Communication from the Commission - A Community framework onthe application of patients' rights in cross-border healthcare {SEC(2008) 2183}
Date: 2008-07-02
Institutions: European Commission
Subjects: European cooperation, cross-border cooperation, health care, health policy, patient's rights, redemption, right to health

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COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels, 2.7.2008 
COM(2008) 415 final 

COMMUNICATION FROM THE COMMISSION 

A Community framework on the application of patients' rights in cross-border 
healthcare 

{SEC(2008) 2183} 

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COMMUNICATION FROM THE COMMISSION 

A Community framework on the application of patients' rights in cross-border 
healthcare 

1. 

INTRODUCTION 

The vast majority of EU patients receive healthcare in their own country and prefer 
to do so. But in certain circumstances patients may seek for some forms of healthcare 
to be provided abroad. Examples include highly specialised care, or in frontier areas 
where  the  nearest  appropriate  facility  is  on  the  other  side  of  the  border.  In  recent 
years,  citizens  have  brought  a  series  of  cases  to  the  European  Court  of  Justice 
seeking  to  assert  rights  to  reimbursement  for  healthcare  provided  in  other  Member 
States. In its judgements on these cases since 1998, the Court has consistently ruled 
that patients have the right to have reimbursement for healthcare received abroad that 
they  would  have  received  at  home.  It  is  necessary  to  clarify  how  the  principles 
established  on  these  specific  cases  should  be  applied  in  general.  Community  rules 
about  how  quality  and  safety  of  cross-border  healthcare  should  be  ensured  more 
generally  are  therefore  necessary.  For  this  purpose,  the  Commission  is  planning  to 
propose in 2008 a Communication and a Council Recommendation on Patient Safety 
and Quality of Health Services as well as a Council recommendation on health care 
associated infections. 

Based  on  this  case-law,  this  initiative  aims  at  ensuring  a  clear  and  transparent 
framework  for  the  provision  of  cross-border  healthcare  within  the  EU,  for  those 
occasions where the care patients seek is provided in another Member State than in 
their home country. When this happens, there should be no unjustified obstacles. The 
care should be safe and of good quality. The procedures for reimbursement of costs 
should be clear and transparent. While respecting principles of universality, access to 
quality care, equity and solidarity, the objectives of this framework will therefore be 
to: 

–  provide sufficient clarity about rights to be reimbursed for healthcare provided in 

other Member States; 

–  and  ensure  that  the  necessary  requirements  for  high-quality,  safe  and  efficient 

healthcare are ensured for cross-border care. 

Member  States  are  responsible  for  the  organisation  and  delivery  of  health  services 
and medical care. They are in particular responsible for determining which rules will 
apply  to  the  reimbursement  of  patients  and  to  the  provision  of  health  care.  This 
proposal  changes  nothing  in  this  respect.  It  is  important  to  underline  that  this 
initiative  does  not  alter  the  Member  States'  choice  of  the  rules  which  will  be 
applicable  to  a  specific  case.  Instead,  this  framework  is  designed  to  facilitate 
European  cooperation  on  healthcare,  such  as  for  European  networks  of  centres  of 
reference; sharing assessments of new health technologies; or using information and 
communication  technology  to  provide  more  efficient  healthcare  ("e-health").  By 
doing so, this will provide additional support to the Member States in achieving their 

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overall objectives of universal access to high-quality healthcare on the basis of equity 
and solidarity, which will benefit all patients, whether they move countries or not. 

These issues have been discussed on several occasions between the Commission and 
the  responsible  authorities  of  all  Member  States,  representatives  of  the  European 
Parliament as well as the health care community and the other stakeholders. Prior to 
bringing  forward  these  proposals,  the  Commission  also  held  a  public  consultation 
regarding Community action on health services, the results of which have provided a 
solid basis for developing and shaping this proposed framework1 Both the Ministers 
in  the  Council  and  the  European  Parliament  have  also  requested  action  on  health 
services  and  their  specific  character  has  been  confirmed  by  the  exclusion  of  these 
services from the general services directive. 

