Study on cross-border health services : enhancing information provision to patients : annexes - final report.
Date: 2018-09-03
Institutions: Directorate-General for Health and Food Safety
Subjects: cross-border cooperation, financing, health care, health care system, health policy, organisation of health care, patient's rights, provision of services, regional policy, social security

Study on cross-border health 
services: enhancing 
information provision to 
patients 

Annexes – Final Report 

Written by the consortium of Ecorys, KU Leuven and GfK Belgium.  

June – 2018 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Authors 

This study has been undertaken by a team of experts of Ecorys, KU Leuven, and GfK 
Belgium.  

Ecorys 
Lotte van de Steeg 
Kim Weistra 
Philip Klein 

KU Leven 
Stefaan Callens 
Nina van Gompel 

GfK Belgium 
Sarah Invernizzi 
Evelien Thieme-Groen 

EUROPEAN COMMISSION 

Directorate-General for Health and Food Safety 
Directorate B — Health systems, medical products and innovation 
Unit B.2 — Cross-border healthcare; Tobacco control 

Contact: Anne-Marie YAZBECK 

Corina VASILESCU 

E-mail:  SANTE-Cross-border-Healthcare@ec.europa.eu  

Anne-Marie.YAZBECK@ec.europa.eu 
Corina.VASILESCU@ec.europa.eu  

European Commission 
B-1049 Brussels 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Study on cross-border health 
services: enhancing 
information provision to 
patients 

Annexes – Final Report 

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Health Programme 

2018 

EN 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Study on cross-border health services: enhancing information provision to patients 

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Study on cross-border health services: enhancing information provision to patients  

Preface 

This  document  includes  all  annexes  of  the  study  on  cross-border  health  services:  enhancing 
information provision to patients.  

The annexes outline the guiding principles and indicators (Annex A), main trends based on the 
online survey to NCPs (Annex B), and the overarching research protocol (Annex C). Furthermore, 
annexes specific to each of the WPs are detailed, including for the website analysis in WP2 (Annex 
D),  for  the  pseudo-patient  investigation  in  WP3  (Annex  E-H),  and  for  the  analysis  of  other 
information centres (Annex I) and the online patient survey (Annex J) in WP4. Then, a list of the 
NCPs and their contact information is presented (Annex K). The final Annex includes a short note 
on the proceedings of the workshop on 8 March 2018 (Annex L). 

 
 
 
Study on cross-border health services: enhancing information provision to patients  

Table of Contents 

ANNEX A – GUIDING PRINCIPLES AND INDICATORS ........................................................ 9 

ANNEX B – MAIN TRENDS BASED ON THE ONLINE SURVEY TO NCPS ................................ 29 

ANNEX C – OVERARCHING RESEARCH PROTOCOL .......................................................... 49 

ANNEX D – UPDATED WEBSITE ANALYSIS METHODOLOGY (WP2) ..................................... 51 

ANNEX E – EMAIL TEMPLATES (WP3) ............................................................................ 53 

ANNEX F – CONTACT INFORMATION NCPS (WP3) ........................................................... 57 

ANNEX G – ASSESSMENT FORMS MYSTERY SHOPPING (WP3) .......................................... 61 

ANNEX H – DETAILED DATA (WP3) ............................................................................... 67 

ANNEX I - ANALYSIS OF OTHER INFORMATION CENTERS (WP4) ....................................... 69 

ANNEX J – ONLINE SURVEY PATIENTS (WP4) ................................................................. 77 

ANNEX K - URLS OF THE NCP WEBSITES OF THE 28 MSS + NORWAY ................................ 81 

ANNEX L – WORKSHOP PROCEEDINGS ......................................................................... 82 

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Study on cross-border health services: enhancing information provision to patients  

ANNEX A – GUIDING PRINCIPLES AND INDICATORS  

This Annex includes: 

1.  Nine General Guiding Principles  
2.  Specific technical Guidelines – up to five key Guidelines per Guiding Principles whilst the 

remainder represent voluntary good practices based on review of evidence  

3.  Voluntary set of Indicators - intended for self-assessment and monitoring 

Purpose:  

The  purpose  of  the  “Guiding  Principles  for  Cross-border  Healthcare  NCPs”  is  to  set  out  key 
principles for good NCP services, in line with NCPs’ obligations under Directive 2011/24/EU1. The 
Guiding  Principles  are  designed  to  assist  NCPs  in  their  daily  public  task  of  providing  clear  and 
accurate  information  on  the  main  aspects  of  cross-border  healthcare.  The  principles  aim  to 
contribute to a NCP practice that is (1) more uniform, (2) of high quality, and (3) always patient-
oriented.   

In this light, the Guiding Principles cover the following main areas:  

1.  Accessibility and availability of the NCP service  
2.  Compatibility of information provision with Directive 2011/24/EU 
3.  Cooperation between NCPs and with other actors  

Methodology:  

The Guiding Principles are developed from the existing legal obligations and standards that rest 
on  NCPs  under  Directive 2011/24/EU,  as  well  as from  the  good  practices  identified  in  a recent 
study on enhancing information provision to patients in cross-border health services2 and previous 
studies3.  Besides,  to  ensure  patient  centeredness,  recommendations  by  the  European  Patients' 
Forum (EPF) are taken into account.4 The Guiding Principles were discussed at the NCP Workshop 
of 8 March 2018 and following further consultations, agreed with the consent of all cross-border 
healthcare NCPs.  

The Guiding Principles provide the underlying framework for the more technical NCP Guidelines, 
that are each time listed under the principle concerned. These guidelines are likewise agreed by 
all  NCPs.  All  guidelines  aim  to  leave  room  for  the  existing  organisational  differences  between 
NCPs.  

To monitor the implementation of the guidelines, a voluntary set of indicators was created (see 
Part  2  of  the  document),  following  the  RACER  methodology.  Accordingly,  indicators  that  are 
Relevant, Accepted, Credible, Easy to monitor and Robust against manipulation are established. 
These indicators are intended for voluntary self-assessment and monitoring in light of compliance 
with the Guiding Principles and Guidelines.  

1 Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of 

patients’ rights in cross-border healthcare, OJ L 088, 4 April 2011, pp. 45-65. 

2 “Study on cross-border health services: enhancing information provision to patients”, on-going.  
3 European Commission, Member State data on cross-border healthcare following Directive 2011/24/EU, 2015, 
p. 37 ; G. Zucca, A. De Negri, A. Berény, A. Kaszap, K.A. Stroetmann, P. Varnai, Evaluative study on the 
cross-border healthcare Directive (2011/24/EU), 2015, p. 179; G. Strban, G. Berki, D. Carrascosa, F. Van 
Overmeiren, Analytical Report 2016: Access to healthcare in cross-border situations, FreSsco, January 2017, 
p.  101;  ANEC,  Cross-border  healthcare.  Accessing  medical  treatment  in  other  EU  countries:  Consumer 
attitudes and experiences, 2018, p. 55. 

4 See amongst others: Summary Report: main conclusions and recommendations arising from EPF’s series of 
Regional Conferences 2013-14; EPF, Recommendations for National Contact Points: arising from  the  EPF 
series of Regional Conferences 2013-14, 2015, p.7; Directive on Patients’ Rights in Cross-border Healthcare: 
EPF Position Statement, 2016, pp. 22.   

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Study on cross-border health services: enhancing information provision to patients  

Besides the agreed Guiding Principles and Part 2 of the document, an additional set of indicators 
and guidelines that did not find common approval is provided in a separate document for further 
consideration, if so wished. 

Schematic overview: 

1.  Nine General Guiding Principles  
2.  Specific technical Guidelines – up to five key Guidelines per Guiding Principle 
3.  Voluntary set of Indicators - intended for self-assessment and monitoring  

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The Guiding Principles  

The Guiding Principles for Cross-border Healthcare NCPs are organised into three main strands, 
reflecting the major categories of NCP requirements according to the legal standards imposed by 
Directive 2011/24/EU:  

  NCP service 

 

Information provision according to Directive 2011/24/EU  

  Cooperation and information exchange  

Each strand contents a number of Guiding Principles, describing the main features of good NCP 
service  provision.  In  their  turn,  the  principles  provide  the  underlying  framework  for  the  more 
technical corresponding NCP Guidelines. In part 2 of this document, these specific guidelines are 
translated into voluntary thematic indicators, making it possible to monitor the implementation 
of the Guiding Principles in practice. 

The Guiding Principles for Cross-border Healthcare NCPs:  

1.  Principle of Visibility 

2.  Principle of Accessibility 

3.  Principle of Transparency 

4.  Principle of Inclusion  

5.  Principle of Duality 

NCP service 

Information 
according to the Directive 

provision 

6.  Principle of Information to outgoing patients in accordance with the Directive  

7.  Principle of Information to incoming patients in accordance with the Directive  

8.  Principle of information to healthcare providers  

9.  Principle of Cooperation  

Cooperation & information 
exchange 

This framework includes the nine Guiding Principles for good NCP practice. Principle 1 to 4 are the 
overarching central principles that should be applied in every feature of the NCP service. Principle 
5  to  7  are  intended  specifically  for  safeguarding  information  provision  in  accordance  with  the 
information  requirements  of  Directive  2011/24/EU,  making  a  distinction  between  information 
provision  to  outgoing  patients  and  information  provision  to  incoming  patients.  Principle  8 
prescribes  the  duty  of  good  information  provision  to  healthcare  providers.  Finally,  principle  9 
concerns cooperation and information exchange between NCPs and with other actors.  

Below, each principle is explained through a short commentary. The associated specific guidelines 
are listed under the Guiding Principle concerned. When applicable, the legal standards supporting 
the principles are outlined in separate boxes. An additional set of indicators and guidelines that 
did not find common approval is provided in a separate document. This constitutes source material 
for further consideration.  

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General Guiding Principles for good NCP service 

Principle 1: Visibility  
To comply with their duty of enhancing visibility of patients’ rights under Directive 2011/24/EU, 
NCPs  make  sure  their  information  reaches  the  general  public.  Accordingly,  NCPs  are  visible, 
present and public. 

NCPs are highly visible and easy to find and recognise as appropriate.  

1. 
2.  When this is within the responsibility of the NCP and subject to available resources, NCPs 

3. 

try to be engaged in campaigns indented to inform the general public of their existence. 
To map the awareness of the existence of NCPs, and as far as possible NCPs collect data 
on the number of patients making use of the NCP service.  

Legal standards: 

 

 

 

Recital  48:  “Appropriate  information  on  all  essential  aspects  of  cross-  border 
healthcare is necessary in order to enable patients to exercise their rights on cross-
border healthcare in practice. For cross-border healthcare, one of the mechanisms for 
providing such information is to establish national contact points within each Member 
State.” 
Art. 6(1): “Each Member State shall designate one or more national contact points for 
cross-border  healthcare  and  communicate  their  names  and  contact  details  to  the 
Commission.  The  Commission  and  the  Member  States  shall  make  this  information 
publicly available. […]” 
Art. 6(5): “The information […] shall be easily accessible and shall be made available 
by  electronic  means  and  in  formats  accessible  to  people  with  disabilities,  as 
appropriate.” 

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Principle 2: Accessibility  
The  NCP  service  is  easily  accessible,  via  multiple  channels  and  to  all  patients,  bearing  in  mind 
special patients’ information needs. 

1. 

2. 

3. 

NCPs  have  an  accessible  website  that  is  informative  and  contains  clear,  structured  and 
understandable information.  
Subject  to  available  resources  and  as  appropriate,  NCPs  are  accessible  for  direct  and 
barrier-free  personal  patient  advice,  e.g.  via  email,  postal  service,  online  contact  forms, 
telephone, or in person.  
Depending on the available resources, NCPs try to provide information besides the national 
official  language(s),  in  foreign  languages,  at  least  English,  making  the  service  also 
accessible for incoming patients. 

Legal standards: 

 

 

 

 

 

 

Art. 6(3): "In order to enable patients to make use of their rights in relation to cross-
border  healthcare,  national  contact  points  in  the  Member  State  of  treatment  shall 
provide them with information concerning healthcare providers, including, on request, 
information on a specific provider's right to provide services or any restrictions on its 
practice, information referred to in Article 4(2)(a), as well as information on patients' 
rights, complaints procedures and mechanisms for seeking remedies, according to the 
legislation  of  that  Member  State,  as  well  as  the  legal  and  administrative  options 
available to settle disputes, including in the event of harm arising from cross-border 
healthcare." 
Art. 6(5): “The information […] shall be easily accessible and shall be made available 
by  electronic  means  and  in  formats  accessible  to  people  with  disabilities,  as 
appropriate.”  
Recital  48:  “Information  that  has  to  be  provided  compulsorily  to  patients  should  be 
specified.”  
Recital 49: “The national contact points should have appropriate facilities to provide 
information on the main aspects of cross-border healthcare.“ 
Recital 48: “Information should be provided by national contact points to patients in 
any  of  the  official  languages  of  the  Member  State  in  which  the  contact  points  are 
situated. Information may be provided in any other language.”  
Recital 20: “In order to help patients to make an informed choice when they seek to 
receive  healthcare  in  another  Member  State,  Member  States  of  treatment  should 
ensure  that  patients  from  other  Member  States  receive  on  request  the  relevant 
information […]” 

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Principle 3: Transparency  
NCPs operate through transparent procedures and clear timelines.  

1. 

2. 

NCPs  provide  information  about  their  organisation  and  service.  They  try  to  answer  all 
inquiries as soon as possible subject to available resources and taking into consideration 
domestic law.  
Taking national work processes under consideration, NCPs try to collect data about their 
working process, aiming to monitor their efficiency and performance.  

3.  When this is within the NCP’s competence, NCPs are transparent on the patients’ rights and 

entitlements in accessing healthcare abroad.  

4.  When  this  is  within  the  NCP’s  competence,  NCPs  provide  patients  with  accessible  and 

transparent procedures regarding accessing healthcare abroad. 

5.  When this is within the NCP’s competence, NCPs provide outgoing patients with transparent 
procedures  and  clear  time  lines  to  appeal  any  decision  regarding  accessing  healthcare 
abroad.  

Legal standards: 

 

 

 

 

 

 

Art.  7(9):“The  Member  State  of  affiliation  may  limit  the  application  of  the  rules  on 
reimbursement  for  cross-border  healthcare  based  on  overriding  reasons  of  general 
interest, such as planning requirements relating to the aim of ensuring sufficient and 
permanent access to a balanced range of high-quality treatment in the Member State 
concerned or to the wish to control costs and avoid, as far as possible, any waste of 
financial, technical and human resources.” 
Art. 7(11): “The decision to limit the application of this Article pursuant to paragraph 
9 shall be restricted to what is necessary and proportionate, and may not constitute a 
means of arbitrary discrimination or an unjustified obstacle to the free movement of 
goods,  persons  or  services.  Member  States  shall  notify  the  Commission  of  any 
decisions to limit reimbursement on the grounds stated in paragraph 9.”  
Art.  8(1):  “The  Member  State  of  affiliation  may  provide  for  a  system  of  prior 
authorisation  for  reimbursement  of  costs  of  cross-  border  healthcare,  in  accordance 
with this Article and Article 9. The system of prior authorisation, including the criteria 
and the application of those criteria, and individual decisions of refusal to grant prior 
authorisation, shall be restricted to what is necessary and proportionate, and may not 
constitute a means of arbitrary discrimination is necessary and proportionate to the 
objective to be achieved, and may not constitute a means of arbitrary discrimination 
or an unjustified obstacle to the free movement of patients.” 
Art.  8(7):  “The  Member  State  of  affiliation  shall  make  publicly  available  which 
healthcare is subject to prior authorisation for the purposes of this Directive, as well 
as all relevant information on the system of prior authorisation.”  
Art.  9(1-4):  “The  Member  State  of  affiliation  shall  ensure  that  administrative 
procedures regarding the use of cross-border healthcare and reimbursement of costs 
of  healthcare  incurred  in  another  Member  State  are  based  on  objective,  non-
discriminatory  criteria  which  are  necessary  and  proportionate  to  the  objective  to  be 
achieved. 
Any  administrative  procedure  of  the  kind  referred  to  in  paragraph  1  shall  be  easily 
accessible and information relating to such a procedure shall be made publicly available 
at the appropriate level. Such a procedure shall be capable of ensuring that requests 
are dealt with objectively and impartially.  

  Member States shall set out reasonable periods of time within which requests for cross-
border healthcare must be dealt with and make them public in advance. […] Member 
States  shall  ensure  that  individual  decisions  regarding  the  use  of  cross-border 
healthcare and reimbursement of costs of healthcare incurred in another Member State 
are properly reasoned and subject, on a case-by-case basis, to review and are capable 
of  being  challenged  in  judicial  proceedings,  which  include  provision  for  interim 
measures.” 
Art. 9(5): “This Directive is without prejudice to Member States’ right to offer patients 
a  voluntary  system  of  prior  notification  whereby,  in  return  for  such  notification,  the 
patient receives a written confirmation of the amount to be reimbursed on the basis 
of  an  estimate.  This  estimate  shall  take  into  account  the  patient’s  clinical  case, 
specifying the medical procedures likely to apply. 

 

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 

 

  Member  States  may  choose  to  apply  the  mechanisms  of  financial  compensation 
between the competent institutions as provided for by Regulation (EC) No 883/2004. 
Where a Member State of affiliation does not apply such mechanisms, it shall ensure 
that patients receive reimbursement without undue delay.”  
Art. 20(2): “[…]The Member States shall provide the Commission with assistance and 
all available information for carrying out the assessment and preparing the reports.”  
Recital 47: “Procedures regarding cross-border healthcare established by the Member 
States  should  give  patients  guarantees  of  objectivity,  non-discrimination  and 
transparency,  in  such  a  way  as  to  ensure  that  decisions  by  national  authorities  are 
made in a timely manner and with due care and regard for both those overall principles 
and  the  individual  circumstances  of  each  case.  This  should  also  apply  to  the  actual 
reimbursement  of  costs  of  healthcare  incurred  in  another  Member  State  after  the 
patient  has  received  treatment.  It  is  appropriate  that,  under  normal  circumstances, 
patients  be  entitled  to  receive  decisions  regarding  cross-border  healthcare  within  a 
reasonable period of time. However, that period should be shortened where warranted 
by the urgency of the treatment in question.”  
Recital  49:  “National  contact  points  should  be  established  in  an  efficient  and 
transparent way […].” 

 

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Principle 4: Inclusion 
NCPs recognise and support the right of people with disabilities to equal access of healthcare in 
other EU/EEA countries under Directive 2011/24/EU. 

1. 

2. 

3. 

Subject  to  available  resources,  NCPs  offer  informed  assistance  to  help  patients  with 
disabilities  to  understand  and  exercise  their  rights  in  accessing  healthcare  abroad. 
Information provision by NCPs is provided in formats that are easily accessible for patients 
with disabilities, as appropriate. 
Subject to available resources, NCPs arrange for education and training of its staff on the 
specific  needs  of  patients  with  disabilities,  taking  into  consideration  different  types  of 
disabilities. 
All  NCPs  provide  information  to  incoming  patients  on  the  accessibility  of  hospitals  for 
persons with disabilities.  

Legal standards: 

  Art. 6(5): “The information […] shall be easily accessible and shall be made available 
by  electronic  means  and  in  formats  accessible  to  people  with  disabilities,  as 
appropriate.” 

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Guiding  Principles 
2011/24/EU 

for 

information  provision  according 

to  Directive 

Principle 5: Duality  
NCPs fulfil a dual function as gateway to cross-border health services for both outgoing patients 
going abroad for treatment as for incoming patients traveling from abroad to receive treatment 
in the Member State where the NCP is located. 

