WRITTEN QUESTION E-1851/00

by Charles Tannock (PPE-DE) to the Commission

(9 June 2000)

Subject: Reciprocity in health care

Can the Commission state what the legal basis is for Member States' obligations to provide health care to each other's nationals (whether residents or tourists) and whether the refusal by some states, such as Belgium, to provide free health care to nationals of other states unless those nationals have contributed to a local health scheme, even though its own nationals will be treated free of charge in some other Member States, constitutes a form of discrimination or impediment to freedom of movement that could be challenged in the European Court of Justice?

Answer given by Ms Diamantopoulou on behalf of the Commission

(12 July 2000)

The Commission would point out that Community law does not affect the power of the Member States to organise their social security systems and, in particular, their health care systems, as they wish.

There is therefore considerable variation in the way in which State health care systems are organised in the Community. For example, certain Member States have opted for a system of direct provision of health benefits in kind without financial consideration from the patient (for example, in Germany and the Netherlands), while other systems provide medical services and products in return for payment by the patient, followed by reimbursement by his health insurance fund according to a corresponding scale (e.g. Belgium and France). Each Member State is also free to choose the range of health care and medical products that are provided or reimbursed on its territory.

However, Community law must be complied with in the exercise of this power that has remained in national hands. Mention should be made in this connection of the existence of Council Regulation (EEC) 574/72 of 21 March 1972 fixing the procedure for implementing Regulation (EEC) No 1408/71 on the application of social security schemes to employed persons and their families moving within the Community(1), which coordinates the statutory social security schemes of the Member States in order to provide effective protection to persons who move within the Community.

These regulations guarantee, in particular, that all citizens who have the nationality of a Member State other than the Member State in which they reside enjoy the same rights as citizens of that Member State. They also lay down the conditions relating to the reimbursement of medical expenses whenever a person requires medical care during a temporary stay in a Member State other than the one in which he is insured or whenever a person moves with the specific aim of receiving care in another Member State. If the conditions laid down in Community regulations are met, notably the proof of entitlement to health care in the State of affiliation, which generally issues an E 111 or E 112 form, any Community citizen may receive care provided under the legislation of the Member State in which he resides, payable by the State in which he is insured.

Belgium is therefore entitled to require all recipients of medical care on its territory to pay the costs of such care, which will, in principle, be reimbursed to them under the scale laid down in Belgian legislation.

(1) OJ L 74, 27.3.1972 Most recent consolidated version: Council Regulation (EC) No 118/97 of 2 December 1996 (OJ L 28, 30.1.1997).