This  proposal  is  based  on  Article  95  of  the  EC  Treaty  on  the  establishment  and 
functioning of the internal market. It is also consistent with the provisions of Article 
152  of  the  EC  Treaty  on  public  health  and  respects  the  responsibilities  of  the 
Member States for the organisation and delivery of health services and medical care 
as interpreted by the Court of Justice. The provisions of the Reform Treaty will not 
affect the legal basis. 

2. 

PROPOSED FRAMEWORK 

In  order  to  achieve  the  objectives  set  out  above,  the  Commission  proposes  the 
establishment of a Community framework for cross-border healthcare, as set out in 
the  accompanying  proposal  for  a  directive.  As  well  as  setting  out  relevant  legal 
definitions and general provisions, this is structured around three main areas: 

–  common  principles  in  all  EU  health  systems,  as  agreed  in  June  2006  by  the 
Council,  setting  out  which  Member  State  shall  be  responsible  for  ensuring 
compliance  with  the  common  principles  for  healthcare  and  what  those 
responsibilities include, in order to ensure that there is clarity and confidence with 
regard  to  which  authorities  are  setting  and  monitoring  healthcare  standards 
throughout  the  EU.  Further  cooperation  amongst  Member  States  will  be 
promoted,  in  particular  in  upcoming  Commission  proposals  for  Communication 
and a Council Recommendation on Patient Safety and Quality of Health Services 
and for a Council recommendation on health care associated infections; 

–  a specific framework for cross-border healthcare: the directive will make clear 
the entitlements of patients to have healthcare in another Member State, including 
the limits that Member States can place on such healthcare abroad, and the level 
of  financial  coverage  that  is  provided  for  cross-border  healthcare,  based  on  the 
principle that patients are entitled to obtain reimbursement up to the amount that 
would have been paid had they obtained that treatment at home;  

1 

See  Commission  communication  "Consultation  regarding  Community  action  on  health  services" 
SEC(2006)1195  of  26  September  2006;  and  the  results  of  the  consultation  and  the  summary  report, 
available 
at: 
http://ec.europa.eu/health/ph_overview/co_operation/mobility/results_open_consultation_en.htm. 

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–  European cooperation on healthcare: the directive establishes a framework for 
European  cooperation  in  areas  such  as,  European  reference  networks,  health 
technology assessment, data collection and quality and safety, in order to enable 
the potential contribution of such cooperation to be put effectively in practice and 
on a sustained basis. 

2.1. 

A specific legal framework regarding reimbursement of cross-border healthcare 

The  directive  will  provide  sufficient  clarity  about  the  rules  to  be  applied  for  the 
reimbursement of healthcare provided in other Member States and how the rights of 
the patients will be implemented in practice in line with the case law of the Court of 
justice. The directive reflects the following principles: 

–  Any  non-hospital care  to  which  citizens are entitled in their  own Member State, 
they may also seek in any other Member State without prior authorisation, and be 
reimbursed up to the level of reimbursement provided by their own system. 

–  Any hospital care to which they are entitled in their own Member State they may 
also  seek  in  any  other  Member  State.  The  directive  allows  Member  States  to 
provide for a system of prior authorisation for reimbursement of costs for hospital 
care  provided  in  another  Member  State,  if  Member  States  can  provide  evidence 
that  the  outflow  of  patients  resulting  from  implementation  of  this  Directive  has 
such an impact that it seriously undermines or is likely to seriously undermine the 
planning  and  rationalisation  carried  out  in  the  hospital  sector.  The  costs  of  such 
hospital care provided in another Member State should also be reimbursed by the 
Member State of affiliation at least up to the level of costs that would have been 
assumed had the same or similar healthcare been provided in the Member State of 
affiliation.  

In any event, the Member States of the patient may impose the same conditions that 
apply domestically, such as the requirement to consult a general practitioner before 
consulting a specialist or before receiving hospital care. 