1. 

2. 

In  accordance  with  Directive  2011/24/EU,  NCPs  make  a  clear  distinction  between 
information provision to outgoing patients and information provision to incoming patients.  
NCPs facilitate the contact of patients with NCPs of other Member States.  

Legal standards: 

  Art. 6(3): “In order to enable patients to make use of their rights in relation to cross-
border  healthcare,  national  contact  points  in  the  Member  State  of  treatment  shall 
provide them with information concerning healthcare providers, […].” 

  Art.  6(4):  “National  contact  points  in  the  Member  State  of  affiliation  shall  provide 

patients and health professionals with the information […].” 

  Art. 6(2): “National contact points shall provide patients on request with contact details 

of national contact points in other Member States.”  

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Principle  6:  Information  to  outgoing  patients  in  accordance  with  Directive 
2011/24/EU 
In their role as NCP of the Member State of affiliation, NCPs provide all mandatory information 
under Directive 2011/24/EU. Besides, NCPs provide patients with practical information needed to 
ensure safe and high-quality cross-border healthcare.  

1. 

2. 

3. 

4. 

5. 

NCPs  provide  outgoing  patients  with  information  on  patients’  rights  and  entitlements  in 
cross-border health services. 
NCPs inform patients on the existence of two parallel routes if appropriate. They make a 
clear distinction on the use of the Social Security Regulations versus Directive 2011/24/EU, 
and the respective consequences for patients.  
NCPs  provide  outgoing  patients  with  information  on  the  financial  aspect  of  cross-border 
healthcare.  They  provide  information  on  the  terms  and  conditions  for  receiving 
reimbursement of costs and on what extra costs need to be covered by the patient him-
/herself.  This  includes  information  on  the  procedures  and  competent  authorities  for 
accessing and determining those entitlements, as well as on the procedures for appeal and 
redress if patients consider that their rights have not been respected.  
NCPs  inform  patients  on  the  importance  of  gathering  sufficient  information  about  the 
treatment and healthcare provider abroad. They refer the patient for this information to the 
NCP of the Member State of treatment.  
NCPs inform patients on the importance of the transfer of medical records. Patients should 
be cautioned on the risk of receiving treatment without such transfer.  

Legal standards: 

 

 

 

 

Art. 5(b): “[…] with information on their rights and entitlements in that Member State 
relating to receiving cross-border healthcare, in particular as regards the terms and 
conditions for reimbursement of costs in accordance with Article 7(6) and procedures 
for accessing and determining those entitlements and for appeal and redress if patients 
consider  that  their  rights  have  not  been  respected,  in  accordance  with  Article  9.  In 
information about cross- border healthcare, a clear distinction shall be made between 
the  rights  which  patients  have  by  virtue  of  this  Directive  and  rights  arising  from 
Regulation (EC) No 883/2004.” 
Art.  6(4):  “National  contact  points  in  the  Member  State  of  affiliation  shall  provide 
patients and health professionals with the information referred to in Article 5(b).”  
Art.  8(7):  “The  Member  State  of  affiliation  shall  make  publicly  available  which 
healthcare is subject to prior authorisation for the purposes of this Directive, as well 
as all relevant information on the system of prior authorisation.” 
Recital 31: “Where the patient is entitled to cross-border healthcare under both this 
Directive and Regulation (EC) No 883/2004, and the application of that Regulation is 
more advantageous to the patient, the patient’s attention should be drawn to this by 
the Member State of affiliation.”  

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Principle  7:  Information  to  incoming  patients  in  accordance  with  Directive 
2011/24/EU 
In their role as NCP of the Member State of treatment, NCPs provide all mandatory information 
under Directive 2011/24/EU. 

1. 

2. 

3. 

4. 

5. 

NCPs  inform  patients  on  the  importance  of  gathering  sufficient  information  on  needed 
application forms and reimbursement. They refer the patient for this information to the NCP 
of the Member State of affiliation. 
To  make  patients  acquainted  with  healthcare  in  their  country,  NCPs  provide  incoming 
patients with general information on their healthcare system, as it pertains to the individual 
patient as appropriate. 
To  ensure  safe  cross-border  treatment,  NCPs  provide  incoming  patients  with  general 
information on quality and safety standards enforced in their MS, as well as information on 
which healthcare providers are subjected to these standards.  
NCPs  provide  incoming  patients  with  accurate  information  on  healthcare  providers  and 
healthcare  facilities  established  in  their  MS  in  so  far  as  possible.  NCPs  provide  general 
information on supervision and assessment of healthcare providers. Besides, NCPs inform 
patients on a specific provider’s right to provide services or any restrictions on this practice, 
e.g. suspension, as available via the IMI or the NCP network. 
NCPs inform incoming patients on patients’ rights, complaints procedures and mechanisms 
for seeking remedies. Besides, NCPs provide information on the legal and administrative 
options  available  to  settle  disputes,  including  in  case  of  harm  arising  from  the  event  of 
cross-border healthcare, bearing in mind that this will mainly relate to referring the patient 
to the relevant responsible body. 

Legal standards: 

 

 

Art.  4(2)(a):  “Patients  receive  […],  upon  request,  relevant  information  on  the 
standards  and  guidelines  referred  to  in  paragraph  1(b)  of  this  Article,  including 
provisions  on  supervision  and  assessment  of  healthcare  providers,  information  on 
which  healthcare  providers  are  subject  to  these  standards  and  guidelines  and 
information on the accessibility of hospitals for persons with disabilities.” 
Art. 6(3): “In order to enable patients to make use of their rights in relation to cross-
border  healthcare,  national  contact  points  in  the  Member  State  of  treatment  shall 
provide them with information concerning healthcare providers, including, on request, 
information on a specific provider’s right to provide services or any restrictions on its 
practice, information referred to in Article 4(2)(a), as well as information on patients’ 
rights, complaints procedures and mechanisms for seeking remedies, according to the 
legislation  of  that  Member  State,  as  well  as  the  legal  and  administrative  options 
available to settle disputes, including in the event of harm arising from cross-border 
healthcare.” 

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Principle 8: Information provision to healthcare providers 
NCPs provide healthcare providers with information on cross-border health services. 

1. 

2. 

NCPs provide healthcare providers with information on patients’ rights and entitlements in 
cross-border  health  services  under  Directive  2011/24/EU  and  the  Social  Security 
Regulations. 
NCPs  provide  healthcare  providers  with  information  on  their  duty  to  provide  information 
towards their patients according to Directive 2011/24/EU.  

Legal standards: 

 

 

 

Art.  4(2)(b):  “Healthcare  providers  provide  relevant  information  to  help  individual 
patients  to  make  an  informed  choice,  including  on  treatment  options,  on  the 
availability, quality and safety of the healthcare they provide in the Member State of 
treatment and that they also provide clear invoices and clear information on prices, as 
well  as  on  their  authorisation  or  registration  status,  their  insurance  cover  or  other 
means of personal or collective protection with regard to professional liability.” 
Art.  6(4):  “National  contact  points  in  the  Member  State  of  affiliation  shall  provide 
patients and health professionals with the information referred to in Article 5(b).” 
Art. 5(b): “[…] with information on their rights and entitlements in that Member State 
relating to receiving cross-border healthcare, in particular as regards the terms and 
conditions for reimbursement of costs in accordance with Article 7(6) and procedures 
for accessing and determining those entitlements and for appeal and redress if patients 
consider  that  their  rights  have  not  been  respected,  in  accordance  with  Article  9.  In 
information about cross- border healthcare, a clear distinction shall be made between 
the  rights  which  patients  have  by  virtue  of  this  Directive  and  rights  arising  from 
Regulation (EC) No 883/2004.” 

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Guiding Principles for good cooperation and information exchange:  

Principle 9: Cooperation amongst NCPs 
To facilitate the exchange of information, NCPs render mutual assistance and cooperate closely 
with each other. 

1. 

2. 

3. 

NCPs  should  maintain  partnerships  amongst  each  other,  making  it  easy  to  exchange 
information and build on each other’s best practices.  
NCPs should assist each other in answering patients’ inquiries and finding solutions that are 
the best fit for the specific patient’s needs during the entire process of treatment abroad.  
NCPs should consult with other stakeholders, such as healthcare providers, national health 
insurance funds, patient organisations,… 

Legal standards: 

 

 

 

Art. 6(2): “National contact points shall facilitate the exchange of information […] and 
shall cooperate closely with each other and with the Commission.” 
Art. 6(1): “[…] national contact points consult with patient organisations, healthcare 
providers and healthcare insurers.” 
Art.  10(1):  "Member  States  shall  render  such  mutual  assistance  as  is  necessary  for 
the implementation of this Directive, including cooperation on standards and guidelines 
on  quality  and  safety  and  the  exchange  of  information,  especially  between  their 
national  contact  points  in  accordance  with  Article  6,  including  on  provisions  on 
supervision and mutual assistance to clarify the content of invoices". 

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Study on cross-border health services: enhancing information provision to patients  

Voluntary  Indicators  for  the  Guiding  Principles  for  Cross-border  Healthcare 

National Contact Points (NCPs) 

Principle 1: Visibility  

1)  NCPs are highly visible and easy to find and recognise as appropriate.  

Indicators:  
‐  NCPs conduct an everyday informative function 
‐  NCP website (independent website or at least dedicated web pages) 
‐ 

Clear statement of the NCP function and provision of contact details on the NCP website 

2)  When this is within the responsibility of the NCP and subject to available resources, NCPs try 

to be engaged in campaigns indented to inform the general public of their existence. 
Indicators:  

‐ 

Participation in conferences or events of patient organisations, healthcare providers or 

other stakeholders 

3)  To map the awareness of the existence of NCPs, and as far as possible NCPs collect data on 

the number of patients making use of the NCP service.  
Indicators:  
‐ 
‐  Website traffic estimates 

Information requests estimates 

Principle 2: Accessibility  

1)  NCPs  have  an  accessible  website  that  is  informative  and  contains  clear,  structured  and 

understandable information.  
Indicators:  
‐ 

Structured format, e.g.: 

o  Structured information (headings, sub-headings, paragraphs,…) 
o 
o  Sitemap or content tree 

Internal search engine 

‐ 

Clear  and understandable information, e.g.: 

o  FAQs 
o  Glossary 
o  Visual tools (e.g. infographics, videos,..) 
o  Guides and checklists 

‐ 

Reviewing of the NCP website on a regular basis with a minimum standard of once a year 
(this  includes  reviewing  of  contact  details,  checking  factual  accuracy,  making 
improvements based on patients’ feedback,..) 

2)  Subject to available resources and as appropriate, NCPs are accessible for direct and barrier-
free personal patient advice, e.g. via email, postal service, online contact forms, telephone, 
or in person.  
Indicators:  
‐  Multiple contact channels, e.g.: 

o  Web contact form 

‐ 

Avoidance of standard responses, e.g.: 

o  Avoidance  of  Interactive  Voice  Response  (IVR;  automated  telephony  system); 
when  IVR  is  inevitable:  clear  routing  of  callers  with  questions  on  cross-border 
treatment 

o  Avoidance of standard email responses 

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Study on cross-border health services: enhancing information provision to patients  

3)  Depending on the available resources, NCPs try to provide information besides the national 
official language(s), in foreign languages, at least English, making the service also accessible 
for incoming patients. 
Indicators:  
‐ 

Information provision in all national official languages of the country the NCP is residing 
in 
Information provision in English (other foreign languages are a plus) 

‐ 

Principle 3: Transparency  

1)  NCPs provide information about their organisation and service. They try to answer all inquiries 

as soon as possible subject to available resources and taking into consideration domestic law.   
Indicators: 
‐ 
‐ 

Information on the NCP’s organisation and service, e.g. last update website 
Reasonable periods of time, e.g.: 
o  Average response time 
o  Automated response that the enquiry is being processed 
o  Response to every incoming enquiry 

2)  Taking  national  work  processes  under  consideration,  NCPs  try  to  collect  data  about  their 

working process, aiming to monitor their efficiency and performance.  
Indicators: 
‐ 
‐  Data collection, e.g.: 

Customer feedback, e.g. online feedback form 

o  Average response time to a patient’s request 
o  Number  of  information  requests  within  the  scope  of  Directive  2011/24/EU 

received a year broken down by media (written, phone or person) 

o  Number of information requests within the scope of Directive 2011/24/EU coming 

from outgoing and incoming patients 

3)  When this is within the NCP’s competence, NCPs are transparent on the patients’ rights and 

entitlements in accessing healthcare abroad.  
Indicators: 
‐ 

Information on health services covered under Directive 2011/24/EU, e.g.: 

Information on health services that are included in the range of sickness benefits 

o 
o  Public detailed list of treatments subject to prior authorisation 

‐ 

Information on possible limitations to reimbursement (art. 7(9) Directive 2011/24/EU) 

4)  When  this  is  within  the  NCP’s  competence,  NCPs  provide  patients  with  accessible  and 

transparent procedures regarding accessing healthcare abroad. 
Indicators: 
‐ 

All requests are dealt with in an objective, transparent and non-discriminatory way 

5)   When this is within the NCP’s competence, NCPs provide outgoing patients with transparent 
procedures and clear timelines to appeal any decision regarding accessing healthcare abroad.  
Indicators: 
‐ 

Clear policy on complaints handling, e.g.: 

o  Possibility of request for review of any decision within reasonable time and taking 

into consideration national legislation 

o  Access to the complaints handling process is free of charge 
o  Receipt of each complaint is notified to the complainant within reasonable time 
o 

Information on the further courses of procedure is provided together with each 
receipt of complaint 

o  Complainants are given a timeline in which they may expect a decision 

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Principle 4: Inclusion 

1)  Subject to available resources, NCPs offer informed assistance to help patients with disabilities 
to understand and exercise their rights in accessing healthcare abroad. Information provision 
by  NCPs  is  provided  in  formats  that  are  easily  accessible  for  patients  with  disabilities,  as 
appropriate. 
Indicators: 
‐ 

Inclusive ways of communication, e.g.: 

o  Provision of information in alternative formats, such as audio, large text, braille 

version,.. 

o  Use of pictures/ infographics to support the meaning of text 

‐ 

Extra software to increase accessibility of the NCP website for patients with disabilities, 
e.g.: 

o  W3C Web Content Accessibility Guidelines 2.0 
o  A minimum standard of screen reader compatibility, self-voicing applications, alt 
text  for  images,  font  size  adjusters,  high  contrast  mode,  keyboard  navigation, 
sitemap and transcripts for video and audio 

2)  Subject to available resources, NCPs arrange for education and training of their staff on the 
specific  needs  of  patients  with  disabilities,  taking  into  consideration  different  types  of 
disabilities. 
Indicators: 
‐ 

Education and training of NCP staff on disability communication, including appropriate 
terminology and way of speaking 

3)  All NCPs provide information to incoming patients on the accessibility of hospitals for persons 

with disabilities.  
Indicators: 
‐ 

Information on the accessibility of hospitals for persons with disabilities 

Principle 5: Duality  

1)  In accordance with Directive 2011/24/EU, NCPs make a clear distinction between information 

provision to outgoing patients and information provision to incoming patients.  
Indicators: 
‐  Distinguished information for outgoing and incoming patients, e.g.: 

o  Distinguished web pages 

2)  NCPs facilitate the contact of patients with NCPs of other Member States.  

Indicators: 

‐ 
‐ 
‐ 

Contact details of other NCPs 
Links to other NCPs’ websites  
Referral to other NCPs 

Principle  6:  information  to  outgoing  patients  in  accordance  with  Directive 
2011/24/EU 

1)  NCPs provide outgoing patients with information on patients’ rights and entitlements in cross-

border health services. 
Indicators: 
‐ 

o 

Information on the legal framework for patients’ rights to cross-border healthcare, e.g.: 
Information  on  the  patient’s  right  to  cross-border  healthcare  under  Directive 
2011/24/EU 
Information  on  the  possibilities  to  access  healthcare  abroad  under  the  Social 
Security Regulations 

o 

o  Distinctive information on planned and unplanned treatment abroad 

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Study on cross-border health services: enhancing information provision to patients  

‐ 

Information on patients’ rights to cross-border healthcare, e.g.: 

o 
o 

Information on prior authorisation and which treatment is subject  
Information  on  the  use  of  prescriptions  abroad  as  detailed  in  the  Directive 
2011/24/EU and Commission Implementing Directive 2012/52/EU 

‐  Up-to-date information on patients’ rights:  

o 

Legislative  or  regulatory  amendments  or  revisions  are  followed  closely  and 
informed about 

2)  NCPs inform patients on the existence of two parallel routes if appropriate. They make a clear 
distinction on the use of the Social Security Regulations versus Directive 2011/24/EU, and the 
respective consequences for patients.  
Indicators: 
‐ 

Information on Directive 2011/24/EU and the Social Security Regulations, their scope of 
application and corresponding advantages and disadvantages 

3)  NCPs  provide  outgoing  patients  with  information  on  the  financial  aspect  of  cross-border 
healthcare. They provide information on the terms and conditions for receiving reimbursement 
of costs and on what extra costs need to be covered by the patient him-/herself, including 
information on the procedures and competent authorities for accessing and determining those 
entitlements,  as  well  as  on  the  procedures  for  appeal  and  redress  if  patients  consider  that 
their rights have not been respected.  
Indicators: 
‐ 

Information on reimbursement and rates, including need of referral and info for patients 
insured under the social security system but living in another country 
Information on the conditions and procedure for obtaining reimbursement, e.g.: 

o 

Information on terms for reimbursement 

4)  NCPs  inform  patients  on  the  importance  of  gathering  sufficient  information  about  the 
treatment and healthcare provider abroad. They refer the patient for this information to the 
NCP of the Member State of treatment.  
Indicators: 
‐ 

Information on the need to contact the NCP of the MS of treatment 

5)  NCPs inform patients on the importance of the transfer of medical records. Patients should be 

cautioned on the risk of receiving treatment without such transfer.  
Indicators: 
‐ 

Information on the importance of  the transfer of medical records, e.g.:  

o 

Information on the right of access and copy of medical record 

Principle  7:  Information  to  incoming  patients  in  accordance  with  Directive 
2011/24/EU 

1)  NCPs  inform  patients  on  the  importance  of  gathering  sufficient  information  on  needed 
application forms and reimbursement. They refer the patient for this information to the NCP 
of the Member State of affiliation. 
Indicators: 
‐ 

Referrals to other NCPs 

2)  To make patients acquainted with healthcare in their country, NCPs provide incoming patients 
with general information on their healthcare system, as it pertains to the individual patient as 
appropriate. 
Indicators: 
‐ 

Information on the healthcare and social security system, e.g.: Information on which 
care is covered by the statutory health insurance, on healthcare tariffs, on availability of 
treatment (including information on waiting lists) 

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Study on cross-border health services: enhancing information provision to patients  

3)  To  ensure  safe  cross-border  treatment,  NCPs  provide  incoming  patients  with  general 
information on quality and safety standards enforced in their MS, as well as information on 
which healthcare providers are subjected to these standards.  
Indicators: 
‐ 

Information on applicable quality and safety standards, e.g.: 

o 

o 

Information  on  bodies  responsible  for  quality  and  safety  standards  and 
supervisory authorities 
Information on which healthcare providers and healthcare facilities are subjected 
to these standards 

‐ 

Information on quality of care, e.g.: treatments per year per facility, patient satisfaction 
ratings (if any) 

4)  NCPs  provide  incoming  patients  with  accurate  information  on  healthcare  providers  and 
healthcare  facilities  established  in  their  MS  in  so  far  as  possible.  NCPs  provide  general 
information  on  supervision  and  assessment  of  healthcare  providers.  Besides,  NCPs  inform 
patients on a specific provider’s right to provide services or any restrictions on this practice, 
e.g. suspension, as available via the IMI or the NCP network. 
Indicators: 
‐  General information on healthcare providers, e.g.: professional liability, supervision and 
assessment, providers working under the statutory health insurance scheme, a specific 
provider's license status/ contact details where to check if a healthcare provider is licensed 
to practice 
Assistance in searching for healthcare providers, e.g.: 

‐ 

o 
o 

Information on finding healthcare providers and healthcare facilities 
Link to search engines for healthcare providers and healthcare facilities 

5)  NCPs  inform incoming  patients  on  patients’  rights,  complaints  procedures  and  mechanisms 
for  seeking  remedies.  Besides,  NCPs  provide  information  on  the  legal  and  administrative 
options available to settle disputes, including in case of harm arising from the event of cross-
border healthcare, bearing in mind that this will mainly relate to referring the patient to the 
relevant responsible body. 
Indicators: 
‐ 

Information on patients’ rights 
Information on complaint procedures and mechanisms for seeking remedies, e.g.: 

o 

Information on ombudsman services; on complaint procedures; on procedures to 
settle disputes; patient insurance and seeking damages after a medical error; on 
procedures  for  appeal  and  redress  against  a  health  insurer’s  decision;  on 
competent authorities/courts. 

