Patient mobility : cross-border access to medical care

Abstract

Two fundamental principles underpin health policy in the European Union: subsidiarity and free movement. The latter Community goal of realising a free movement of persons inevitably raises questions about the degree to, and the conditions under, which beneficiaries can obtain medical care in other Member States. Undoubtedly, the movement of patients and professionals from country to country is on the increase. Many move for reasons unrelated to health. Whatever the reason, all these movements have an impact on health services, creating new needs and demands. Furthermore, citizens' expectations about healthcare are increasingly influenced by what they know of other systems in Europe and beyond, not just what their own system provides. This thesis will attempt to analyse the development of the current situation with regards to patient mobility within the European Union and will attempt to anticipate future developments in this field. Firstly a brief introduction will give an overview of the principles, values and rights of patients in the EU and will give a broad overview of the variety of issues that impinge on patient mobility within the European Union. Such will be followed by an analysis of the competence of the Member States and the European Union institutions in the field of health care and an outline of the relevant secondary legislation and Treaty articles in this field. It will be noted that in line with the Maastricht and more so the Amsterdam Treaty, the European Community has gained quite a number of new responsibilities to assure co-ordinated measures concerning particular health risks. The Community does, however, not have a direct or indirect mandate to interfere with the health related proceedings concerning the national health care or health insurance systems since the principle of subsidiarity leaves all responsibility for the nationalsystems of insurance or provision to the policy-makers and institutional actors at national level. The following chapter will then deal with the evolving legal situation concerning free movement of patients through the jurisprudence of the European Court in which the latter held that the procedures laid down in the secondary legislation although still valid were not an exhaustive exposition of the possibilities that were available to someone seeking care in another Member State and thus consistently applied internal market rules to the health care field. It will thus be seen that the European Court has recognised health care services as 'services' within the meaning of the EU Treaty hence according to the Court's case-law patients have been given a right to reimbursement of health care services provided in another Member State under certain circumstances. Therefore, the following chapter will refer to the fact that although previously most Member State Governments assumed that they have full responsibility and control over their own health services, recent discussions in the Council and the high level reflection process on patient mobility indicated that this attitude is changing. Finally, the last chapter will dwell on the fact that the growing attention given to crossing a border for health care is an indicator of important developments affecting the health sector. Indeed, whereas for many years, health services developed in the relatively isolated context of national policy, the health sector is increasingly undergoing the influence of 'internationalisation' and market integration at European level.