This  does  not  change  the  right  of  Member  States  to  define  the  benefits  that  they 
choose to provide. If a Member State does not include a particular treatment as part 
of  the  entitlement  of  their  citizens  at  home,  this  directive  does  not  create  any  new 
entitlement  for  patients  to  have  such  treatment  abroad  and  be  reimbursed.  For 
instance,  the  conditions  upon  which  plastic  surgery  is  reimbursed  in  the  Member 
State  of  origin  of  a  patient  will  continue  to  apply  when  this  patient  will  seek 
reimbursement for a treatment provided in another Member State The same applies 
for instance for hydro or balneo-therapy as well as spa cure. In addition, the proposal 
does not prevent the Member States from extending their benefits in kind schemes to 
healthcare  provided  in  other  Member  States  a  possibility  already  implemented  by 
several Member States. 

The proposed directive will also clarify some relevant terms as well as the criteria for 
the  procedures  to  be  followed  for  cross-border  care  to  ensure  that  these  are 
objectively  justified,  necessary  and  proportionate.  It  will  also  require  appropriate 
mechanisms  to  be  put  in  place  to  provide  information  and  assistance  to  patients 
through national contact points.  

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By  providing  a  clear  legal  framework  regarding  rights  to  reimbursement  for  cross-
border  healthcare,  the  proposal  will  reduce  the  inequalities  inherent  in  the  current 
uncertainty  regarding  the  general  application  of  the  principles  established  by  the 
case-law. Citizens will be sure about when they will and will not be reimbursed for 
care  received  in  another  Member  State,  and  on  what  basis,  and  will  have  clear 
processes for any decisions or appeals. Member States may also take further steps to 
address such inequalities, such as through advancing costs, or making arrangements 
to  reimburse  healthcare  providers  directly  rather  than  requiring  patients  to  advance 
money. 

Alongside the proposed directive, the existing framework for coordination of social 
security schemes would remain in place with all the general principles on which the 
regulations  on  coordination  of  social  security  schemes  are  based,  including  putting 
the  patient  receiving  healthcare  in  another  Member  State  on  equal  footing  with  the 
residents of that Member State, and the existing European Health Insurance Card. In 
terms of patients seeking planned cross-border healthcare, this regulation ensures that 
if  the  appropriate  care  for  the  patients'  condition  cannot  be  provided  in  their  own 
country  without  undue  delay,  then  they  will  be  authorised  to  go  abroad,  and  any 
additional  costs  of  treatment  will  be  covered  by  public  funds.  Whenever  the 
conditions set out in Article 22(2) of Regulation (EC) No 1408/71 are fulfilled, the 
authorisation  shall  be  granted  and  the  benefits  provided  in  accordance  with  that 
Regulation. This is explicitly recognised by the proposed directive.  The Regulation 
(EC) No 1408/71 will therefore continue to provide the general tool and the "safety 
net"  to  ensure  that  any  patient  who  cannot  have  access  to  healthcare  in  their  own 
country within a reasonable time will be authorised to have that healthcare in another 
Member State. 

2.2. 

Guaranteeing quality and safety for cross-border healthcare 

Whenever healthcare is provided, it is vital for patients to ensure: 

–  clear  information  that  enables  people  to  make  informed  choices  about  their 

healthcare; 

–  mechanisms for ensuring the quality and safety of the healthcare that is provided; 

–  continuity of care between different treating professionals and organisations; 

–  and  mechanisms  to  ensure  appropriate  remedies  and  compensation  for  harm 

arising from healthcare. 

However, there are no clear rules at Community level about how these requirements 
should  be  met  for  cross-border  healthcare,  or  who  is  responsible  for  ensuring  that 
they are. This is the case no matter how the care is paid for – whether it is paid for 
publicly or privately, whether it is undertaken through the regulation on coordination 
of  social  security  systems  or  whether  it  is  in  application  of  the  additional  free 
movement rights described above. Without such clarity, there is a risk of confusion 
leading  to  difficulties  in  ensuring  quality  and  safety  of  healthcare  in  cross-border 
cases. 