Principle 8: Information provision to healthcare providers 

1)  NCPs  provide  healthcare  providers  with  information  on  patients’  rights  and  entitlements  in 
cross-border health services under Directive 2011/24/EU and the Social Security Regulations. 
Indicators: 
‐ 

Information intended for healthcare providers, e.g.: 

o  Separate section on the NCP website with information for healthcare providers 
o 

Information  for  healthcare  providers  on  applicable  legislation  on  cross-border 
healthcare 
Information for healthcare providers on patients’ rights and entitlements 
Information for healthcare providers on documents patients have to present 
Information for healthcare providers on equal prices for incoming patients 
Information for healthcare providers on medical records of incoming patients 
Information for healthcare providers on cross-border prescriptions 

o 
o 
o 
o 
o 

2)  NCPs  provide  healthcare  providers  with  information  on  their  duty  to  provide  information 

towards their patients according to Directive 2011/24/EU.  
Indicators: 

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Study on cross-border health services: enhancing information provision to patients  

‐ 

Information on healthcare providers’ duties and responsibilities, e.g.: 

o 

o 
o 

o 

o 

o 

Information on  a  healthcare  provider’s  duty  to  help  patients  make  an informed 
choice 
Information on interpretation 
Information on a healthcare provider’s duty to provide information on treatment 
options 
Information  on  a  healthcare  provider’s  duty  to  provide  information  on  the 
availability, quality and safety of the healthcare they provide 
Information  on  a  healthcare  provider’s  duty  to  provide  clear  invoices  and 
information on prices 
Information  on  a  healthcare  provider’s  duty  to  provide  information  on  their 
authorisation or registration status, and their insurance cover 

Principle 9: Cooperation amongst NCPs 

1)  NCPs  should  maintain  partnerships  amongst  each  other,  making  it  easy  to  exchange 

information and build on each other’s best practices.  
Indicators: 
‐ 

Partnerships and cooperation amongst NCPs, e.g.: 

o  Meet and exchange workshops with other NCPs 
o  Exchange information and best practices amongst NCPs 
o  Specific dedicated communication channels (e.g. for invoices) 

2)  NCPs should assist each other in answering patients’ inquiries and finding solutions that are 
the best fit for the specific patient’s needs during the entire process of treatment abroad.  
Indicators: 
‐ 

Information exchange between the NCP of the MS of affiliation and the NCP of the MS of 
treatment 

3)  NCPs  should consult  with other  stakeholders,  such as  healthcare  providers, national  health 

insurance funds, patient organisations,… 
Indicators: 
‐ 

Consultation with other stakeholders 

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Study on cross-border health services: enhancing information provision to patients  

ANNEX B – MAIN TRENDS BASED ON THE ONLINE SURVEY TO NCPS 

Template online survey NCPs 

NCPs for Cross-border Healthcare Survey 2017 

#  Question  

1 

The NCP of which MS do you represent? 

2  What is the name of the NCP you represent? 

3  What is the e-mail address of the NCP you represent? 

4 

5 

6 

7 

8 

9 

How many NCPs in total are installed in your MS? Please explain when more than one 

How is your NCP organised?  

Is the NCP organised as a separate organ or integrated into another service that is also engaged in 
other matters? 

Do you have a separate organisational division competent for outbound and inbound patients? If yes, 
please explain  

How many FTEs (full-time equivalents) work for the NCP? 

Does your NCP include a multidisciplinary team? If yes, please explain 

10  How is the NCP funded? Please explain  

11  Since when has the NCP been operational to the general public? 

12  Since when has the website been accessible to the general public? 

13  What are the possible ways of contacting the NCP? 

14 

Is your NCP active on social media? If yes, through which channels? 

15  Do you plan to add communication channels in order to become more accessible to the general public? 

If yes, which channels? 

16  Are you aware of any activities carried out by your MS or NCP in order to inform the general public of 

the existence of the NCP? If yes, please explain  

17  Can you indicate the time period as well as the duration of time at which the activities referred to in 

the previous question were running?  

18  According to your experience, are most patients aware of the existence of the NCP in your country? 

19 

In the past year, how many patients requested information from the NCP per month (on average)? 

20  What  is  the  average  number  of  information  requests  in  the  course  of  one  single  cross-border 
healthcare event initiated by any stakeholder? Please be as specific as you can be with regard to the 
data gathered since your NCP function has been set up 

21  What  would  you  estimate  is  the  average  time-period  it  takes  your  NCP  to  process  an  information 

request? 

22  Do foreign patients contact you when seeking cross-border healthcare in your country? 

23 

In how many languages do you provide information?  

24  Please explain in which languages your NCP provides information  

25  Do  you  make  a  difference  in  use  of  language  for  information  provision  to  inbound  or  outbound 

patients? 

26  Was the NCP website developed on the basis of W3C Web Content Accessibility Guidelines 2.0? 

27  Has the NCP website been tested by visually impaired people? 

28  How would you rate the level of cooperation and information sharing with stakeholders?  

29  Please  give  a  short  overall  explanation  of  the  dialogues  in  place  between  the  NCP  and  other 

stakeholders 

30  Does your NCP provide the information requested by the patient directly or does the NCP refer the 

patient with their questions to other stakeholders? 

31  What are the reasons for (in some cases/most of the time) preferring to refer the patient to other 

stakeholders?  

32  Do you sometimes experience difficulties in gathering all the information needed to answer patients' 

questions? 

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Study on cross-border health services: enhancing information provision to patients  

NCPs for Cross-border Healthcare Survey 2017 

33  Are you aware of the official number of national patients using healthcare abroad under the Directive 

2011/24/EU? If yes, please fill in the number  

34  Are  you  aware  of  the  official  number  of  foreign  patients  using  public  or  private  healthcare  in  your 

country? If yes, please fill in the number 

35 

Is it possible to come to any conclusion as to the most often visited countries by outbound patients 
from your MS? 

36  Please provide comments on the main reasons for the outbound patient’s country of choice 

37 

Is it possible to come to any conclusion as to the typical countries of origin of inbound patients seeking 
cross-border healthcare in your MS? 

38  Please provide comments on the main reasons for which inbound patients seek medical treatment in 

your MS  

39 

40 

Is it possible to come to any general conclusions as to the types of treatment most frequently sought 
by outbound patients? 

Is it possible to come to any general conclusions as to the types of treatment most frequently sought 
by inbound patients? 

41  According to your experience, what is the level of awareness of patients regarding the existence of 
the right to receive cross-border treatment in a different MS under the Social Security Regulation (EC) 
No 883/2004 or the Cross-border Healthcare Directive 2011/24/EU? 

42  Do  you  make  a  clear  distinction  between  the  right  of  cross-border  healthcare  and  the  different 
conditions  under  the  Directive  2011/24/EU  and  under  the  Social  Security  Regulation  (EC)  No 
883/2004 on your website and in your contact with patients? 

43  Does your NCP provide information about the relevant provisions under the Social Security Regulation 

(EC) No 883/2004? 

44  Do you experience difficulties in communicating the difference between the relevant provisions of the 

Directive 2011/24/EU and those of the Social Security Regulation (EC) No 883/2004? 

45  Do you inform patients of the fact that the Social Security Regulation (EC) No 883/2004 will prevail 
in case it is more beneficial for them, unless the patient explicitly requests otherwise and explicitly 
asks for the applicability of the Directive 2011/24/EU? 

46  Does your NCP make a distinction between information provision to inbound and outbound patients? 

If yes, how? 

47  Do you provide general information on the healthcare system of your MS? If yes, please explain if you 

provide this information on your website, by telephone,… 

48  Do you provide general information on the healthcare system of other MSs? If yes, please explain if 

you provide this information on your website, by telephone,… 

49  Do most information requests concern public or private healthcare? 

50  Please  evaluate  the  frequency  of  information  requests  by  patients  seeking  cross-border  healthcare 

regarding the following topics:  
Hospitals and healthcare providers/ Quality and safety of healthcare providers/ Waiting times/ Medical 
documentation/ Travel and accommodation/ Reimbursement process and level of costs/ Procedures 
for complaint and redress/Language used  

51  Does your NCP provide information on prior authorisation? 

52  Has your MS opted for a system of prior authorisation in certain cases? 

53 

If  there  is  a  system  of  prior  authorisation  in  place,  what  types  of  treatment  are  subject  to  prior 
authorisation in your country? Please describe briefly 

54  Has a detailed list of treatments that are subject to prior authorisation been published in your country? 

55  What is the time-limit for granting/refusing a prior authorisation's request? 

56  Does your NCP provide information on reimbursement?  

57 

Is there a national tariff for treatments? Please explain 

58  Are there domestic reimbursement rules other than the tariffs that are applied? 

59  Are there any specific rules on tariffs that are applied for cross-border healthcare? 

60  According to your experience, do health insurance companies experience difficulties in the recognition 
of  treatments  provided  in  another  MS?  For  example  due  to  different  basket  of  treatments?  Please 
explain  

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NCPs for Cross-border Healthcare Survey 2017 

61 

62 

 In  your  view,  does  paying  the  costs  of  cross-border  healthcare  upfront  under  the  Directive 
2011/24/EU cause any difficulty for patients? Please explain  

In order to reduce the financial burden of upfront payment for the patient, has your MS opted for a 
system of financial compensation directly between institutions? 

63  What kind of documentation must be submitted by the patient in order to be reimbursed?  

64  What is the average time period for the reimbursement of a patient's invoice starting from the delivery 

of the documentation? 

65 

Is there a possibility to cover the extra costs of the patient as well (e.g. accommodation, travel,..)? 
If yes, which extra costs precisely? 
Which documents are needed in order to have this kind of reimbursement (e.g. invoices translation 
of invoices,..)?  

66  Are  you  involved  in  a  process  to  monitor  whether  healthcare  providers  comply  with  their  duties? 

Please explain  

67  Do  you  have  access  to  information  on  healthcare  providers  their  right  to  practice  or  possible 
restrictions to this right (e.g. suspension)? If yes, please explain where you get this information 

68  Does your NCP provide information on the following topics? Information on procedures for complaint 
and redress/ information on quality and safety standards/ information on the accessibility of hospitals 
in your MS for persons with disabilities/ information on how to contact other NCPs in other MSs  

69  What do you consider to be the most important improvements under the Directive 2011/24/EU? 

70  What do you think could be improved or developed in order to further enhance NCP practice 

71  Do you have any other comments or suggestions?  

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Study on cross-border health services: enhancing information provision to patients  

1.2. Findings  

Organisational context of NCPs 

There are great organisational differences between NCPs, regarding:  

  Single/multiple contact points; 
  Host institution; 
 
  Staff; 
  Organisational handling incoming/ outgoing patients. 

Funding; 

The online survey confirmed great organisational differences between NCPs. Most MSs have opted 
for  one  single  NCP.  In  other  MSs  multiple  contact points  are  established.  In  case  of  the latter, 
different  approaches  may  be  distinguished:  two  different  NCPs  for  incoming  and  outgoing 
patients,  Multiple  NCPs  for  autonomous  regions,  or  one  “umbrella”  NCP  acting  as  coordinating 
NCP for multiple RCPs.  

The online survey showed four main categories of host institutions for the NCP:  

  NCP as part of a ministry; 
  NCP as part of a national health insurance fund/ social health insurance institute/ NHS; 
  NCP as part of an association between health insurance funds; 
  NCP as part of a government agency or public service. 

Almost all NCPs are integrated into a service that is also engaged in other matters, such as for 
example,  social  security,  patient  counselling,  patients’  rights,  supervision  and  licensing  of 
healthcare  providers,  quality  and  safety  standards  and  health  research.  Nearly  all  overarching 
bodies  were  also  engaged  in  matters  concerning  the  Social  Security  Regulations.  A  number  of 
NCPs explicitly mentioned to be also designated as liaison body between the national and foreign 
social security institutions under the Regulations.  

The survey showed that MSs have opted for different funding strategies for NCPs. Most NCPs that 
answered the question stated to be funded directly from the budget of the competent ministry or 
through  general  taxation  (Austria,  Cyprus,  Denmark,  Estonia,  Finland,  Hungary,  Italy,  the 
Netherlands,  Norway,  Malta,  Iceland,  Ireland,  Lithuania  (NCP  incoming  patients),  Luxembourg 
(NCP  incoming  patients),  Portugal,  Sweden).  A  number  of  NCPs  is  funded  within  the  financing 
system of the national health insurance fund or social health insurance institute (Croatia, Lithuania 
(NCP outgoing patients), Poland, Romania, Slovenia), or by compensations of all health insurance 
funds  (Czech  Republic,  Germany,  Latvia,  Slovakia).  Another  funding  strategy  mentioned  was 
funding by different stakeholders based on a common agreed distribution key (Belgium). Finally, 
the  survey  showed  that  for  two  out  of  29  NCPs  there  is  no  special  funding(Greece  and  United 
Kingdom).  

Regarding the NCP staff, the number of full-time equivalent (FTE) staff members working for the 
NCP  function  is  ranging  from  zero  in  the  Lithuanian  NCP  for  incoming  patients  to  ten  in  the 
Lithuanian NCP for outgoing patients (mean = 2). Most NCPs have between one and three FTEs. 
The survey shows that out of 27 NCPs, most NCPs with four or more than four FTEs are hosted in 
a national health insurance fund or social health insurance institute/ NHS these include the NCPs 
of Croatia, Estonia, Finland and Lithuania (outgoing patients) 

Figure B.1 Number of FTE per NCP (n = 27) 

15 NCPs

4 NCPs

4 NCPs

4 NCPs

0 ≤ 1 FTE

1 ≤ 3 FTE

4 ≤ 6 FTE

7 ≤ 10 FTE

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Study on cross-border health services: enhancing information provision to patients  

On the question if the NCP staff consists of a multidisciplinary team, positive and negative answers 
were almost equally divided. However, slightly more NCPs stated not to include a multidisciplinary 
team. Out of 30 NCPs that answered the question, 14 NCPs confirmed to have representatives of 
different  disciplines  amongst  their  staff  members,  such  as  for  example  lawyers,  office  clerks, 
physicians,  economists,  reimbursement  scheme  specialists  and  communication  counsellors.  A 
number of NCPs highlighted that according to necessity also colleagues of other departments are 
involved in the NCP function.  

Figure B.2 Multidisciplinary NCP teams (n = 30) 

Does your NCP include a 
multidisciplinary team?

No

Yes

16 NCPs

14 NCPs

Finally, NCPs were asked if they have separate organisational divisions competent for outgoing 
and  incoming  patients.  Only  four  NCPs  answered  yes,  including  the  NCP  of  Estonia,  Hungary, 
Lithuania (outgoing patients) and Sweden (outgoing patients) (n = 31). The NCPs of Lithuania 
and Sweden stated to have separate NCPs in their country competent for outgoing and incoming 
patients,  each  with  their  own  organisational  structure  and  staff.  The  Estonian  NCP,  that  is  the 
single  NCP  in  the  country  concerned,  stated  to  make  an  internal  organisational  distinction  by 
means of different staff.  

However,  the  answers  show  that  the  question  is  possibly  interpreted  too  narrowly  by  some 
respondents of MSs where there are two separate NCPs for outgoing and incoming patients. Four 
of such NCPs (i.e. the NCPs for incoming patients of Lithuania and Sweden as well as both NCPs 
of  Luxembourg),  have  answered  the  question  negatively,  assumingly  only  referring  to  the 
organisational  context  within  their  own  NCP  and,  as  a  result,  overlooking  the  organisational 
distinction in two independent NCPs at MS level.  

Figure B.3 Separate divisions for outgoing and incoming patients (n = 31) 

Do you have a separate organisational
division competent for 
outbound and inbound patients?

No

Yes

3 NCPs*

28 NCPs*

Communication channels  

Most NCPs are reachable through a variety of communication channels. Besides, 
most NCPs also offer the possibility of in-person consultations.   

The online survey showed that, on top of the websites available for all NCPs, NCPs are reachable 
through a variety of communication channels. Most NCPs can be contacted via telephone, e-mail 
and in person. A number of NCPs is also reachable through other channels, like traditional postal 
letter, fax or an online contact form. Four NCPs stated to be solely accessible through one single 
communication channel. The NCP of Austria, Finland and Portugal answered that the only way of 
contacting the NCP is through e-mail. The Finnish NCP also had an exclusive phone line in the 
past, which was closed due to low traffic. The Dutch NCP can only be contacted through an online 
contact form on the NCP website.  

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Study on cross-border health services: enhancing information provision to patients  

Figure B.4 Available channels of NCPs (n = 31) 

12 NCPs

8 NCPs

4 NCPs

3 NCPs

2 NCPs

1 NCP

1 NCP

Phone + email
+ in person

Phone + email
+ in person
+other

Phone + email

Email

Phone + email
+ other

Online contact
form

Email + other

*Other =  letter, fax, or online contact form

The most common means of contacting an NCP is through email. Out of 31 NCPs, all NCPs except, 
the  NCP  of  the  Netherlands  which  only  provides  an  online  contact  form,  indicated  to  provide 
information through email. Telephone is the second most common means and is used by 26 NCPs. 
Thirdly, 20 out of 30 NCPs offer the opportunity of in-person consultations at the NCP office.  

Figure B.5 Means of contacting the NCP (n = 31) 

30 NCPs

26 NCPs

20 NCPs

5 NCPs

4 NCPs

3 NCPs

Email

Phone

In person

Letter

Online contact
form

Fax

Almost all NCPs stated to provide information in English. Besides, information is 
sometimes also provided in other non-official languages.  

The online survey found that almost all NCPs self-report to provide information in English. NCPs 
were asked to enumerate the languages in which they provide information. 30 out of 31 NCPs 
listed English. Only the NCP of Iceland reported to only communicate in the own language. The 
NCP  for  incoming  patients  of  Luxembourg  mentioned  they  already  communicated  in  English  to 
patients, but that the NCP website was not jet available in English, which is planned for the end 
of 2018. The NCP of Malta reported to only provide information in English, as English is a official 
language. However, they do not provide information in Maltese, regardless of the fact that this is 
also an official language. Besides, seven NCPs indicated to also provide information in other non-
official languages.  

