health care or may reflect totally private (non-subsidised) health care either paid out of pocket or met by some form of personal or employer funded insurance. All EU and many other European countries offer their citizens a free European Health Insurance Card which, on a reciprocal basis, provides insurance for emergency medical treatment insurance when visiting other participating European countries. [ 199 ] A directive on cross-border healthcare aims at promoting co-operation on health care between member states and facilitating access to safe and high-quality cross-border healthcare for European patients. [ 200 ] [ 201 ] [ 202 ] In 2010, 47.3 million people lived in the EU, who were born outside their resident country. This corresponds to 9.4% of the total EU population. Of these, 31.4 million (6.3%) were born outside the EU and 16.0 million (3.2%) were born in another EU member state. The largest absolute numbers of people born outside the EU were in Germany (6.4 million), France (5.1 million), the United Kingdom (4.7 million), Spain (4.1 million), Italy (3.2 million), and the Netherlands (1.4 million). [ 206 ] Language policy is the responsibility of member states, but EU institutions promote the learning of other languages. [ u ] [ 214 ] English is the most spoken language in the EU, being spoken by 51% of the EU population when counting both native and non-native speakers. [ 215 ] German is the most widely spoken mother tongue (about 88.7 million people in 2006). 56% of EU citizens