The proposed directive would therefore set out what the common principles in all EU 
health  systems  are,  taking  as  a  basis  the  Council  conclusions  on  "Common  values 

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and  principles  in  European  Union  Health  Systems"  in  June  2006,  and  the  principle 
that  it  should  be  for  the  authorities  of  the  Member  State  on  whose  territory  the 
healthcare  is  provided  to  ensure  compliance  with  such  common  principles.  The 
directive  would  make  clear  that  responsibilities  of  the  authorities  of  that  Member 
State would include ensuring that healthcare is provided according to clear standards 
of  quality  and  safety  defined  by  the  Member  State  in  advance,  that  healthcare 
providers  make  available  relevant  information  to  enable  informed  choices  by 
patients,  that  patients  have  a  means  of  making  complaints  and  obtaining  redress  if 
they suffer harm from the healthcare they receive, and that both access to and privacy 
of medical records is guaranteed.  

Member States remain responsible for setting the standards that apply to healthcare 
provided  in  their  country.  But  by  making  clear  which  is  the  Member  State  that  is 
responsible in any given situation, the directive will ensure that the quality and safety 
of healthcare is guaranteed throughout the Union.  

2.3. 

Future practical European cooperation on healthcare 

There are situations where European cooperation can add value to the actions of the 
Member  States  because  of  the  scale  or  nature  of  the  healthcare  concerned.  The 
framework  established  by  the  directive  will  help  to  realise  the  potential  of  this 
European  added-value.  It  makes  provision  for  developing  future  practical 
cooperation at European level in three areas in particular. 

2.3.1.  European reference networks 

European  networks  of  centres  of  reference  ("European  reference  networks")  would 
bring  together  on  a  voluntary  basis  specialised  centres  in  different  Member  States. 
These could  help to provide healthcare to patients who have conditions requiring a 
particular concentration of resources or expertise in order to provide high quality and 
cost-effective  care.  This  can  often  be  achieved  by  using  such  networks  to  bring 
relevant expertise to the patient, although in some instances patients will need to go 
to centres in other countries. 

European  reference  networks  could  also  be  focal  points  for  medical  training  and 
research,  information  dissemination  and  evaluation.  Collaboration  in  this  area  has 
great potential to bring benefits to patients through easier access to highly specialised 
care,  and  to  health  systems  by  enabling  the  most  efficient  use  of  resources,  for 
example by pooling resources to tackle rare conditions. 

The  Commission  is  already  funding  pilot  projects  to  test  the  concept  of  European 
reference  networks  developed  by  the  High  Level  Group  on  health  services  and 
medical care2 The aim of these pilot projects, developed especially in the area of rare 
diseases, is to identify best practice for establishing European reference networks, to 
identify  outstanding  legal  or  practical  obstacles  that  the  networks  are  facing  and  to 
develop  general  conclusions  and  recommendations  that  could  be  used  beyond  the 
area  of  rare  diseases.  A  clear  framework  for  European  reference  networks  can  be 
established under the proposed directive on the basis of the results of these projects. 

2 

See http://ec.europa.eu/health/ph_overview/co_operation/mobility/high_level_hsmc_en.htm. 

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In  addition,  under  the  cross-border  strand  of  the  Territorial  Cohesion  Objective  of 
Cohesion  Policy  a  wide  range  of  projects  that  facilitate  the  access  of  patients  to 
cross-border health services are financially supported. The Commission will also be 
actively  involved  in  one  of  the  projects  funded  under  the  URBACT  II  programme. 
This project has the title 'Building Healthy Communities'. 