Four NCPs stated to provide personal counselling in additional languages besides the languages 
used  on  the  NCP  website.  The  NCP  of  Czech  Republic  even  mentioned  the  use  of  external 
translation services for any other EU languages.  

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Study on cross-border health services: enhancing information provision to patients  

Only  five  NCPs  out  of  31  seem  to  be  active  on  social  media.  Some  other  NCPs  still  prefer 
conventional media, like newspapers, radio and television to inform the public. 

Eight out of 31 NCPs stated to be active on social media. However, the survey data showed that 
this number has to be nuanced. NCPs were asked to specify on which social media channels they 
are active. Out of the eight NCPs that answered the question positively, only five NCPs listed social 
media  channels,  like  Twitter,  Facebook  and  LinkedIn,  including  the  NCP  of  Denmark,  Finland, 
France, Iceland and Lithuania (outgoing patients). The other three NCPs clarified to be active on 
conventional media, such as newspapers, website, radio and television.  

Figure B.6 Social media activities of NCPs (n = 31) 

Is the NCP active on social media? 

No

Yes

23 NCPs

8 NCPs

The  Danish,  Finnish  and  French  NCPs  stated  to  be  active  on  Twitter.  The  Lithuanian  NCP  for 
outgoing patients and the Icelandic NCP are active on Facebook. Only the Danish NCP mentioned 
to have a LinkedIn profile. The Lithuanian NCP for outgoing patients mentioned to be active on 
“all channels”. A quick scan of the NCP’s website shows that the NCP is also active on Youtube 
and Instargram.5 Of the 23 NCPs that answered not to be active on social media, the NCP of Czech 
Republic mentioned to have had a Facebook page in the past, which was deleted because it proved 
to be ineffective. The Italian NCP mentioned to have an app for consultation of healthcare abroad, 
called “Se Parto per”.  

NCPs were also asked if they planned to add more communication channels in the future. Eight 
out of 31 NCPs stated to have indeed additional channels under consideration.  

Figure B.7 Additional channels under consideration (n = 31) 

Do you plan to add 
communication channels?

No

Yes

23 NCPs

8 NCPs

Five NCPs plan to add social media channels, of which Facebook is the most mentioned. Four NCPs 
intend to improve the actual channels, such as their website. The Greek NCP explicitly mentioned 
to plan to develop an enhanced upgrade of the English version of the NCP website. The Estonian 
NCP reported to be in the process of developing a self-service portal and mentioned the following: 
“We are in the process of developing our own Estonian Health Insurance Fund's self-service portal 
to  make  it  easier  for  people  to  contact  us  and  also  among  other  services  have  access  to 
information regarding cross-border healthcare”. 

The Norwegian NCP answered no to the question, but specified that despite of the fact that there 
are not yet specific plans to add more communication channels, they are considering a live chat 
and other technological solutions.6  

5   One respondent answered to be active on all social media channels. A short analysis of the NCP website 

showed that the NCP concerned was active on Facebook, YouTube, Instagram and Flickr.  

6   Despite the fact that it is not mentioned in the online survey, the website analysis shows that one other 

NCP website already contains a live chat.  

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Study on cross-border health services: enhancing information provision to patients  

All NCPs have a website available. Already a number of NCP websites is developed on the 
basis of the W3C Web Content  Accessibility Guidelines 2.0. However, the online survey 
showed there is still room for improvement.  

As mentioned, all NCPs have a website available. Due to the fact that a website analysis is already 
conducted, the online survey did not focus on NCP websites. However, as it is of great importance 
those  NCPs  are  easily  accessible,  the  online  survey  did  ask  some  questions  regarding  the 
accessibility of the website for visually impaired people.  

Figure B.8 Website accessibility (n = 25)  

Was the NCP website developed on 
the basis of W3C Web Content Accessibility 
Guidelines 2.0?

No

Yes

10 NCPs

15 NCPs

Figure B.9 Testing of the website by visually impaired people (n = 26)  

Has the NCP website been tested 
by visually impaired people?

No

Yes

18 NCPs

8 NCPs

Patient awareness  

Only half of the NCPs were aware of any activities carried out in order to inform the 
general pubic of the existence of the NCP. Besides, some NCPs referred to the 
information on the NCP website, which often already presupposes a level of 
awareness on the part of the user. This may explain why patient awareness of the 
existence of NCPs is generally considered to be low, as well as the limited number of 
information requests some NCPs receive. 

15 out of 29 NCPs indicated that activities are carried out to inform the public of their existence, 
such as announcements in the media, press conferences, presentations, trainings for healthcare 
providers, and participation in public events. Two NCPs stated to have distributed a leaflet. The 
Polish NCP has issued two books and a briefer leaflet on the comparison between the Directive 
and the Social Security Regulations. The NCP of Luxembourg for outgoing patients has developed 
an informative leaflet explaining the NCP mission. Since 2016, the flyer is made available in most 
hospitals and other healthcare structures in the MS, and is resent on demand. The NCP stated 
that: “A flyer concerning our missions is available in most hospitals and in many other healthcare 
structures.  It  concerns  both  NCP  and  non  NCP  missions.  The  national  Health  Portal  and  the 
Internet  site  of  CNS  have  detailed 
informed. 
Patientevertriedung,  an  independent  patient  organisation,  is  offering  an  independent  monthly 
information  session  with  focus  on  cross-border  healthcare  rights  (mainly  focussing  on 
reimbursement issues)”. 

information.  Patient  associations  are 

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Study on cross-border health services: enhancing information provision to patients  

Figure B.10 Public campaigns (n = 29)  

Are you aware of any activities carried out 
by your MS or NCP in order to inform 
the general public of the existence of the NCP?

No

Yes

14 NCPs

15 NCPs

Out of the 15 NCPs that answered yes, five NCPs referred to the existence of the NCP website. 
However, when patients or stakeholders consult the NCP website, most of the time this already 
presupposes that they are aware of the existence of the NCP.  

Ten out of the 15 NCPs indicated that the activities are held on a regular basis. As regards the 
other five NCPs, including the NCP of Belgium, Italy, Latvia, Poland, Slovakia, the activities took 
only  place  during  a  short  period  of  time  after  the  implementation  of  the  Directive.  The  NCP  of 
Portugal  reported  to  be  not  aware  of  any  activities  to  inform  the  general  public  on  Directive 
2011/24/EU, as this is not within the competence of the NCP. 

A  high  number  of  NCPs  was  not  aware  of  any  information  campaigns  targeted  at  the  general 
public to raise awareness of the existence of the NCPs (14 out of 29 NCPs). This can explain why 
patient awareness of the existence of NCPs is generally considered to be low.  

No less than 22 out of 31 NCPs experience a low level of patient awareness. More specifically, 
71% of the NCPs that participated in the survey believe that most patients are not aware of their 
existence. 

Figure B.11 Patient awareness of the existence of NCPs (n = 31)  

According to your experience, are most
patients aware of the existence of the NCP? 

No

Yes

22 NCPs

9 NCPs

The  remarkably  low  level  of  patient  awareness  may  in  turn  explain  the  limited  number  of 
information requests NCPs receive.  

Figure B.12 Number of information requests per NCP (n = 29)  

3 NCPs

5 NCPs

2 NCPs

19 NCps

≤  50 requests 

50 ≤ 100 requests 

100 ≤ 500 requests 

≥ 1000 requests 

NCPs were asked how many information requests on average they received monthly in the past 
year.  NCPs  received  on  average  185.6  requests  each  month.  However,  great  outliers  can  be 
determined (n = 29; range 1 to 1340; mean = 37). 19 NCPs received less than 50 requests each 
month  (n  =  19;  range  1  to  50;  mean  =  14).  Eight  of  these  19  NCPs  received  less  than  ten 
requests. On the contrary, three NCPs received 1000 or more requests a month.  

The NCP of the UK commented that it did not answer the question explained that they rarely get 
any direct information request, as most patients usually get in touch with them using different 
routes.  

The online survey showed that for most NCPs it takes less than a week to process an information 
request.  

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Study on cross-border health services: enhancing information provision to patients  

Figure B.13 Estimated time period to process an information request (n = 29) 

18 NCPs

4 NCPs

6 NCPs

1 NCP

Less than a week

A week

More than a week

Several weeks

Next to the awareness of patients of the existence of NCPs, also the general patient awareness of 
the right to receive reimbursable cross-border healthcare under the Directive 2011/24/EU or the 
Social Security Regulations was in general not considered to be high.  

Figure  B.14  Patient  awareness  of  the  right  on  reimbursable  cross-border  treatment  
(n = 29) 

15 NCPs

3 NCPs

5 NCPs

5 NCPs

1 NCP

Very poor

poor

Moderate

Good

Very good

Cross-border healthcare  

Most NCPs are not aware of the official number of outbound and inbound patients using cross-
border healthcare under Directive 2011/24/EU. None of the NCPs was aware of the official number 
of incoming patients (n = 27). 11 out of 25 NCPs could provide the official number of outgoing 
patients, ranging from 2 to 3000 patients (mean = 414.5). The low number of NCPs answering 
this  question,  may  be  explained  by  the  fact  that  NCPs  are  often  not  the  instance  in  charge  of 
collecting such data.  

The online survey asked if most information requests concern public or private healthcare. Most 
NCPs stated to mostly receive information requests regarding public care. This seems not to be 
the case in Cyprus, Finland, Ireland, Latvia and Norway. 

Figure B.15 Public/ private healthcare (n = 27) 

Do most information requests 
concern public or 
private healthcare?

5 NCPs

22 NCPs

Public

Private

NCPs  were  asked  to  share  their  opinion  on  the  main  reasons  for  which  outbound  and  inbound 
patients  seek  cross-border  treatment  outside/in  their  MS.  NCPs  could  choose  out  of  four 
categories,  which  were  chosen  based  on  findings  in  literature  and  official  data.  Besides,  NCPs 
could add other reasons.  

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Study on cross-border health services: enhancing information provision to patients  

Figure B.16 Main reasons of outbound patients (n = 29) 

11 NCPs

8 NCPs

14 NCPs

5 NCPs

6 NCPs

To receive not
available treatment

To receive better
quality treatment

To receive treatment
more quickly

To receive cheaper
treatment

Other

Figure B.17 Main reasons of inbound patients (n = 27) 

4 NCPs

3 NCPs

7 NCPs

6 NCPs

To receive not
available treatment

To receive better
quality treatment

To receive treatment
more quickly

To receive cheaper
treatment

3 NCPs

Other

NCPs experience that both outgoing and incoming patients most often travel abroad to receive 
treatment  more  quickly.  Other  reasons  that  were  mentioned  for  outgoing  patients  to  receive 
cross-border  treatment  include  treatment  in  private  facilities,  medically  necessary  treatment, 
familiarity with healthcare systems abroad, to receive treatment closer to family members, and 
the activity of companies and agencies which coordinate and organise the access to healthcare 
abroad. For incoming patients, the reasons additionally mentioned were private stays, medically 
necessary treatment, commuting from neighbouring countries and medical tourism. The NCPs of 
Estonia  and  Czech  Republic  explicitly  mentioned  that  there  were  no  official  data  available  of 
incoming patients. The Belgian NCP indicated to not have such specific information available both 
for incoming and outgoing patients.  

25 out of 31 NCPs indicated that their MS has opted for a system of prior authorisation. The NCP 
of the Czech Republic, that did not opt for a system of prior authorisation, explicitly stated that it 
would  be  very  useful  to  have  a  detailed  list  of  prior  authorisation  measures  in  other  MSs.  The 
Directive 2011/24/EU requires that each state has to make publicly available which healthcare is 
subject to prior authorisation. However, only 13 out of 30 NCPs indicated that a detailed list of 
treatments subjected to prior authorisation was published in their MS. 

The  survey  showed  that  on  average  it  takes  31  days  to  grant  or  refuse  a  request  for  prior 
authorisation (n = 19). The NCP of Luxembourg that is competent for outgoing patients answered 
that there is no time-limit in their MS. The Dutch and Austrian NCP indicated to not have such 
information available.  

Figure B.18 Time-limit for granting/refusing a request of prior authorisation (n = 19) 

Days 

14

14

15

20

21

5

7

30

30

30

30

30 31,5 35

45

45

75

60

60

The survey also asked some questions regarding reimbursement. 10 out of 24 NCPs stated that 
health  insurance  companies  experience  difficulties  in  the  recognition  of  treatments  provided  in 
another MS. Most common reasons mentioned were difficulties resulting from different invoicing 
systems, making it often challenging for health insurers to determine which specific healthcare 
was provided. NCPs also stated that the use of different DRG coding systems is experienced as a 
significant barrier. The NCP of Ireland mentioned the need for a means of cross-matching DRG 
codes of different countries, stating that “Ideally there would be a means of inputting a DRG code 
from one country for cross match with another country”.  

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Study on cross-border health services: enhancing information provision to patients  

NCPs  were  also  asked  which  documents  must  be  submitted  by  patients  in  order  to  receive 
reimbursement.  Most  frequently  returning  answers  include  prior  authorisation  forms,  referrals, 
medical records of the treatment, prescriptions of medicines, and original invoices, including bills 
for prescriptions. The French NCP, the Estonian NCP, the Romanian NCP, Hungarian NCP and the 
Italian  NCP mentioned  the  need  to  present  an  official  application  form  for  reimbursement.  The 
NCP  of  Ireland  also  reported  the  need  to  present  a  GP  referral  letter  or  waiting  list  letter,  an 
original  invoice,  proof  of  travel  and  an  optional  pro-forma  invoice.  The  NCP  of  Czech  Republic 
mentioned the need to present a translation of invoice in cases where the Czech Health Insurance 
Fund does not know the original language. Also the NCP of Luxembourg listed the need to present 
bills in a language understandable for the clerk. The NCP of Norway also mentioned the need to 
present a proof of the authorisation status of the healthcare provider abroad. The NCP of Greece 
indicated  the  need  to  present  amongst  others  a  proof  of  the  professional  status  of  the  foreign 
healthcare provider, as well as documentation on “the patient's history (in cases of hospital care) 
and in cases of patients with certified disabilities who have received relevant prior authorisation, 
proof of payment for travelling and accommodation expenses”. The NCP of Portugal stated that 
the patient amongst other things has to provide information from the family doctor confirming 
the need for the treatment. The Romanian NCP included the need of a referral from a Romanian 
healthcare professional which has a contractual relationship with the health insurance house. 

The  survey  showed  that  on  average  it  takes  45  days  for  patients  to  obtain  reimbursement  for 
healthcare received abroad (mean; n = 19). However, for three NCPs the time-limit mentioned is 
only applicable when there is no need for gathering additional information. In some cases, specific 
time frames have to be respected. Other NCPs gave the time-limit that was handled in practice. 
Also here, it should be kept in mind that NCPs are not always the instance competent for collecting 
such data. 

Figure B.19 Time-limit for reimbursement (n = 19) 

360

Days 

14

20

20

28

30

30

30

37

40

45

60

60

65 69,5

90

90

90 105

Two out of three NCPs identified upfront payment as an impediment. 
NCP of Luxembourg: “Directive 2011/24/EU: medicine for the rich, not the poor” 
NCP of Estonia: “Yes, because the costs for different services are much higher in other 
MSs. Patients who do not contact us beforehand to find out in what amount they most 
likely would be reimbursed are unsatisfied with the reimbursement sum”. 
NCP of Germany: “Often the costs are high and the patient does not exactly know how 
much he will get reimbursed”. 
NCP of Greece: “Mostly the patients resent the bureaucracy (translated and 
authenticated docs etc.) involved and the time they have to anticipate 
reimbursement.” 

Two out of three NCPs identified upfront payment as a barrier for patients to receive cross-border 
treatment under Directive 2011/24/EU (n = 27). Only three out of 28 NCPs stated that in order 
to  reduce  the  financial  burden  of  upfront  payment,  there  was  a  system  in  place  of  financial 
compensation directly between institutions. More specifically, such system is provided in Belgium, 
Germany and France. The French NCP stated that “France has submitted certain heavy treatments 
with prior authorisation and the insured must obtain an S2 form. Therefore, if this form is granted, 
the  patient  does  not  have  to  advance  the  expenses,  except  for  the  possible  co-payment.  In 
addition,  France  has  concluded  certain  cross-border  agreements  with  Belgium,  Germany, 
Switzerland  and  Spain  containing  specific  financial  provisions:  settlement  of  expenses  by  the 

40 

 
 
 
Study on cross-border health services: enhancing information provision to patients  

social security funds of the country of care on behalf of France or reimbursement of health care 
providers directly by the French social security funds, sometimes on the basis of negotiated rates”. 
The NCP of Germany mentioned contracts between healthcare insurers and healthcare providers 
abroad, resulting in third party payments. The Czech NCP stated that in their point of view such 
system is legally not possible. 

Figure B.20 Upfront payment (n = 27) 

In your view, does paying the costs of 
cross-border healthcare upfront under 
the Directive cause any difficulty for patients?

No

Yes

9 NCPs

18 NCPs

13 out of 28 NCPs indicated that there is a possibility in their MS to cover extra costs for travel 
and accommodation. Two NCPs indicated that this was depending on the financial situation of the 
patient.  The  NCP  of  Greece  mentioned  that  this  was  only  possible  for  patients  with  a  certified 
disability, after prior authorisation based on case-by-case assessment. 

Figure B.21 Reimbursement of extra costs (n = 28) 

Is there a possibility to cover the extra costs 
of the patient (e.g. accommodation, travel,..)?

No

Yes

15 NCPs

13 NCPs

The  online  survey  showed  that  18  out  of  30  NCPs  have  access  to  information  on  a  healthcare 
provider’s right to practice or possible restrictions placed on this right. Six NCPs mentioned they 
do not have direct access to such information but that they can request such information from 
the  competent  authorities.  The  Irish  NCP  mentioned  the  use  of  the  IMI  system  to  request 
information on healthcare providers abroad. Other NCPs have access to the information through 
public registers or online databases.  

Figure B.22 Healthcare providers’ right to practice (n = 30) 

Do you have access to information on 
healthcare providers their right to practice 
or possible restrictions to this right?

No

Yes

12 NCPs

18 NCPs

Information provision  

Almost all NCPs indicate to provide information on the Social Security Regulations. 
Besides, most NCPs state to make a clear distinction between the right on cross-
border treatment under Directive 2011/24/EU and the Social Security Regulations. 
However, a high number of NCPs experience difficulties in providing information on 
this distinction.   

It  is  almost  impossible  to  treat  Directive  2011/24/EU  independently  from  the  Social  Security 
Regulations.  NCPs  therefore  also  have  the  duty  to  inform  patients  on  the  differences  between 
both legal instruments. Besides, NCPs have to draw patients' attention to the priority rule the EU 
legislator has installed in favour of the Regulations, more specifically, to the fact that when the 
conditions  for  its  application  are  met,  the  Social  Security  Regulations  will  prevail  (unless  the 
patient specifically requests otherwise).  

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Study on cross-border health services: enhancing information provision to patients  

Figure B.23 Information on the Social Security Regulations (n = 31) 

Does your NCP provide information about 
the relevant provisions under the 
Social Security Regulation (EC) No 883/2004?

No

2 NCPs

Yes

29 NCPs

Figure B.24 Priority of the Social Security Regulations (n = 30) 

Do you inform patients on the priorty of 
the Social Security Regulations,
unless explicit request? 

