EN Official Journal of the European Union CE 84/952

(2004/C 84 E/1052)

WRITTEN QUESTION P-1151/04

by Elizabeth Lynne (ELDR) to the Commission

(6 April 2004)

Subject: Commissioning medical treatment abroad

Does the Commission regard medical practitioners' assessments of a patient's clinical need (and thus the determination of reasonable waiting time before a patient can seek treatment abroad) to be potentially compromised by their position in health institutions with limited resources and competing demands on those resources?

According to the ruling by the European Court of Justice in the case of Geraets-Smits v. Stichting Ziekenfonds (Case C-l57/99), a patient can be denied medical treatment abroad only if ‘the patient can receive the same or equally effective treatment without undue delay from an establishment with which his sickness insurance has contractual arrangements.’

Considering that ‘undue delay’ is determined by a patient's clinical need, what steps has the Commission taken to ensure that the assessment of a patient's need is not compromised by the financial considerations of the competent institutions?

Answer given by Mr Bolkestein on behalf of the Commission

(30 April 2004)

In some Member States, patients are facing sometimes long waiting periods before getting medical treatment which may prejudice their state of health.

The Court in its judgement in Smits and Peerboom (1) and in Muller-Fauré-van Riet (2) indicated that authorisation to receive treatment in another Member State may be refused only if treatment which is the same or equally effective for the patient can be obtained without undue delay in the Member State of registration of the patient. The Court put the patient's medical situation first in indicating that in considering the condition of undue delay, ‘the national authorities are required to have regard to all circumstances of each specific case and take due account not only of the patient's medical condition at the time when authorisation is sought and where appropriate, of the degree of pain and the nature of the patient's disability which might, for example, make it impossible or extremely difficult for him to carry out a professional activity, but also of his medical history’ (Müller-Fauré/van Riet, C-385/99, paragraph 90). Member States are therefore required to make an assessment on a case-by-case basis of all the circumstances surrounding the medical situation of the patient concerned and cannot simply refer to predefined waiting times to refuse an authorisation for hospital treatment abroad.

The Commission would wish to inform the Honourable Member that in order to improve legal certainty for the sake of patients who benefit as recipients from the free movement of services, and for health professionals and managers of social security systems, it has recently adopted a proposal for a Directive on Services in the Internal Market (3) that clarifies the conditions under which Member States shall ensure that authorisation by their social security system is given for the assumption of the costs of hospital care provided in another Member State. In particular, it specifies that such authorisation cannot be refused where the treatment in question is among the benefits provided for by the legislation of the Member State of affiliation and where such treatment cannot be given to the patient within a time frame which is medically acceptable in the light of the patient's current state of health and the probable course of the illness.

This will allow medical practitioners to ensure that, where medically necessary, their patients can benefit from the principles of the Internal Market. It will also assist Member States to make more efficient use of existing health care infrastructures within the Union.

(1) Smits and Peerbooms judgement, Case C-157/99 of 12.07.01, ECR 2001 p. I-05473.

(2) Müller-Fauré and van Riet judgement, Case C-385/99 of 13.050 03, ECR 2003 p. I-04509.

(3) COM(2004) 2 final.