2.3.2.  Health Technology Assessment 

Constant  innovations  in  medical  science  and  health  technologies  bring  benefits  in 
better  healthcare.  However,  they  also  create  a  continuing  challenge  for  health 
systems to ensure that they are properly evaluated and used in the most cost-effective 
manner possible. Health technology assessment (HTA) is a multidisciplinary process 
that summarises information about the medical, social, economic and ethical issues 
related to the use of a health technology, in order to ensure this. This is a clear area 
of European added-value, where cooperation at Community level can help to reduce 
overlap and duplication of efforts and hence promote the effective and efficient use 
of resources. 

The  Commission  is  supporting  a  pilot  European  network  on  health  technology 
assessment  called  "EUnetHTA".  The  overall  aim  of  EUnetHTA  is  to  establish  an 
effective  and  sustainable  European  network  for  health  technology  assessment  that 
informs  policy  decisions.  EUnetHTA  connects  public  HTA  agencies,  research 
institutions  and  health  ministries  to  enable  effective  exchange  of  information  and 
support to policy decisions by the Member States. The EUnetHTA project is being 
co-financed by the European Commission and contributions from network members. 
As  with  European  reference  networks,  a  clear  framework  for  taking  forward  these 
activities  can  be  established  under  the  directive  on  the  basis  of  the  results  of  this 
pilot. 

2.3.3.  E-health 

Information  and  communication  technologies  have  enormous  potential  to  improve 
the  quality,  safety  and  efficiency  of  healthcare.  The  European  Commission  is 
supporting work in this area in accordance with the E-Health Action Plan3, and many 
examples  of  e-health  projects  already  exist.  These  cover  areas  such  as  remote 
provision of specialist support from large hospitals to smaller local facilities; remote 
reading of diagnostic images; monitoring of  chronic diseases  to enable people with 
chronic conditions to remain active, rather than requiring hospitalisation; or ensuring 
coordination  between  different  healthcare  providers  to  provide  integrated  packages 
of care to individual patients.  

However,  safe  and  efficient  provision  of  e-health  services  requires  shared  formats 
and standards that can be used between different systems and different countries, and 
these  are  currently  lacking.  The  directive  will  therefore  allow  for  such  formats  and 
standards to be put in place, enabling informal cooperation and individual projects to 
be  continued  and  generalised  on  a  more  solid  and  sustainable  basis.  The  proposal 
does not oblige any introduction of e-Health systems or services but aims at ensuring 
interoperability  once  the  choice  of  introducing  such  systems  is  done  by  Member 
States. 

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COM(2004)356 of 30 April 2004. 

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3. 

THE IMPACT OF THE FRAMEWORK 

3.1. 

How large is cross-border healthcare? 

The Commission estimates that around 1% of public healthcare budgets is spent on 
cross-border  healthcare,  equating  to  around  €10  billion  for  the  Community  as  a 
whole. This share can be higher in some cases:  

–  in border regions 

–  for smaller Member States 

–  for rare diseases  

–  in areas attracting large amounts of tourists; 

though even in these case, cross-border healthcare remains limited to a few percent 
of overall volumes. 

This relatively small scale of cross-border healthcare is unsurprising, as people prefer 
to have healthcare as close to home as possible. The Commission surveys4 show that 
healthcare needs of the vast majority of patients throughout the EU are met through 
the care provided by their domestic system – over 90% across the EU as a whole. So 
although  this  framework  is  of  great  importance  for  the  individuals  concerned,  the 
overall  volume  of  cross-border  healthcare  will  not  have  a  major  impact  on  health 
systems as a whole.  