5 NCPs

No

Yes

25 NCPs

The  survey  showed  that  almost  all  NCPs  stated  to  provide  information  on  the  Social  Security 
Regulations. Five out of six NCPs also indicated to inform patients on the priority of the Social 
Security Regulations, unless specifically requested otherwise by the patient. 

Besides, 27 out of 30 NCPs declared to make a clear distinction between the right on cross-border 
treatment  and  the  different  conditions  under  Directive  2011/24/EU  and  under  the  Regulations, 
both on the NCP website as in their direct contact with patients.  

Figure  B.25  Distinction  between  Directive  2011/24/EU  and  the  Social  Security 
Regulations (n = 30) 

Do you make a clear distinction between 
the right of cross-border healthcare under the 
Directive/ the Social Security Regulation?

No

3 NCPs

Yes

27 NCPs

However,  on  the  question  if  the  NCP  sometimes  experienced  difficulties  in  communicating  the 
differences  between  the  relevant  provisions  of  Directive  2011/24/EU  and  those  of  the  Social 
Security Regulations, 12 out of 29 NCPs answered yes. In light of the legal requirements under 
Directive 2011/24/EU, this number may be considered as very high and striking.  

Figure B.26 Difficulties in making a distinction between Directive 2011/24/EU and the 
Social Security Regulations (n = 29) 

Do you experience difficulties in communicating 
the difference between Directive 2011/24/EU 
and the Social Security Regulations? 

No

Yes

17 NCPs

12 NCPs

NCPs fulfil a twofold function as NCP of the MS of affiliation and NCP of the MS of 
treatment.  

NCPs have an information duty towards both incoming and outgoing patients. The survey showed 
that almost all NCPs are indeed also contacted by foreign patients seeking cross-border healthcare 

42 

 
 
 
 
 
 
 
 
Study on cross-border health services: enhancing information provision to patients  

in their country. Three NCPs, including the NCPs for incoming patients of Lithuania and Sweden, 
as well as the Irish NCP stated to be solely contacted by outgoing patients. Thus, only two of them 
are NCPs only competent for outbound patients.  

Figure B.27 Information requests of incoming patients (n = 30) 

Do foreign patients contact you 
when seeking cross-border 
healthcare in your country?

3 NCPs

No

Yes

27 NCPs

As the Directive 2011/24/EU makes a clear distinction between information duties of the NCP of 
the MS of affiliation and information duties of the NCP of the MS of treatment, NCPs were also 
asked if they make a distinction between information provision to inbound patients and outbound 
patients.  

14 out of 30 NCPs stated to make a distinction between incoming and outgoing patients. NCPs 
referred most often to different parts on the NCP website with information dedicated to inbound 
or  outbound  patients.  The  NCP  of  Greece  explicitly  mentioned  that  the  part  in  the  national 
language, covering information to outbound patients, was more detailed than the English version 
intended for incoming patients. Other NCPs referred to the existence of two separate NCPs, one 
competent for incoming patients and the other for outgoing patients.  

Figure  B.28  Distinction  in  information  provision  to  incoming  and  outgoing  patients  
(n = 30) 

Does your NCP make a distinction
between information provision to inbound 
and outbound patients?

No

Yes

16 NCPs

14 NCPs

Most MSs provide patients with general information on their own healthcare system. Almost all 
NCPs indicated that information on their own healthcare system is provided on the NCP website 
and  through  other  communication  channels.  Only  ten  out  of  31  NCPs  also  provide  general 
information  on  the  healthcare  systems  of  other  MSs.  The  French,  Finnish  and  United  Kingdom 
NCP  indicated  that  information  on  healthcare  systems  of  other  MSs  and  foreign  social  security 
schemes was provided on the NCP website itself. Other NCPs answered to refer the patient for 
more information to the NCP of other MSs concerned. They also provide contact details and links 
of other NCPs on their website.  

Figure B.29 Information on the own healthcare system (n = 31) 

Do you provide general information 
on the healthcare system of 
your MS?

No

2 NCPs

Yes

29 NCPs

Figure B.30 Information on healthcare systems of other MSs (n = 31) 

Do you provide general information 
on the healthcare system of 
other MSs?

No

Yes

21 NCPs

10 NCPs

43 

 
 
 
 
Study on cross-border health services: enhancing information provision to patients  

One of the general principles of the Directive is that appropriate information on all  
essential aspects of cross-border healthcare is necessary in order to enable patients 
to exercise their right to treatment abroad. NCPs play a crucial role in such 
information provision. However, one out of two NCPs declares to sometimes 
experience difficulties in gathering all the information themselves. 

The survey showed that NCPs receive information requests regarding different topics. NCPs seem 
to  receive  a  high  number  of  requests  on  reimbursement  and  costs.  Requests  on  hospitals  and 
healthcare providers also seem to occur frequently. On the contrary, 19 out of 26 NCPs said to 
never or rarely receive any request on quality and patient safety. Also information requests on 
waiting times, on travel and accommodation and on procedures for complaint and redress seem 
to be rather exceptional. 

Figure B.31 Frequency of information requests regarding different topics  

19

18

15

13

15

14

1

0

11

11

7

7

6

4

5

5

22

14

6

4

4

1

6

0

Never or Rarely

Sometimes

Often or Very often

Hospitals and healthcare providers (n = 26)

Quality and safety of healthcare (n = 26)

Waiting times (n = 26)

Medical documentation (n = 26)

Travel and accommodation (n = 27)

Reimbursement process and level of costs

Procedures for complaint and redress (n = 26)

Language used (n = 25)

NCPs were also asked if they do provide information on procedures for complaint and redress, 
quality and safety standards, and on the accessibility of hospitals for persons with disabilities. 5 
out of 30 NCPs do not provide information on quality and safety standards (i.e. Denmark, Latvia, 
Lithuania as well as both the Luxembourgish NCP for incoming and outgoing patients answered 
no). Besides, 9 NCPs indicated they do not provide information on the accessibility of hospitals 
(i.e. Denmark, Estonia, Finland, Luxembourg, Netherlands, Portugal, Sweden and both NCPs of 
Lithuania). The latter can be considered as a high number, considering the specific obligation to 
provide such information under Directive 2011/24/EU. 

Figure B.32 Information provision on procedures for complaint and redress, quality and 
safety standards and accessibility of hospitals  

31 NCPs

25 NCPs

0 NCPs

5 NCPs

Yes

No

21 NCPs

9 NCPs

Information on procedures for
complaint and redress ( n = 31)

Information on quality and safety
standards (n = 30)

Information on the accessibility of
hospitals for persons with disabilities
(n = 30)

The  survey  showed  that  one  out  of  two  NCPs  sometimes  experiences  difficulties  in  gathering 
information needed to answer patients’ questions. Four NCPs stated to even often encounter such 
difficulties. 

44 

 
 
 
 
Study on cross-border health services: enhancing information provision to patients  

Figure B.33 Difficulties in information gathering (n = 30)  

4 NCPs

10 NCPs

Rarely
Sometimes
Often

16 NCPs

Cooperation  

NCPs explained in general to cooperate well with other stakeholders. However, 10 out of 28 NCPs 
evaluated the cooperation with patient organisations negatively. NCPs seem to be most satisfied 
with the level and form of cooperation with other NCPs and with governmental organisations.  

Figure B.34 Cooperation with other stakeholders  

s
P
C
N

1

1

0

0

2

8

4

3

0

0

19

18

16

10

10

11

8

7

7

6

3

2

1

2

0

Very poor

Poor

Fair

Very good

Excellent

Other NCPs (n = 28)

Healthcare providers (n = 27)

Insurance organisations ( n = 28)

Governmental organisations (n = 28)

Patient organisations (n = 28)

NCPs  were  asked  if  they  most  often  refer  patients  directly  to  other  stakeholders  or,  on  the 
contrary, provide the information directly to the patient. Only one NCP answered the latter. Two 
out of three NCPs inform the patients themselves (n = 30).  

Figure B.35 Referring of the patient to other stakeholders (n = 30) 

20  NCPs

1 NCP

9 NCPs

The NCP most often provides the
information to the patient directly

The NCP most often refers the patient
to other stakeholders

This depends on the particular case

NCP views and recommendations  

NCPs overall experience great improvements under Directive 2011/24/EU. However, 
they also consider there is still room for improvement regarding comparability of 
invoices, NCP websites, visibility of NCPs and patient awareness, as well as regarding 
cooperation and information exchange between NCP.  

At the end of the survey, NCPs were asked to share some final views and recommendations.  

NCPs  were  asked  what  they  considered  as  most  important  improvements  under  Directive 
2011/24/EU. Most NCPs indeed experienced some great improvements: 

45 

 
 
 
 
 
Study on cross-border health services: enhancing information provision to patients  

 

 
 
 

 

 

 

 

 
 

 

“The contact possibilities to private healthcare providers in another MS and the possibility to 
get routing information about crossborder healthcare possibilities from the NCPs”; 
”The existence of a rather clear legal basis for healthcare abroad”; 
“The fact that the Directive clarified the possibilities for treatment abroad”; 
“Reimbursement  of  all  outpatient  care  without  prior  authorisation”;  “The  possibility  of 
receiving care more easily in case of rare diseases”; 
“European Reference Networks, so that persons with rare diseases may receive help in other 
MS by their experience, specifications and scientific work”; 
“The right to choose one's healthcare provider, whether it is in one's own country or across 
border. The right to have financial assistance from one's own national healthcare service or 
ministry  for  health  for  healthcare  undertaken  in  another  country.  This  has  improved  the 
capacity  to  choose  alternative  treatment  options,  alternative  healthcare  providers  and 
professionals whom one may have more trust, through information they might have gathered 
or  whom  they  might  have  consulted  previously  either  through  direct  consultation  or  via  e-
mail or other means of communication”; 
“The possibility to transfer knowledge of medical professionals among all EU” ” “The possibility 
to get more specific healthcare for the patient with rare diseases”; 
”The creation of a basic set of patients’ rights at EU level” “the clarification of the obligations 
of the Member States of affiliation, on the one hand, and the Member State of Treatment, on 
the other hand”; 
“Faster access to healthcare services”; 
 “The  potential  benefits  of  cross-border  cooperation  regarding  prescriptions,  e-health, 
ERNs,..”; 
“Free mobility of patients; choice of public or private providers; NCP network; familiarisation 
with health systems of other MS”; 

  … 

Two NCPs consider there are no improvements under Directive 2011/24/EU. The Czech NCP refers 
to the fact that cross-border treatment was already possible under the Social Security Regulations. 
A  RCP  of  Denmark  stated  that  cross-border  healthcare  was  not  considered  preferable  as 
healthcare in the own MS is already of a very high standard and besides patients most often prefer 
to communicate in their own language when receiving healthcare.  

Some NCPs also mentioned some remaining impediments and possible improvements to facilitate 
cross-border healthcare and enhance NCP practice: 

“Involve the NCPs in the routing of patients with rare diseases in cooperation with the ERN 
and making the NCP´s more public”; 
 “The standardisation of invoices for reimbursement process (mandatory data and standard 
codification of the procedures)”; 
“Reimbursement procedures”; 
“If a system of reconciling DRG codes used by each country could be developed this would be 
a significant help to providers abroad for patients”; 
“Sharing information of accessibility of special health care service on EU common portals”; 
 “Difficulties  that  patients  encounter  in  finding  a  health  professional  or  health  facility  in 
another European country and in finding reliable information about the quality and/or safety 
of care: The  sites of the  national contact points  are not always translated into English and 
they do not give direct access to databases of providers but only provide links to internal and 
non-translated  sites”  “The  completeness  of  the  websites  of  our  partners  in  the  different 
European  countries”  “The  information  provided  on  the  various  websites  of  foreign  NCPs  is 
often succinct, general and rarely discloses the concrete information that patients need”; 
“Language barriers”; 
“We have felt that we are lacking knowledge about other MSs health care systems”; 
“More international exchanges of health system functioning”; 
“Better cooperation between NCP's of all EU Member States”; 
“More efficient cooperation with healthcare providers and patients' organizations”; 

X 

X 

X 
X 

X 
X 

X 
X 
X 
X 
X 

46 

 
 
Study on cross-border health services: enhancing information provision to patients  

X 

X 

X 

X 

X 

X 

“More cooperation between NCPs. Not only meetings where all NCPs are present, but meetings 
between just a couple of NCPs would be a learning experience”; 
 “Better sharing of information among NCPs. IT systems could help (for example, website or 
IT based forum) to share actual information of NCPs”; 
 “I think that overall the NCP practice is good, but we have felt that we are lacking knowledge 
about other Member States health care systems. It would be also good to have a platform to 
exchange thoughts from time to time in certain cases” “Improve and develop our own NCP 
function and increase the awareness of our insured persons”; 
“Nationally, there is the need for further HR support and funding for the communication of 
the Directive's scope and objectives to the stakeholders involved” “NCPs could team up to be 
involved in projects collecting info from all MS on priority issues such as quality and safety, a 
summary/presentation of the national health system, using e.g. checklists or templates, which 
would feed into the websites of the NCPs network”; 
“In future we need to improve NCPs as a multidisciplinary team, which can give people high 
quality, instant answers and recommendations”;  
“Raise awareness among the general public on the existence of the NCPs and their role (i.e. 
explain very well what they can do but also be clear what not)” “At this moment, I have the 
feeling we find ourselves in a vicious circle: as the NCPs are not known, they do not receive 
many questions; as the NCPs do not receive many questions, stakeholders are not inclined to 
invest in the improvement of the functioning of the NCPs,... “; 
“Create better visibility via campaigns”. 

X 
X  … 

47 

 
Study on cross-border health services: enhancing information provision to patients  

ANNEX C – OVERARCHING RESEARCH PROTOCOL 

WP1: Inception phase

Review of literature and information provision 

Draft guiding principles and thematic (RACER) 
indicators 

Review of legal texts

Update work plan and preliminary training material 

WP2: Website analysis

WP3: Mystery shopping

Individual website analysis

Mystery shopping

Analysis using stars

Analysis using stars

Updating research protocol

Updating research protocol

WP4: Developing a toolbox and training material

Online survey of NCPs

Patient interviews 

Drafting a toolbox and training material

List of guiding principles for the work of NCPs and list 
of RACER indicators

A country specific description of the circumstances 
under which NCPs operate

WP5: Training in good NCP practices

Bilateral exchanges with NCPs

Organising a workshop to deliver the training material 
to the NCPs

Drafting the workshop report

Drafting the draft final report and the final report

Presentation of the study in the Expert Group on 
Cross-border healthcare

49 

 
 
Study on cross-border health services: enhancing information provision to patients  

ANNEX D – UPDATED WEBSITE ANALYSIS METHODOLOGY (WP2) 

The methodology for the website analysis is based on the Evaluative study in which 48 Specific 
Analytical Items were developed to structure the website analysis.7 According to the Evaluative 
study, the purpose of these SAIs was to “analyse the website design, its functionalities, its ease 
of access, and as well as to gauge whether a citizen would be able to find the information required 
under the Directive and what is necessary to access cross-border healthcare services”.  

Based on the analysis of the legal texts (WP1), the literature review (WP1), a review of studies 
on  quality  assessment  of  websites  aimed  at  patients8,9,  and  the  pilot,  we  have  updated  the 
methodology for the website analysis.  

Categories 

The website analysis looks at nine categories, with three of these focusing on the website itself – 
technical  elements,  accessibility,  usability  –  and  six  categories  focused  on  the  content  of  the 
website – general information, healthcare providers, patients’ rights, prior authorization, quality 
and safety standards, entitlement for reimbursement of costs -. 

Language 

The SAIs from the categories that focus on the website itself should be analysed using the English 
language  website  (where  available).  The  content  SAIs  aimed  at  outbound  patients  should  be 
analysed using the native language website, and the SAIs aimed at inbound patients using the 
English language website.  

Table 1 shows the SAI to be analysed in English in blue and the SAIs to be analysed in the native 
language(s) in green. The SAIs that do not have a background colour, are the SAIs we recommend 
analysing  by  using  both  the  English  and  the  native  language(s)  websites.  These  SAIs  include 
answer  categories  that  show  whether  the  information  was  available  in  English,  the  native 
language(s) or both.  

Table D.1 SAIs by language in which they should be analysed 

SAI category 
A. Technical elements 

B. Accessibility 

Specific Analytical Item 
1. 
2. 
3. 
4. 
5. 
6. 
7. 

Independence of the NCP's address; 
Presence of background information about the website; 
Presence of NCP e-mail address; 
Presence of the NCP office address; 
Presence of NCP telephone numbers; 
Presence of other contact information (e.g. social media); 
Presence of contact details of other NCPs (previously: presence of contact 
details for other NCPs); 

8.  Date of the last update of the website (previously: last date of update of 

information). 

9.  Order in search (Google) for: "NCP + the name of the MS"; 
10.  Order in search (Google) for: "NCP + healthcare + the name of the MS"; 
11.  Which website opens when clicking on the EU DG Sanco NCP's contact list; 
12.  Ease of opening the website (previously: accessibility); 
13.  The  availability  of  the  website  in  different  languages,  even  if  only  partly 

translated. (native / English/other); 

14.  Availability of options for people with decreased sensory functioning (e.g. 

read-out-loud, increased text size, different colour mode). 

C. Usability 

15.  Presence of most visited pages; 
16.  Presence of frequently asked questions; 
17.  Presence of internal search engine; 

7   Evaluative study on the cross-border healthcare Directive (2011/24/EU), 2015, 

http://ec.europa.eu/health//sites/health/files/cross_border_care/docs/2015_evaluative_study_frep_en.
pdf. 

8   Siddhanamatha HR et al. Quality assessment of websites providing educational content for patients with 

rheumatoid arthritis. Seminars in Arthritis and Rheumatism 2017.  

9   Eysenbach G, Powell J, Kuss O, Sa ER. Empirical studies assessing the quality of health information for 

consumers on the world wide web: a systematic review. J AM Med Assoc 2002;287:2691-700. 

51 

                                                 
Study on cross-border health services: enhancing information provision to patients  

SAI category 

Specific Analytical Item 
18.  Presence  of  Media  Library  containing  video's  regarding  cross-border 

healthcare; 

19.  Visual  appeal  and  layout  (scored  on  the  use  of  menus,  (sub)headings, 

D. General information  20. 

21. 

22. 

23. 

illustrations, and overall attractiveness). 
Information  for  inbound  patients.  In  English  (previously:  information  on 
inbound patients; 
Information for outbound patients. In the native language(s) (previously: 
information on outbound patients; 
Information that clarifies the differences between EU Regulation 883/2004 
and  the  Directive  2011/24/EU  (previously:  Clarifying  differentiating  EU 
policies  -  Specifically  the  Regulation  883/2004  and  the  Directive 
2011/24/EU.); 
Information  on  patients'  rights  regarding  cross-border  care  (previously: 
patients' rights to seek treatment in other EU countries). 

E. Healthcare providers  24.  A description of the health system; 

F. Patients’ rights 

G. Prior authorisation  

H.  Quality  and  safety 
standards 

I. 
for 
Entitlement 
reimbursement of costs 

34. 

Information on healthcare providers (e.g. available services); 

25. 
26.  Contact details of national healthcare providers; 
27.  Presence of tools to find a specific national healthcare provider. 
28. 
29. 
30. 
31. 
32. 
33. 

