there is prepared to conduct the surgery in two weeks’ time.

The estimated cost of the hip replacement is £2,000 less than the cost of the surgery done within the NHS but the primary care trust will only pay the cost of the Hungarian treatment, no more. Mr S is disappointed as he planned to use the difference to pay his travel expenses, but the rules of the Directive are clear on this point and he reluctantly accepts he will have to pay his air fare and hotel bills himself.

What the Directive does not mean

The Directive does not mean that you will automatically receive funding for treatment in another EU state. Your home state retains the right to pre-authorise treatment and you must comply with the rules and regulations in order to make an application. There are set circumstances under which that application can be refused.

The Directive does not alter the right of a member state to define the benefits that they choose to provide for their citizens, and so if your treatment is not funded locally by your healthcare provider, you cannot expect them to fund it for you in another country.

Example

Miss T, a 32-year old retail manager living in Kent was struggling with her weight problem. Despite joining several diet clubs and trying to lose weight for 2 years, she now weighs 14 stones; this is 6 lbs more than she did when she started her first weight loss program.

Miss T finds a hospital in Poland that is willing to operate on her to fit a gastric band and she applies to the NHS to authorise her treatment. The NHS refuses, as her BMI of 32.6 is way below the recommended minimum of 40 (or 35 if someone has a chronic health condition such as type 2 diabetes). As the NHS would not agree to perform a gastric band operation on Miss T, they also are within their rights not to agree to pay for her to have the surgery in another European Union Member State. She is, however, able to seek private weight loss surgery either at home or abroad.

Cross border treatment is your choice

The Directive has been created to support your rights to choose treatment anywhere in the EU, however it is not intended to encourage or to facilitate that decision. That means that although your local healthcare provider may fund your treatment, they will not arrange treatment or recommend providers in other countries. It is your decision to seek healthcare outside of your home state and therefore it is up to you to source that healthcare and make all the arrangements.

While the Directive obliges EU states to provide a range of information for visitors, by establishing National Contact Points, states are not obliged to provide their own citizens with details of treatment options elsewhere.

It is important to remember that even if your country has a system of prior authorisation, this does not constitute a recommendation of your chosen provider and carries no duty of care for the home state. Prior authorisation only confirms that your home state has agreed to reimburse the costs of your healthcare in another EU country.

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In this guide

Download the guide to the European Directive on Cross Border Healthcare
The EU Directive on patient rights in cross border healthcare provides the framework by which EU citizens can travel to other countries for treatment. Our guide to EU treatment explains patient rights from a UK patient's perspective.
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