3.2.  What will the impact of this proposal be for citizens? 

Even  though  the  directive  is  based  on  rights  already  established  by  the  Court  of 
Justice  interpreting  the  Treaty,  the  directive  brings  added-value  in  the  sense  that  it 
will provide clarity about these additional rights conferred to patients when they seek 
the healthcare, to which they are entitled from providers in other Member States and 
how they are reimbursed. And whenever cross-border healthcare is provided, patients 
can  have  confidence  about  the  quality  and  the  safety  of  that  healthcare.  For  those 
who cannot get the healthcare to which they are entitled to within a reasonable time 
in their own country, the existing social security regulations ensure that they can go 
to another Member State5.  This system remains unaffected. This proposal therefore 
provides  an  additional  option  for  cross-border  healthcare,  responding  to  the  cases 
brought by citizens themselves and having resulted in the jurisprudence of the Court. 
It is important to underline that the rights stemming from this jurisprudence do not 
substitute any rights existing under the national frameworks or Regulation (EC) No 
1408/71  but  they  represent  additional  rights  that  citizens  can  choose  to  exercise. 
They thus provide better access for all to different healthcare within the EU. It should 
be  noted,  as  already  mentioned,  that  certain  Member  States  have  already  chosen, 
under  certain  conditions,  to  extend  the  benefits  in  kind  schemes  to  the  patients 
seeking  cross-border  healthcare.  The  provisions  of  the  proposal  will  also  help 

4 

5 

See  the  estimates  of  unmet  medical  need  provided  by  the  European  Statistics  on  Income  and  Living 
Conditions (EU-SILC). 
Using the E112 forms – see 
http://ec.europa.eu/employment_social/social_security_schemes/healthcare/e112/conditions_en.htm. 

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creating  added-value  from  broader  and  more  efficient  EU-wide  cooperation  on 
healthcare. Additional benefits for the patient can be drawn from the proposal. The 
creation of European reference networks while on a voluntary basis will enhance the 
expertise in new therapeutic fields and will help making these therapies more easily 
available to patients irrespective of their home country. The improved co-operation 
on  management  of  new  health  technologies  will  provide  additional  tools  to  the 
Member States in order to evaluate those technologies, and make their choices more 
efficient  and  more  sustainable.  Through  better  monitoring  of  data  and  pooling  of 
statistical  tools  the  proposed  directive  will  also  improve  the  monitoring  of  the 
provision  of  cross-border  healthcare,  with  the  direct  effect  on  inducing  a  better 
knowledge on epidemiological patterns.  

3.3.  What will the impact of this proposal be for health professionals? 

This  proposal  is  aimed  at  ensuring  a  clear  framework  for  safe,  high-quality  and 
efficient healthcare throughout the Union. Health professionals will therefore benefit 
from a clear set of rules about the quality and safety standards applicable when they 
treat  patients  from  other  Member  States  or  when  they  provide  services  in  other 
Member States.  

However, this directive will not affect the existing provisions of Community law. In 
particular,  it  will  not  affect  provisions  regarding  the  recognition  of  professional 
qualifications or create additional barriers to such recognition; nor will it affect the 
rights  of  health  professionals  to  establish  themselves  in  other  Member  States. 
Moreover, it will make clear that regardless of the status of a healthcare professional, 
the rules applicable to healthcare are those of the country of treatment (meaning the 
country where the care is provided). 

3.4.  What  will  the  impact  of  this  proposal  be  on  the  Member  States  and  public 

budgets? 

In  the  long  term,  the  added  value  of  European  cooperation  on  issues  such  as 
European  networks  of  centres  of  reference;  sharing  assessments  of  new  health 
technologies; and using information and communication technology to provide more 
efficient healthcare ("e-health") will help to improve the quality and efficiency of all 
healthcare, both for those patients who move and those who do not.  

In the short term, our impact assessment shows that the additional costs of treatment 
arising  from  these  proposals  are  not  likely  to  be  such  as  to  undermine  the 
sustainability or planning of health systems overall. This is because citizens are only 
entitled  to  be  reimbursed  for  healthcare  that  they  were  entitled  to  at  home,  so 
Member States only have to pay for healthcare that they would have had to pay for in 
any  case.  The  impact  assessment  estimated  that  the  additional  costs  of  treatment 
would  be  a  small  fraction  of  one  percent  of  overall  health  expenditures,  and  far 
outweighed by the benefits. And if in the short term an unpredictable surge of cross-
border  healthcare  were  to  cause  a  major  problem  -  in  planning  local  facilities,  for 
example  -  the  proposal  allows  Member  States  to  put  in  place  limits  necessary  to 
safeguard  their  overall  system  ),  respecting  the  caselaw  of  the  Court  of  Justice.  In 
such  a  case,  a  Member  State  can  introduce  prior  authorisation  for  patients  seeking 
cross-border hospital care under the conditions set out by the Directive which reflect 
the case law by the Court. 