Information on the definition of waiting time; 
Information on patients' rights in case of undue delay; 
Information on patients' rights in the event of harm; 
Information on access to hospitals for disabled patients; 
Information on how to access electronic medical records; 
Information  on  mechanisms  to  settle  disputes  (e.g.  reimbursement 
issues); 
Information  on  rare  diseases  for  patients  with  a  rare  disease  without 
references to ERNs (European Reference Networks); 
Information on ERNs for patients with a rare disease; 
Information on complaint procedures in case of follow-up treatment issues. 

35. 
36. 
37.  Presence of information on which treatments require prior authorisation; 
38.  Presence of list of treatments requiring prior authorisation; 
39. 
40.  Presence of forms for prior authorisation; 
41.  Presence of information on time period for requests to be dealt with. 
42. 
43. 

Information on national legislation and policies regarding patient safety; 
Information  on  medical  certifications  and  qualifications  required  by  the 
national healthcare system; 
Information on the national quality strategy; 
Information on compliance checks and regulatory activity with respect to 
quality and safety standards (e.g. hospital inspection bodies, etc.); 
Information on quality measurements/indicators for healthcare providers.  
Information on which treatments are reimbursed; 
Information on which treatments are not to be reimbursed; 
Information  on  requirements  for  the  recognition  of  invoices/clinical 
information; 
Information on time period for reimbursement; 
Information regarding payment tools for reimbursement; 
Information on type of tariffs to be applied. 

44. 
45. 

46. 
47. 
48. 
49. 

50. 
51. 
52. 

Information on procedures to obtain the reimbursement; 

Practical tips for website analysis 

 

Prior to starting the analysis of multiple websites, organise a small pilot analysing two to 
three websites. This will give the researcher(s) the chance to familiarise themselves with 
the SAIs and to discuss any differences in interpretation of SAIs; 

  Ensure all researchers involved in the websites analysis take sufficient and clear notes, to 

 

ensure transparency of the analysis; 
Involve  researchers  without  a  background  in  IT  or  computer  science  in  conducting  the 
website analysis, to ensure the researchers look at the NCP websites in a manner similar 
to the average patient.  

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Study on cross-border health services: enhancing information provision to patients  

ANNEX E – EMAIL TEMPLATES (WP3) 

Box E.1 Email template Scenario 1 

Subject: Seeking reconstructive surgery abroad 

Dear Sir or Madam,  

I  am  writing  to  you  to  find  out  more  about  the  possibility  to  travel  to  another  EU  country  to 
undergo  surgery.  My  younger  brother  suffered  an accident  as  a child  and  as a  result  has third 
degree burns on his shoulder. He is now a young adult and would like to undergo reconstructive 
surgery to improve the scarring and function of his shoulder. We were thinking about whether he 
could travel abroad for this as we have heard that there are some private specialists that are very 
well  known  for  the  type  of  reconstructive  surgery  my  brother  would  need.  Before  we  go  any 
further with our research into this possibility, I was hoping to find out more about the practicalities 
of this option. 

Is my brother entitled to receive this hospital treatment in our country? Is treatment available 
here? What is a normal waiting time for this type of surgery? 

Is it possible to seek reconstructive surgery privately under the right to go to another EU country? 

Does my brother need any kind of authorisation before he can travel abroad to have this kind of 
surgery? If so, where or how should we enquire about this authorisation and how long would it 
take for me to get it? 

If my brother is a good candidate for the reconstructive surgery with a private specialist, will he 
be reimbursed for it? How much could he be expected to be reimbursed? 

Related to this, does he have to pay upfront? What about any extra costs, such as transport costs, 
can he be reimbursed for those? 

What paperwork would be needed to get reimbursed any of these costs and how would I go about 
claiming this reimbursement? Would you be able to support me in arranging the paperwork for 
my brother? 

Do we need a referral? 

How can we have access to my brother's medical records? How much would this cost us? 

Will follow-up care be provided at home or abroad? 

We were wondering if you have any reports, flyers or videos that I could share with my younger 
brother  about  travelling  abroad  for  surgery?  Do  you  have  any  information  from  other  patients 
that have done this?  

Is there any other information that we should be aware of before seeking this surgery abroad? 

Many thanks for any help and information you can give us – it is very helpful that this information 
point exists. 

Could you please provide a telephone number where it is possible to contact you? 

Warm Regards, 

Box E.2 Email template Scenario 2 

Subject: Information about a hip replacement in another country 

Dear Sir/Madam,  

53 

 
Study on cross-border health services: enhancing information provision to patients  

I am a pensioner living here in [Country X], but I spent all of my working life in [Country Y10]. I 
am  interested  in  the  possibility  of  seeking  a  hip  replacement  operation  in  back  in  the  country 
where I worked all my life. I still have strong connections of family and friends there who could 
help me during my recovery. I was thinking of approaching some of the larger public hospitals to 
find  out  how  long  the  waiting  list  would  be  and  find  out  if  I  can  be  placed  on  it.  I  have  some 
questions about how the right to travel abroad works before I start getting in touch with these 
public hospitals.  

Is  it  possible  that  I  have  the  right  to  go  abroad  to  have  a  hip  replacement  in  another  public 
hospital? 

Do I need any kind of authorisation before I travel to another EU country for a hip replacement? 
Can you tell me how I go about requesting this authorisation (which institution should I contact, 
what documentation do I need, how long does it take, etc.)? 

Will I be reimbursed for the costs involved if I get a hip replacement abroad? How much can I 
expect to be reimbursed? 

How does payment work, do I have to pay for the costs myself and then be reimbursed? What 
about the costs associated with travelling there, are they reimbursed at all? How and where do I 
apply for reimbursement? Would you assist me in putting together my paperwork? 

As I don’t know anyone else who has done this, I would really appreciate it if you could tell me if 
there is anything else I need to know about seeking this kind of treatment abroad? Is a referral 
needed? 

What if something goes wrong – who would I get in touch with and how?  

Will my treatment be followed up by the health services when I return to [Country X]?  

I look forward to hearing from you – great to know you are there to answer my questions! 

Best, 

Box E.3 Email template Scenario 3 

Subject: Cataract surgery abroad 

Dear Sir/Madam,  

I  am  from  [Germany  or  Belgium],  but  a  friend  of  mine  told  me  that  it  is  possible  to  travel  to 
another EU country for health care. I am retired and have been on a pension for the last 7 years. 
Recently I am having trouble with my eyesight and when I visited my doctor, he said that I will 
need to have cataract surgery. My friend told me she knows of people who have gone to your 
country, as there are private surgeons that can do this much quicker than if I am on the waiting 
list here. I was wondering whether you can give more detailed information about this option. 

Is my friend correct that I have the right to get this treatment in your country? Does it apply if I 
opt to have this surgery carried out by a private surgeon? I read something about some things 
needing to have authorisation, do I need authorisation for this?  

Do I have to pay upfront for the surgery? What about refunding the costs-, will I be refunded? 
What will I be refunded for will it cover transport and accommodation? 

Are you able to recommend a good private surgeon who performs cataract surgery? Or a good 
private hospital?  

Do I need to show any special document to be accepted as a patient? Do I need a referral? 

10   Belgium, Germany, Greece, Spain, France, Italy, Luxembourg, Austria or Sweden.  
54 

 
 
                                                 
Study on cross-border health services: enhancing information provision to patients  

If I do have this surgery in your country and something goes wrong, what do I have to do? 

Finally, I assume that in order to get reimbursed I will have to provide invoices of the treatment 
I received. But what should I do if the invoices are written in a language I do not understand? 
Will there be assistance in translating the invoices?  

Are there other considerations or information that you can give me? 

I would really appreciate if you could help me find out more about this possibility. 

Kind regards, 

Box E.4 Email template Scenario 4 

Subject: Orthopaedic consultation for my daughter 

Dear Sir/Madam,  

I  am  interested  in  the  possibility  of  travelling  to  your  country.  My  daughter  was  born  with  a 
clubfoot. We are from [Bulgaria or Romania] but I am interested in having a consultation with an 
orthopaedic surgeon in your country to seek another opinion about what treatment would help 
her. We have heard from other parents that early treatment is the most effective so we hope to 
find the right care for her whilst she is still young.  

Do  I  have  the  right  to  travel  with  my  daughter  to  your  country  to  have  an  orthopaedic 
consultation? Is there any kind of authorisation that we would need? 

What about the costs involved, what are my rights to be reimbursed? Which costs will I be paid 
back? Do I have to pay the costs upfront? 

I would like to know what quality and safety standards there are in your country. 

Due  to  my  daughter’s  disability,  she  has  some  difficulties  walking.  Can  you  tell  me  about  the 
accessibility of hospitals? 

If she then gets treatment in your country but something goes wrong, what do we do? What are 
our rights? 

What documentation would we need for the hospitals in your country? Is a referral needed? 

What else do we need to know in this case? Would you be able to recommend a specialist? 

I’d be really grateful for any information and guidance you can provide 

Are there other considerations or information that you can give me? 

I would really appreciate if you could help me find out more about this possibility. 

Kind regards, 

55 

 
 
Study on cross-border health services: enhancing information provision to patients  

ANNEX F – CONTACT INFORMATION NCPS (WP3) 

AUSTRIA  
Gesundheit Österreich GmbH  
Website: 
https://www.gesundheit.gv.at/Portal.Node/ghp/public/content/kontaktstellepatientenmobilitaet.html  
Email: patientenmobilitaet@goeg.at  
Telephone number: +43 (0)1 71100-0 
BELGIUM  
Soins de santé transfrontaliers  
Website: www.crossborderhealthcare.be  
Email: information@crossborderhealthcare.be  
Telephone number: +32 (0)22902844 
BULGARIA  
National Health Insurance Fund Website: www.nhif.bg  
Email: crossbordercare@nhif.bg  
Telephone number: +359 2 965 9116 
CROATIA  
Croatian Health Insurance Fund  
Website: www.hzzo.hr  
Email address: ncp-croatia@hzzo.hr  
Telephone number: + 385 1 644 90 90 
CYPRUS  
Ministry of Health  
Website: www.moh.gov.cy/cbh  
Email: ncpcrossborderhealthcare@moh.gov.cy  
Telephone number: +357 22 605 407 
CZECH REPUBLIC  
Health Insurance Bureau  
Website: www.kancelarzp.cz  
Email: info@kancelarzp.cz  
Telephone number: +420 236 033 411 
DENMARK  
Danish Patient Safety Authority  
Website: http://stps.dk/da/borgere/internationalsygesikring/nationaltkontaktpunktforbehandling-i-eueoes  
Email: IS-kontor@patientombuddet.dk  
Telephone number: +4572286600 
ESTONIA  
Estonian Health Insurance Fund  
Website: www.haigekassa.ee/kontaktpunkt  
Email: info@haigekassa.ee  
Telephone number: +372 669 6630 
FINLAND  
Kela  
Website: www.hoitopaikanvalinta.fi  
Email: yhteyspiste@kela.fi  
FRANCE  
Centre des Liaisons Européennes et Internationales de Sécurité Sociale (CLEISS)  
Website: http://www.cleiss.fr/presentation/pcn.html  
Email: soinstransfrontaliers@cleiss.fr  
General  telephone  number:  +33  1  45  26  33  41  (Monday,  Wednesday,  Friday:  9.00  –  12.30;  Tuesday, 
Thursday: 14.00 – 17.00) 
GERMANY  
Deutsche Verbindungsstelle Krankenversicherung - Ausland (DVKA)  
Website: www.eu-patienten.de  
Email: info@eu-patienten.de  
Telephone number: +49 228 9530-802/800 //+492289529 
GREECE 
National organization for health care services, provision, division of international affairs, National Contact 
Points GR Department Website: www.eopyy.gov.gr  
Email: ncp_gr@eopyy.gov.gr  
For Greek citizens seeking healthcare in the EU: 
Telephone number: 210 8110935, 2108110936 
For EU citizens intending to use Greek healthcare: 
Telephone number: +30 2108110916, +30 2108110918, +30 2108110925, +30 2108110919 
HUNGARY  
Országos Betegjogi, Ellátottjogi, Gyermekjogi és Dokumentációs Központ  
National Center for Patients' Rights and Documentation  
For EU citizens that intend to use Hungarian healthcare:  
Website: http://www.patientsrights.hu/  
Email: info@patientsrights.hu  

57 

Study on cross-border health services: enhancing information provision to patients  

Telephone number: +36 20 999 0025 
For Hungarian citizens seeking healthcare in EU:  
Website: http://www.eubetegjog.hu/  
Email: info@eubetegjog.hu  
Telephone number: 06-80-620-600 
IRELAND  
Cross-Border Healthcare Directive Department  
Website: http://hse.ie/eng/services/list/1/schemes/cbd/CBD.html  
Email: Crossborderdirective@hse.ie  
Telephone number: +353 (0)56 778 4546/4547/4556 
ITALY  
Ministry of Health, Directorate-General for health planning  
Website: http://www.salute.gov.it/portale/temi/p2_4.jsp?lingua=english&area=healthcareUE  
Contact form: http://www.salute.gov.it/portale/temi/p_sendMailNCP_ENG.jsp  
No telephone number 
LATVIA  
National Health Service  
Website: www.vmnvd.gov.lv  
Email: nvd@vmnvd.gov.lv  
Telephone number: +37167045005 Working days: 8:30 - 17:00 Lunch break: 12:30 - 13:00 
LITHUANIA  
State Health Care Accreditation Agency under the Ministry of Health  
Website for NCP where patients could find the information in one place: www.lncp.lt  
For EU citizens intending to use Lithuanian healthcare  
Website: http://www.vaspvt.gov.lt/en  
Email: contact.point@vaspvt.gov.lt 
Telephone number: +370 5 261 5177 (open Monday – Thursday 8.00 – 12.00 and 12.45 – 17.00, Friday 
8.00 – 12.00 and 12.45 – 15.45) 
For Lithuanian insured persons seeking healthcare in the EU  
National Health Insurance Fund under the Ministry of Health  
Website: www.vlk.lt/vlk/en/  
Email: vlk@vlk.lt  
Telephone  number:  +37052364100  (open  Monday  –  Thursday  8.00  –  12.00  and  12.45  –  17.00,  Friday 
8.00 – 12.00 and 12.45 – 15.45) 
LUXEMBOURG  
Service national d’information et de médiation santé  
For EU citizens intending to use Luxemburgish healthcare:  
Website: www.mediateursante.lu  
Email: info@mediateursante.lu  
Telephone number: +352 24 77 55 15 (open Monday – Tuesday 9.00 – 13.00, Wednesday 13.00 – 17.00, 
Thursday – Friday 9.00 – 13.00) 
Ministry of Social Security (Caisse nationale de santé)  
For Luxemburgish insured persons seeking healthcare in the EU:  
Website: www.cns.lu  
Email: cns@secu.lu  
Telephone number: +352 27 57 - 1 
MALTA  
Ministry for Health  
Website: http://health.gov.mt/en/cbhc/Pages/Cross-Border.aspx  
Email: crossborderhealth@gov.mt  
Telephone number: +356 22992381 
NETHERLANDS  
Netherlands NCP Cross-border Healthcare  
Website: www.cbhc.nl  
Contact form: www.cbhc.nl/nl-nl/contact 
No telephone number  
POLAND  
National Health Fund  
Website: http://www.kpk.nfz.gov.pl/en/  
Email: ca17@nfz.gov.pl  
Telephone number: +48 71 79 79 180 
PORTUGAL  
The Central Administration of the Health System  
Website: http://diretiva.min-saude.pt/ 
Email: diretiva.pcn@acss.min-saude.pt  
General telephone number: +351 21 792 58 00 
ROMANIA  
National Health Insurance House  
Website: www.cnas-pnc.ro  
E-mail: pnc@casan.ro  
Telephone number: +40 (0)372 309 135 
SLOVAKIA  
Healthcare Surveillance Authority  

58 

 
Study on cross-border health services: enhancing information provision to patients  

Website: www.udzs-sk.sk  
Email: web@udzs-sk.sk 
General telephone number: +421-2-208 56 226 
SLOVENIA  
Health Insurance Institute of Slovenia (HIIS)  
Website: http://www.nkt-z.si/wps/portal/nktz/home  
Email: kontakt@nkt-z.si  
Telephone number: +386 (0)1 30 77 222 
SPAIN  
Ministry of Health, Social Services and Equity  
Website: http://www.msssi.gob.es/pnc/home.htm  
Email: oiac@msssi.es  
Telephone number: 901 400 100; +34 91 596 10 89; +34 91 596 10 90 (open June 16 to September 15 
Monday to Friday 8.00 – 15.00, Saturday 9.00 – 14.00; winter: Monday to Frida 9.00 – 17.30, Saturday 
9.00 – 14.00)  
SWEDEN  
For Swedish insured persons seeking healthcare in the EU:  
Försäkringskassan  
Website: www.forsakringskassan.se  
Email: kundcenter@forsakringskassan.se; huvudkontoret@forsakringskassan.se  
Telephone number: 771-524 524 
For EU citizens intending to use Swedish healthcare:  
Socialstyrelsen  
Website: www.socialstyrelsen.se  
Email: socialstyrelsen@socialstyrelsen.se  
Telephone number: +46(0)75-247 30 00 

UNITED KINGDOM  
NHS England 
Website: http://www.nhs.uk/NHSEngland/Healthcareabroad/Pages/Healthcareabroad.aspx 
E-mail: england.contactus@nhs.net 
Telephone number: +44 300 311 22 33 
NHS 24 Scotland 
Website: www.nhsinform.co.uk/rights/europe 
Email: nhs.inform@nhs24.scot.nhs.uk 
Telephone number: 0800 22 44 88 
NHS Direct Wales 
Website: www.nhsdirect.wales.nhs.uk/travelhealth/NCPs/ 
Email: NCPWales.amb@wales.nhs.uk 
Telephone number: 0845 46 47  
Health and Social Care Board HSC Northern Ireland 
Website: www.hscboard.hscni.net/travelfortreatment/  
Email: NationalContactPoint@hscni.net 
Telephone number: +44(0)28 9536 3152 
Gibraltar Health Authority 
Website: www.gha.gi/  
Email: infoGCHCP@gha.gi 
Telephone number: +350 2000 7444 
NORWAY  
HELFO (The Norwegian Health Economics Administration)  
Website: https://helsenorge.no/norwegian-national-contact-point-for-healthcare1  
Email: servicesenteret@helfo.no 
For Norwegians seeking information: 
Telephone number: 800 43 573 (open from 8.00 – 15.30) 
For callers outside Norway: 
Telephone number: +47 23 32 70 30 (open from 8.00 – 15.30) 

59 

 
Study on cross-border health services: enhancing information provision to patients  

ANNEX G – ASSESSMENT FORMS MYSTERY SHOPPING (WP3) 

Mystery Shopping – Assessment Form 
Mystery Shopper name 

Country 

Channels used 

Telephone ☐  Email ☐ 

Email address contacted 

Telephone 
contacted 

number 

No 
telephone 
number  provided 
☐ 

Date of email sent 

Date of response email 
received 
Attempts to call made 

Date  and  time  of  final 
telephone call 
Duration  of  telephone 
call 

Scenario 1 – Reconstructive surgery (outbound patient)  
1  Were you able to enter into contact with the NCP? 
2  Was  the  fact  that  there  are  two  legal  instruments  which  may  apply  (Regulation 

Yes ☐  No ☐ 
Yes ☐  No ☐ 

883/2004 and Directive 2011/24/EU) explained? 
If  yes,  please  provide  the 
answer: 

3  Was it explained if the patient is entitled to receive hospital treatment domestically?  Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

4  Was  information  provided  about  the  availability  of  the  necessary  treatment 

Yes ☐  No ☐ 

domestically? 
If  yes,  please  provide  the 
answer: 

5  Was  information  provided  about  the  typical  waiting  time  for  this  type  of  surgery 

Yes ☐  No ☐ 

domestically? 
If  yes,  please  provide  the 
answer: 

6  Was it explained if the patient is entitled to receive private health care in another 

Yes ☐  No ☐ 

Member State? 
If  yes,  please  provide  the 
answer: 

7  Was it explained if the patient needs prior authorisation? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

8  Was it explained which institution is competent to grant prior authorisation? 

Yes ☐  No ☐ 

9 

If  yes,  please  provide  the 
answer: 
Did the NCP explain what documentation is needed? 
If  yes,  please  provide  the 
answer: 

Yes ☐  No ☐ 

10  Was  it  explained  what  the  expected  time  period  for  requesting  prior  authorisation 

Yes ☐  No ☐ 

will be? 
If  yes,  please  provide  the 
answer: 

11  Was information about the right to be reimbursed provided? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

12  Was information about the amount that will be reimbursed for the specific treatment 

Yes ☐  No ☐ 

provided? 
If yes, explain further: 

13  Was it explained which institution is responsible for reimbursement? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

14  Was information provided about the payment procedure for the treatment? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

15  Was information provided about the procedures of appeal and redress? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

16  Was it explained whether the patient should pay upfront? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

17  Was it explained if extra costs such as transportation or accommodation costs will 

Yes ☐  No ☐ 

be reimbursed?  

61 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Study on cross-border health services: enhancing information provision to patients  

If  yes,  please  provide  the 
answer: 

18  Was it explained which documents need to be provided for reimbursement? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

19  Did the NCP offer assistance in putting together the paperwork? 

Please explain further: 

20  Was it explained if a referral is needed? 

If  yes,  please  provide  the 
answer: 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

21  Was information provided about accessing the patients’ medical records? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

22  Was information provided on the costs of accessing medical records? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
costs: 

23  Was information provided about where the patients will receive follow-up care? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

24  Did  the  NCP  provide  information  about  receiving  treatment  abroad  or  patient 

Yes ☐  No ☐ 

feedback in the form of reports, flyers, video, infographics, etc? 
If  yes,  please  explain  further 
and  provide  materials  shared 
by the NCP: 

25  Was a reference made to another contact or website? (Including a different NCP) 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

26  Did the NCP provide any additional information? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
information: 

Mystery Shopping – Assessment Form 
Mystery Shopper name 

Country 

Channels used 

Telephone ☐  Email ☐ 

Email address contacted 

Telephone 
contacted 

number 

response 

Date of email sent 
Date  of 
email received 
Attempts 
to 
made 
Date  and  time  of 
final telephone call 

call 

No 
telephone 
number  provided 
☐ 

Duration 
telephone call 

of 

Scenario 2 – Hip replacement for a pensioner (outbound patient)  
1 
2 

Where you able to enter into contact with the NCP? 
Was  the  fact  that  there  are  two  legal  instruments  which  may  apply  (Regulation 
883/2004 and Directive 2011/24/EU) explained? 
If  yes,  please  provide  the 
answer: 
Did the NCP indicate that they are not competent to grant authorisation or to pay 
the costs? 
If  yes,  please  provide  the 
answer: 
Did the NCP refer the patient to the NCP of another Member State?  
If  yes,  please  provide  the 
answer: 
Was it explained if the patient is entitled to receive public health care in another 
Member State? 
If  yes,  please  provide  the 
answer: 
Was it explained if the patient needs prior authorisation? 
If  yes,  please  provide  the 
answer: 
Was it explained which institution is competent to grant prior authorisation? 
If  yes,  please  provide  the 
answer: 
Did the NCP explain what documentation is needed? 
If  yes,  please  provide  the 
answer: 

3 

4 

5 

6 

7 

8 

62 

Yes ☐  No ☐ 
Yes ☐  No ☐ 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Study on cross-border health services: enhancing information provision to patients  

9 

Was it explained what the expected time period for requesting prior authorisation 
will be? 
If  yes,  please  provide  the 
answer: 

Yes ☐  No ☐ 

10  Was information about the right to be reimbursed provided? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

11  Was  information  about  the  amount  that  will  be  reimbursed  for  the  specific 

Yes ☐  No ☐ 

treatment provided? 
If yes, explain further:  

12  Was information provided about the payment procedure for the treatment? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

13  Was information provided about the procedures of appeal and redress? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

14  Was it explained if the treatment needs to be paid upfront? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer 

15  Was it explained if extra costs such as transportation or accommodation costs will 

Yes ☐  No ☐ 

be reimbursed?  
If  yes,  please  provide  the 
answer: 

16  Was it explained which institution is responsible for reimbursement? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

17  Was it explained which documents need to be provided for reimbursement? 

Yes ☐  No ☐ 

18 

If  yes,  please  provide  the 
answer: 
Did the NCP offer assistance in putting together the paperwork? 
Please explain further: 

19  Was it explained is a referral was needed? 

If  yes,  please  provide  the 
answer 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

20  Was information provided about accessing the patients’ medical records? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

21  Was information provided about where the patients will receive follow-up care? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer 

22  Was a reference made to another contact or website?  

Yes ☐  No ☐ 

23 

If  yes,  please  provide  the 
answer: 
Did the NCP provide any additional information? 
If  yes,  please  provide  the 
answer: 

Mystery Shopping – Assessment Form 
Mystery Shopper name 

Country 

Channels used 

Email address contacted 

Telephone 
☐ 

Email ☐ 

response 

Date of email sent 
Date  of 
email received 
Attempts 
to 
made 
Date  and  time  of 
final telephone call 
Duration 
telephone call 

call 

of 

number 

Telephone 
contacted 
Scenario 3 – Cataract surgery for a pensioner (inbound patient) 
1 
2 

No 
telephone 
number provided ☐ 

Were you able to enter into contact with the NCP? 
Was information about the right to cross-border treatment given? 
If  yes,  please  provide  the 
answer: 
Was  information  provided  about  the  right  to  have  the  surgery  carried  out  by  a 
private surgeon? 
If  yes,  please  provide  the 
answer: 
Was it explained if the patient needs prior authorisation? 
If  yes,  please  provide  the 
answer: 

3 

4 

Yes ☐  No ☐ 

Yes ☐  No ☐ 
Yes ☐  No ☐ 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

63 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Study on cross-border health services: enhancing information provision to patients  

5 

6 

7 

8 

9 

Was information about the right to be reimbursed provided? 
If  yes,  please  provide  the 
answer: 
Was  information  about  the  amount  that  will  be  reimbursed  for  the  specific 
treatment provided? 
If yes, explain further:  
Was information provided about the payment procedure for the treatment? 
If  yes,  please  provide  the 
answer: 
Was information provided about the procedures of appeal and redress? 
If  yes,  please  provide  the 
answer: 
Was it explained if the treatment needs to be paid upfront? 
If  yes,  please  provide  the 
answer 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

10  Was it explained if extra costs such as transportation or accommodation costs will 

Yes ☐  No ☐ 

be reimbursed?  
If  yes,  please  provide  the 
answer: 

11  Was it explained which institution is responsible for reimbursement? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

12  Was it explained which documents need to be provided for reimbursement? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

13  Was information provided on health care providers? 

If yes, please provide the answer: 

14  Was information provided about quality and safety standards? 

If  yes,  please  provide  the 
answer: 

15  Was information on documentation provided? 

If  yes,  please  provide  the 
answer: 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

16  Was  information  provided  about  accessibility  of  hospitals  for  people  with 

Yes ☐  No ☐ 

disabilities? 
If yes, please provide the answer: 

17  Was information about the need for a referral provided? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

18  Was information provided about complaint procedures and mechanisms for seeking 

Yes ☐  No ☐ 

remedies? 
If  yes,  please  provide  the 
answer: 

19  Was  information  provided  on  the  legal  and  administrative  options  to  settle 

Yes ☐  No ☐ 

disputes? 
If  yes,  please  provide  the 
answer: 

20  Was information provided about the transfer of medical records? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

21  Was information provided about what to do if invoices are in a foreign language? 

Yes ☐  No ☐ 

22 

If  yes,  please  provide  the 
answer 
Did  the  NCP  offer  assistance  to  translate  the  invoices?  Or  did  the  NCP  provide 
information about translating documentation? 
If  yes,  please  provide  the 
answer 

23  Was a reference made to another contact or website? 

24 

If  yes,  please  provide  the 
answer: 
Did the NCP provide any additional information? 
If  yes,  please  provide  the 
answer: 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

Yes ☐  No ☐ 

64 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Study on cross-border health services: enhancing information provision to patients  

Mystery Shopping – Assessment Form 
Mystery Shopper name 

Date of email sent 

Country 

Channels used 

Telephone ☐ 

Email ☐ 

Email address contacted 

Telephone 
contacted 

number 

No 
telephone 
number  provided 
☐  

call 

response 

Date  of 
email received 
to 
Attempts 
made 
Date and time of final 
telephone call 
Duration 
telephone call 

of 

Scenario 4 – Orthopaedic consultation for a disabled patient (inbound patient) 
1  Were you able to enter into contact with the NCP? 
2  Was it explained if the patient is entitled to receive health care in another Member 

Yes ☐  No ☐ 
Yes ☐  No ☐ 

State? 
If  yes,  please  provide  the 
answer: 

3  Was it explained if the patient needs prior authorisation? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

4  Was information about the right to be reimbursed provided? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

5  Was information about the amount that will be reimbursed for the specific treatment 

Yes ☐  No ☐ 

provided? 
If yes, explain further:  

6  Was information provided about the payment procedure for the treatment? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

7  Was information provided about the procedures of appeal and redress? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

8  Was it explained if the treatment needs to be paid upfront? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer 

9  Was it explained if extra costs such as transportation or accommodation costs will 

Yes ☐  No ☐ 

be reimbursed?  
If  yes,  please  provide  the 
answer: 

10  Was it explained which institution is responsible for reimbursement? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

11  Was it explained which documents need to be provided for reimbursement? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

12  Was information provided about quality and safety standards? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

13  Was information provided on health care providers? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

14  Was information provided about accessibility of hospitals for people with disabilities?  Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

15  Was information provided about complaint procedures and mechanisms for seeking 

Yes ☐  No ☐ 

remedies? 
If  yes,  please  provide  the 
answer: 

16  Was information provided on the legal and administrative options to settle disputes?  Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

17  Was information provided about the transfer of medical records? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

18  Was information provided about the need for a referral? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer 

19  Was a reference made to another contact or website? 

Yes ☐  No ☐ 

65 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Study on cross-border health services: enhancing information provision to patients  

If  yes,  please  provide  the 
answer: 

20  Did the NCP provide any additional information? 

Yes ☐  No ☐ 

If  yes,  please  provide  the 
answer: 

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Study on cross-border health services: enhancing information provision to patients  

ANNEX H – DETAILED DATA (WP3) 

This annex provides additional detailed data harvested from the pseudo-patient investigations.  

Reachability of the NCPs 

The table below provides a detailed overview of the channels used by the pseudo-patients and 
whether the NCPs were reached successfully through these channels. In the analysis reachability 
stars were assigned according to the following guidelines: when the pseudo-patient made contact 
by email/phone and was able to make inquiries four stars were assigned; 3 stars were assigned 
when contact was made by email/phone after being forwarded or having to resend the email after 
which inquiries were made; when the pseudo-patient was able to make contact by email/phone 
but no inquiries addressed two stars were assigned; a single star was assigned when no contact 
by email/phone was made and no inquiries were addressed. 

For  Scenario  1,  2  and  3  one  NCP  was  not  contacted  by  phone  as  sufficient  information  was 
provided by email. Similarly, for Scenario 4, two other NCPs were not contacted by phone due to 
this reason. A total of three NCPs did not provide a telephone number for inquiries. 

In terms of reachability there are some variations between NCPs for several reasons. NCPs may 
provide  a  reply  later  than  the  cut-off  point  of  seven  weeks,  others  were  not  reachable  due  to 
language barriers, and yet others were difficult to reach due to being forwarded or the need to 
resend the enquiry. Others requested the provision of additional or personal information. 

Some NCPs provided information but there was a delay in delivery. One NCP sent a response to 
scenario  3  after  five  weeks.  Another  NCP  sent  a  response  to  Scenario  4  after  six  weeks,  for 
Scenario 3 it was sent after nine weeks and this response was not included in the analysis. Yet 
another NCP sent the response after five weeks for Scenario 1 and 4. It was communicated by 
the NCP that they legally have 30 days to respond to an email enquiry. In addition, one NCP sent 
a reply to the email enquiry up to 15 weeks later; these were also excluded from the analysis.  

In  scenario  3,  one  NCP  was  not  reached  due  to  language  barriers  of  the  call  menu.  Language 
barriers were also faced in two other MSs for the inbound scenarios. 

In one particular case the pseudo-patient was forwarded to another body, in both scenario 1 and 
scenario 3. 

One  NCP  could  not  provide  any  additional  information  for  the  outbound  scenarios  as  personal 
information was required. In one MS outbound patients were requested to provide a referral from 
a doctor. 

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Study on cross-border health services: enhancing information provision to patients  

ANNEX I - ANALYSIS OF OTHER INFORMATION CENTERS (WP4) 

This annex expands a preliminary comparison of the present cooperation between NCPs with other 
information centres and networks. This comparison aims to identify the possibilities to evolve to 
a more uniform practice and effective collaboration between NCPs. The idea behind it is to provide 
realistic  pathways  to  improve  the  effectiveness  of  NCP  collaboration,  thus  achieving  a  more 
consistent level of NCP service, and this at little extra cost, drawing on intelligence available in 
other policy fields. Possible tools towards these objectives are: 

  Measuring instruments, such as guidelines, guiding principles, indicators; 
  Support and information materials (e.g. FAQ, checklists, manuals...);  
  European web portal; 
  Benchmarking and monitoring.  

Background - Present Collaboration  

The Cross-border healthcare Directive 2011/24/EU prescribes a twofold way of cooperation. First 
NCPs should consult with other stakeholders in order to fulfil their duty to inform patients, namely 
with healthcare insurers, healthcare providers and patient organisations.11 Second, NCPs should 
cooperate closely with each other and with the Commission.12  

The  Directive  does  not  state  how  such  cooperation  amongst  NCPs  themselves  must  be 
established. However, it provides a framework for cooperation beyond NCPs in other areas such 
as  European  Reference  Networks,  e-health  and  health  technology  assessment.13  Cooperation 
between NCPs and with the Commission can be seen in the light of new governances modes within 
the  EU,  which  may  according  to  Sable  and  Zeitlin  all  be  reduced  to  the  traditional  underlining 
architecture of decision making in the EU.14 The latter consisting of four elements: 

 

 

 

 

framework  goals  and  measures  for  determining  their  achievements  are  established  by 
joint action of the MSs and EU institutions; 
lower-level units such as national authorities are free in choice of means to achieve these 
goals; 
in  return  for  this  autonomy,  they  must  report  regularly  on  their  performance  and 
participate in peer review in which their results are compared with those pursuing other 
means to the same general ends; 
framework  goals,  performance  measures,  and  decision-making  procedures  themselves 
are periodically revised by the actors.15 

An example of such a new form of governance is the Open Method of Coordination (OMC). The 
OMC does not result in EU legislation, but is a method of soft governance which aims to spread 
best practice and achieve convergence towards EU goals in those policy areas which fall under 
the partial or full competence of MSs.16 The OMC is principally based on:  

 
 
 

jointly identifying and defining objectives to be achieved; 
jointly established measuring instruments (statistics, indicators, guidelines); 
benchmarking,  i.e.  comparison  of  EU  countries'  performance  and  the  exchange  of  best 
practices, peer review (monitored by the Commission).17 

11   Art. 6(1) Directive 2011/24/EU. 
12    Art. 6(2) Directive 2011/24/EU. 
13    Chapter IV Directive 2011/24/EU. 
14    F. Sabel, J. Zeitlin, Learning from Difference: The New Architecture or Experimentalist vernance in the 

EU, European Law Journal 14(2008), 271-327.  

15   F. Sabel, J. Zeitlin, Learning from Difference: The New Architecture or Experimentalist Governance in 

the EU, European Law Journal 14(2008), 271-327. 

16   M. Prpic, The Open Method of Coordination: At a glance, EPRS, 2014, 

http://www.europarl.europa.eu/EPRS/EPRS-AaG-542142-Open-Method-of-Coordination-FINAL.pdf. 

17    See glossary of summaries on EUROPA, EUR-lex, http://eur-

lex.europa.eu/summary/glossary/open_method_coordination.html. 

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Study on cross-border health services: enhancing information provision to patients  

Regardless of the existing opposition against the technique of OMC, some proponents advocate 
expanding the method to other areas such as health. The future will tell if cooperation under the 
Directive 2011/24/EU will lead to formalisation of OMC.18  

The  Evaluative  Study  showed  that  the  general  level  of  cooperation  between  different  NCPs  is 
relatively  intense.  A  number  of  professional  events,  seminars  and  workshops,  held  after  the 
adoption  of  Directive  2011/24/EU  resulted  in  intense  knowledge-sharing  amongst  the  newly 
established NCPs.19 Meetings with NCP coordinators, organised by the European Commission, are 
regularly held. The NCP survey showed that most NCPs evaluate cooperation with other NCPs as 
very positively.20 However, it was also shown that cooperation between NCPs was mainly ad hoc. 
Enhancing  cooperation  and  information  exchange  between  NCPs  was  most  often  mentioned  as 
possible improvements under Directive 2011/24/EU. A number of NCPs mentioned the usefulness 
of shared information platforms. Cooperation aiming to establish a more standardised way of NCP 
practice  is  still  missing.21  Such  standardisation  may, however,  be a  solution  to  redress  current 
shortcomings in information provision to patients in cross-border healthcare.22  

To  map  the  possibilities  for  a  more  formal  collaboration  between  NCPs,  the  current  practice  of 
some other information centres and their networks is analysed. These centres and networks differ 
greatly  in  organisation  and  working  process  but  may  all lead  to  some  examples  which  may  be 
used for NCP collaboration. Considering the starting point of new governance modes, the focus 
will be mainly on framework goals, performance measuring instruments and benchmarking.  

Examples from other information centres and their networks  

HORIZON 2020 NCPs 

Horizon 2020 NCPs are national structures established and financed by governments of the EU 
MSs and the states associated to the Framework Programme Horizon 2020, which is the biggest 
EU Research and Innovation programme running from 2014 till 2020. The national system of NCPs 
is the main structure to provide guidance, practical information and assistance on all aspects of 
participation in Horizon 2020. NCPs ensure that the community is timely and adequately informed 
about open and upcoming calls. They support and assist researchers in the preparation and follow-
up of their application.23 

As the NCPs are national structures, appointed and financed at national level, the type and level 
of services offered may differ from country to country. In general, the following basic services are 
available in accordance with the NCP Guiding Principles agreed upon by all countries24: 

  Guidance on choosing relevant Horizon 2020 topics and types of action; 
  Advice on administrative procedures and contractual issues; 
 
  Distribution of documentation (forms, guidelines, manuals etc.); 
  Assistance in partner search. 

Training and assistance on proposal writing; 

The  national  system  of  NCPs  can  vary  from  one  country  to  another  from  highly  centralised  to 
decentralised  networks,  and  involve  a  number  of  very  different  actors,  from  ministries  to 
universities, research centres and special agencies to private consulting companies. However, all 

18   T. Clemens, E. Cox, B. Van der Zanden et al., Activity Report. Implementation of National Contact 
Points for cross-border healthcare in EU MSs: a comparative analysis using websites and short 
interviews, Maastricht University, 2015.  