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3.5.  What will be the impact on the overall organisation of health systems? 

Some  stakeholders  have  raised  concerns  about  the  potential  of  cross-border 
healthcare to alter the possibilities of Member States to control access to healthcare. 
Cross-border  healthcare  can  provide  a  route  for  quicker  access  to  care.  It  can  also 
help  in  ensuring  efficient  overall  organisation  of  health  systems.  Healthcare 
provision  requires  a  critical  mass  of  patients  in  order  to  enable  and  maintain  high-
quality  services  and  of  course  to  justify  investments  which  can  be  for  certain  new 
therapies heavy and not available in certain Member States. If providing cross-border 
care  can  help  to  generate  such  a  critical  mass,  it  can  also  help  to  support  more 
developed healthcare which will also benefit domestic patients. 

In any event, providing care to patients from other countries must not undermine the 
primary  purpose  of  the  health  systems  of  the  Member  States,  which  is  to  provide 
healthcare to their own residents. The proposed directive makes clear that using this 
framework  for  cross-border  care  does  not  entitle  people  from  abroad  to  be  treated 
more  quickly  than  domestic  patients.  Where  there  are  waiting  lists  for  a  particular 
kind  of  treatment,  patients  from  other  Member  States  should  be  integrated  on  the 
same basis, and should wait as long as a domestic patient with a similar health need. 
Moreover,  healthcare  providers  are  not  obliged  to  accept  patients  from  abroad  for 
planned  treatment  if  this  would  endanger  the  maintenance  of  treatment  capacity  or 
medical  competence  in  the  receiving  Member  State.  But  where  the  country  has 
capacity to treat patients more quickly than at home without increasing waiting times 
for  others,  and  the  patients  concerned  are  willing  to  incur  the  inconvenience  of 
travelling  to  another  country  to  have  that  treatment,  then  this  means  more  efficient 
care for everyone. 

4. 

CONCLUSION 

The shared objectives of health systems throughout the European Union reflect some 
of  the  most  fundamental  values  of  European  citizens.  The  underlying  principles  of 
universality, equity, good quality and solidarity must be respected. The organisation 
and  delivery  of  health  services  and  medical  care  is  and  will  remain  under  the 
competences  of  the  Member  States,  competences  which  must  be  exercised  in  the 
respect of the Treaty. In addition, the European Union can bring significant added-
value through enhanced cooperation to the benefit both of those patients who move 
and those who do not. By doing so, the EU will be also helping to meet some of the 
most central priorities of its citizens, and will be providing a tangible example of the 
benefits of European integration into their daily lives. It has to be remembered that 
all the case-law of the Court of Justice in this matter are based on referrals initiated 
by single citizens trying to exercise individual rights stemming from the EC Treaty 
itself.  

The  main  objective  of  the  proposed  legal  framework  is  thus  to  clarify  the  Court  of 
Justice  principles  stating  that  the  patients  have  the  right  to  be  reimbursed  for 
healthcare  received  in  another  Member  State  up  to  the  level  that  they  would  have 
been  for  healthcare  received  in  their  own  Member  State.  This  right  is  the  direct 
application of the EC Treaty and the legal framework proposed by the Commission 
aims at facilitating its practical application.  

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Much of this Community support is therefore about cooperation and mutual learning. 
Nevertheless, the key first step is to establish a clear legal framework within which 
such European cooperation can take place. That is the aim of this initiative. 

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