19   G. Zucca, A. De Negri, A. Berény, A. Kaszap, K.A. Stroetmann, P. Varnai, Evaluative study on the cross-

border healthcare Directive (2011/24/EU), 2015, 36 and 60.  

20   See infra. 
21   G. Zucca, A. De Negri, A. Berény, A. Kaszap, K.A. Stroetmann, P. Varnai, Evaluative study on the cross-

border healthcare Directive (2011/24/EU), 2015, 60.  

22   A. Santoro, A. Silenzi, W. Ricciardi, M. McKee, Obtaining health care in another European Union MS: 
how easy is it to find relevant information?, Eur J of Public Health (25)1 (2015) 29-31; G. Strban, G. 
Berki, D. Carrascosa, F. Van Overmeiren, Analytical Report 2016: Access to healthcare in cross-border 
situations, FreSsco, January 2017. 

23   http://ec.europa.eu/research/participants/portal/desktop/en/support/national_contact_points.html. 
24   Minimum Standards and Guiding Principles for setting up systems of National Contact Points (NCP 

systems) under HORIZON 2020, DG Research and Innovation, available at: 
http://ec.europa.eu/research/participants/data/support/20131125_NCP%20Minimum%20standards.pdf
.  

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NCP  systems  have  a  common  structure  (National  NCP  coordinator,  Legal  and  financial  aspects 
NCP, SMEs NCP, Access to finance NCP, European Research Infrastructures NCP,…), as prescribed 
by the guiding principles. 

The cooperation between HORIZON 2020 NCPs is thus founded in NCP Minimum Standards and 
Guiding  Principles,  agreed  upon  by  all countries.  These  Guiding Principles  start  by  defining  the 
objectives  to  be  achieved  by  all  NCPs.  Besides,  a  common  set  of  key  principles  and  minimum 
standards is established. Also, the core functions and core structure of an NCP are prescribed. 
Compliance with the guiding principles is monitored by the European Commission. The latter may 
"de-recognise" NCPs as a sanction in case of persisting non-compliance with the guiding principles. 
In  case  of  "de-recognition"  the  NCP  will  be  removed  from  the  mailing  lists  and  will  no  longer 
receive information directly from the Commission, including confidential information.  

There is no H2020 NCP at EU level, nor an independent website. A web portal for participants is 
integrated in EUROPA, including assisting tools such as: 

  H2020 Online Manual; 
 
  Specific contact details of each NCP (per function).25  

FAQ; 

The H2020 NCPs cooperate closely together in transnational joint networks, e.g. ACCESS4SMES26, 
Idealist201827, Net4Society28, HNN2.029, NCP Academy30,... These international NCP networks all 
have  a  distinct  web  portal.  Different  tools  are  used  in  these  networks  to  enhance  cooperation 
between NCPs of different MSs. Examples are: 

 
 
 

information and training materials offered on the network's website, including webinars;31 
the organisation of advanced NCP training days and workshops;32  
online platform/Intranet for sharing questions among NCPs33 or a joint Google group34. 

Besides, NCP coordinator meetings are regularly organised by the Commission. Also cooperation 
exists at regional level, e.g. in Belgium where there are 5 NCP organisations which work with a 
strict regional division according to the location of the seat of the organisation of the applicant, 
NCPs  work  together  through  the  co-organisation  of  information  sessions,  strategic  meetings, 
information sharing,...35  

The NCP_WIDE.NET36 is a transnational network of NCPs for Spreading Excellence and Widening 
Participation.  In  this  network,  a  special  focus  is  given  to  benchmarking  and  monitoring.  The 
network is meant to help less experienced NCPs, which wish to draw on know-how accumulated 
in  other  countries  and  access  resources  in  the  network,  through  mentoring  visits,  a  learning 
platform for trans-national activities of the Spreading Excellence and Widening Participation NCPs, 
and  to  create  a  network  of  NCPs  exploiting  the  synergies  of  distributed  knowledge,  collective 
development and trainings.37  

FreSsco Legal Experts 

FreSsco (Free movement of workers and Social security coordination) is a network of independent 
legal  experts  in  the  fields  of  free  movement  of  workers  and  social  security  coordination  in  the 

25   http://ec.europa.eu/research/participants/portal/desktop/en/support/national_contact_points.html.  
26   Network of NCPs for Small Medium-sized Enterprises and Access to Risk Finance (SME and ARF). 
27   ICT NCP network. 
28   Network of NCPs for the Societal Challenge 6, "Europe in a changing world: inclusive, innovative and 

reflective societies".  

29   Network of NCPs for the Health, Demographic Change and Wellbeing Societal Challenge 1.  
30   Network of NCP Coordinators and Legal and Financial NCPs.  
31   E.g. website Net4Society.  
32   E.g. ACCESS4SMES.  
33   E.g. website Rich 2020 and NCP_WIDE.NET. 
34   Legal and Financial Google Group, NCP Academy. 
35   A. Van Hauwaert, NCP tools for daily work. Organisation at national level amongst multiple NCPs, 

http://www.ncpacademy.eu/wp-content/uploads/2017/06/20170530-
31_NCPToolsForDailyWorkFlanders.pdf. 

36   Network of NCPs for Spreading Excellence and Widening Participation. 
37   See the website of NCP_Wide.Net, https://www.ncpwidenet.eu/project-wide-net/. 

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Study on cross-border health services: enhancing information provision to patients  

European Union. The network is funded by the European Commission and covers all 28 MSs, as 
well as Iceland, Liechtenstein, Norway and Switzerland. It consists of national legal experts on 
coordination  and  national  legal  experts  on  free  movement,  as  well  as  analytical  experts.  The 
FreSsco  network  provides  the  European  Commission  with  expertise  via  annual  comparative 
reports on national legislation and ad hoc analytical support regarding specific themes. Besides, 
the network organises multiple seminars for stakeholders each year.38  

The FreSsco network is operated by the University of Ghent, in partnership with the consultancy 
company  Eftheia.  It  consists  of  a  project  management  and  coordination  team39,  a  team  of 
independent  national  experts  on  coordination  and  on  free  movement  of  workers,  a  team  of 
analytical experts, an advisory board and a communication web team.  

A  web  portal  for  FreSsco  is  integrated  in  the  EUROPA  website.  The  annual  reports  and  ad  hoc 
analytical  reports  are  published  on  the  website.  Besides,  an  integrated  E-learning  tool  which 
consists of keywords and a list of Q&A per keyword is provided. Also, a list of all the members of 
the network is provided.40  

The legal experts cooperate through LinkedIn: closed LinkedIn group FreSsco Coordination and 
closed LinkedIn group FreSsco Free Movement of Workers. Members are also informed through a 
bi-annual newsletter.  

National SOLVIT centres 

SOLVIT helps people who encounter difficulties in another country when public authorities do not 
apply  EU  legislation  correctly;  more  specifically  it  tries  to  solve  cases  regarding  breach  of  a 
citizen's right or a business' right by public authorities in another EU country.41 SOLVIT is a service 
provided by the national administration in each EU MS, Iceland, Liechtenstein and Norway. SOLVIT 
centres are mostly organised within the Ministry of foreign or economic affairs. They work together 
via an online database, where they provide information on cases and on their practices.  

Cases will be handled by two SOLVIT centres: the SOLVIT centre of the home country and the 
SOLVIT centre of the country where the problem occurred. The SOLVIT centre of the home country 
will submit the problem to the lead centre, which will try to find a solution with the public authority 
concerned. The target deadline is published on the SOLVIT website and counts 10 weeks, starting 
from acceptance of the case by the lead centre. SOLVIT is mainly an online service. An informative 
YouTube animation is provided on the SOLVIT portal on EUROPA to explain this procedure.  

Minimum  operational  and  quality  standards  are  outlined  in  the  2013  SOLVIT  governing 
recommendations established by the Commission.42 In these recommendations the objective of 
SOLVIT is set out, as well as several guidelines for SOLVIT service, e.g. that the "SOLVIT service 
should be available by telephone or e-mail, and should provide a prompt reply to communications 
directed to them", that the deadline for handling cases must be limited to ten weeks, that refused 
cases must be based on appropriate justifications,... Besides, a set of guidelines prescribes how 
SOLVIT centres should be organised. Other chapters are for example the chapter on guidelines 
for  regular  quality  checks  and  reporting.  In  May  2017  an  Action  plan  on  the  Reinforcement  of 
SOLVIT was published.43 Reports on the NCP practice are published on the website.  

There is no distinct website for SOLVIT at EU level. The SOLVIT website is integrated in EUROPA. 
A list of contact details of all national SOLVIT centres is provided. Although it is a national service, 
there is also a generalised contact form at EU level for submitting cases to SOLVIT. An inquiry or 
complaint can be submitted on one single portal, which can be experienced as a low-threshold 
procedure.  On  the  SOLVIT  portal  also  successful  outcomes  achieved  by  SOLVIT  centres  are 
published.  

38   See the web portal of FreSsco on EUROPA, http://ec.europa.eu/social/main.jsp?langId=en&catId=1098. 
39   Consisting of a project director, project manager, scientific manager, project management assistant, 

editor and financial manager.  

40   See the web portal of FreSsco on EUROPA, http://ec.europa.eu/social/main.jsp?langId=en&catId=1098. 
41   See the web portal of SOLVIT on EUROPAhttp://ec.europa.eu/solvit/index_en.htm.  
42   Commission recommendation of 17 September 2013 on the principles governing SOLVIT, 

http://ec.europa.eu/solvit/_docs/2013/20130917_recommendation_solvit_en.pdf. 

43   http://ec.europa.eu/solvit/_docs/2017/com-2017-255_en.pdf.  
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Study on cross-border health services: enhancing information provision to patients  

NCP performance tracking data by indicator (first response time, preparation time, resolution time 
and  resolution  rate)  are  also  published  on  the  website.44  Besides,  analytical  information  on 
number of received cases, handling times, staffing level, etc. are provided for each MS.  

On the SOLVIT portal on EUROPA there is also a page for website feedback and scoring "Help us 
improve  our  website".  Visitors  of  the  website  are  invited  to  answer  5  small  yes/no  questions 
regarding the user-friendliness and comprehensibility of the website. There is also the possibility 
to submit personal comments.  

European Network of Information Centres in the European Region (ENIC) 

The European Network of Information Centres in the European Region (ENIC) aims to implement 
the Lisbon Recognition Convention and aims, in general, to develop policy and practice for the 
recognition of qualifications.45 The Council of Europe and UNESCO jointly provide the Secretariat 
for the ENIC Network. The ENIC Network cooperates closely with the NARIC Network (National 
Academic Recognition Information Centres in the European Union) of the European Union. The 
Network  is  made  up  of  the  national  information  centres  of  the  Parties  to  Lisbon  Recognition 
Convention.  An  ENIC  is  a  body  set  up  by  the  national  authorities.  While  the  organisation  and 
specific competences of ENICs may vary, they will generally provide information on:  

 
 
 

the recognition of foreign diplomas, degrees and other qualifications; 
education systems in both foreign countries and the ENIC’s own country; 
opportunities for studying abroad, including information on loans and scholarships, as well 
as advice on practical questions related to mobility and equivalence.46 

There is one ENIC bureau at EU level, consisting of a president and 2 vice-presidents, elected for 
2 years. The ENIC Bureau meets twice or three times a year. Representatives of national ENIC 
centres  meet  once  a  year,  meanwhile  ad  hoc  parties  deal  with  specific  topics.  Working  Parties 
prepare proposals for the annual network meeting. The network also plays an important role in 
the exchange of information between national centres.  

In June 2004, the Joint ENIC-NARIC charter was adopted by the Committee of the Convention on 
the  Recognition  of  Qualifications  concerning  Higher  Education  in  the  European  Region.47  The 
charter prescribes the tasks and activities of national ENIC and NARIC centres and their networks, 
including guidelines for their staff and technical equipment.  

There is an independent website at EU level for both the ENIC network and the NARIC network. 
The website provides a country page with information for each MS, containing references to all 
relevant national actors and official information on e.g. the national information centres, national 
education bodies, system of education, university education,... 

The website provides an e-manual (EAR manual)48 which contains standards and guidelines on all 
aspects of the recognition of foreign qualifications and aims to provide the credential evaluators 
from the ENIC and NARIC networks with a practical tool to assist them in their daily recognition 
work. 

Expert Reviewers for Orphanet 

The  Orphanet  network  consists  of  expert  reviewers  who  annually  contribute  to  updating  the 
scientific information contained in the Orphanet database of rare diseases.49 Expert reviewers are 
recognised each year. The experts are chosen after being identified through their publications and 
their activity. They are invited to examine a form containing scientific information related to given 
diseases that is pre-filled with information of the Orphanet database.  

44   Action plan on the Reinforcement of SOLVIT: Bringing the benefits of the Single Market to citizens and 

businesses (Communication from the Commission), 
http://ec.europa.eu/internal_market/scoreboard/performance_by_governance_tool/solvit/index_en.htm
.  

45   See the ENIC-NARIC website: http://www.enic-naric.net.  
46   See the ENIC-NARIC website: http://www.enic-naric.net/welcome-to-the-enic-naric-website.aspx. 
47   Joint ENIC-NARIC charter of activities and services, 2004, available at: https://rm.coe.int/16807462ca. 
48   http://ear.enic-naric.net/emanual/. 
49   Expert reviewers for Orphanet in 2016, Orphanet report series, available at: 

http://www.orpha.net/orphacom/cahiers/docs/GB/Expert_reviewers_2016.pdf. 

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The  Orphanet  network  makes  use  of  an  independent  website.  On  the  website,  access  to  the 
Orphanet database is made available. Besides, a vocabulary tool, Orphanet Rare Disease Ontology 
(ORDO) is provided which consists of a structured vocabulary for rare diseases derived from the 
Orphanet database, capturing relationships between diseases, genes and other relevant features, 
which will form a useful resource for the computational analysis of rare diseases. Also, Orphanet 
reports are regularly published and updated.  

The cooperation between expert reviewers consists of a platform for experts. As mentioned, the 
network consists of an ad hoc composition. A list of the experts reviewers is published each year. 
The  procedure  is  regulated  in  the  Orphanet  Standard  Operating  Procedures  version  02.1, 
published in June 2016.50 

50   Orphanet Standard Operation Procedures 02.1, June 2016, available at: 

http://www.orpha.net/orphacom/special/eproc_SOPs_V2.pdf. 

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Overview 

MEASURING 
INSTRUMENTS 

HORIZON 
2020 NCPs 

NCP 
Standards 
Guiding Principles 

Minimum 
and 

AND 

SUPPORT 
INFORMATION 
MATERIALS 
  H2020 Manual; 
  FAQ. 

FreSsco 

-- 

  E-learning tool. 

SOLVIT 

SOLVIT 

2013 
governing 
recommendations 

  YouTube  animation 

fragment; 

  General 
form; 

contact 

  Success stories. 

EUROPEAN  WEB 
PORTAL 

COOPERATION 

REGULAR MEETINGS 

BENCHMARKING 

in 

Several international 
joint networks 

Sharing 
experiences 
during  meetings,  best 
practices, trainings. 

NCP 
coordinator 
meetings,  organised  by 
the EC to: 
  Discuss 

collaboration; 
Share experiences; 
Identify 
good 
practices; 
Address problems. 

 
 

 

in 

Closed 
groups. 

LinkedIn 

10  seminars  with  other 
stakeholders a year. 

-- 

Support 
information 
material; 
List 
members. 

and 

of 

in 

SOLVIT database. 

-- 

Analytical 
information; 
quality 
reporting. 

SOLVIT 
regular 
checks  and 

Integrated 
EUROPA: 
 

and 

Support 
information 
materials; 
Contact  details 
NCPs 
(per 
function). 

Integrated 
EUROPA: 
 

Integrated 
EUROPA: 
 

and 

Support 
information 
materials; 
List  of  contact 
details  SOLVIT 
centres; 
Analytical 
information. 

 

 

 

 

ENIC 

ENIC-NARIC charter 

Independent 
website: 
 

Contact  details 
and  information 
per MS.  

  E-manual; 
  The 

ENIC-NARIC 

Networks: 
Reference 
Documents 
(e.g. 
legal framework and 
background; 
adopted 
documents) 

Orphanet 

Orphanet  Standard 
Operating 
Procedures  version 
02.1 

  Orphanet database; 
(Orphanet 
  ORDO 
Disease 
Rare 
Ontology). 

Independent 
website: 
 

and 

Support 
information 
materials; 
List  of  expert 
reviewers. 

 

 
 

Ad hoc parties; 
Joint meetings. 

Annual 
meetings. 

network 

-- 

Orphanet database. 

Expert platform. 

-- 

75 

 
 
 
 
 
 
 
 
 
 
Recommendation for NCPs for Cross-border healthcare  

Five main recommendations may be formulated based on the results of the analysis: 

1.  Develop standardised measuring instruments, such as guiding principles and indicators; 
2.  Use support and information materials (e.g. manuals, FAQ, e-learning tool, webinar); 
3.  Collect analytical information on the NCP practice for monitoring and benchmarking; 
4.  Create  an  EU  web  portal  for  NCPs,  including  analytical  information,  website  feedback, 

information on the healthcare system per MS; 

5.  Establish joint networks between NCPs. 

 
 
 
ANNEX J – ONLINE SURVEY PATIENTS (WP4) 

MS  

Austria 

Belgium 

On  suggestion  of  the 
Flemish 
patient 
platform: 

Bulgaria 

Croatia 

Cyprus 

Czech Republic 

Denmark 

Estonia 

Finland 

France 

Patient organisation 

Website  

of 

of 

of 

of 

cancer 

patient 

patient 

patient 

Cystitis 

coalition 

coalition 

coalition 

coalition 

dysplasie 

Österreichische Krebshilfe 
(National 
assocations) 
Flemish patient platform 
(Flemish 
organisations) 
Angelman Syndroom België  
Angioedema Belgium vzw 
Bardet-Biedl Oudercontact 
Ectodermale 
België/Nederland 
Interstitiële 
Patiëntenvereniging België 
Liga Myasthenia Gravis vzw 
MSA-AMS vzw 
Prader-Willi Vlaanderen vzw 
Ligue  des  Usagers  des  Services  de 
Santé  
(French 
organisations) 
NPO - National Patients' Organisation 
(National 
organisations) 
KUZ  -  Coalition  of  Associations  in 
Healthcare 
(National 
organisations) 
Pancyprian  Federation  of  Patients 
Associations and Friends  
(National 
organisations) 
Arcus onko centrum 
(Cancer patient organisation) 
Česká 
vzácná 
asociace 
onemocnění  (Czech  Association  for 
Rare Diseases) 
Danske Patienter/ Danish patients  
(Association of 81 patients associations 
in Denmark) 
EPIK  -  Estonian  Chamber  of  Disabled 
People 
(National 
organisations) 
Cancer society of Finland  
(Coalition  of  12 
regional  cancer 
associations  and  six  national  patient 
organisations) 
l'Union  nationale  des  associations 
agréées d'usagers du système de santé 
(période de transition le CISS) 
(National  coalition  of  72  patient 
organisations) 

coalition 

coalition 

coalition 

patient 

patient 

patient 

pro 

of 

of 

of 

www.krebshilfe.net 

www.vlaamspatientenplatform.be 

www.angelmansyndroom.be 
www.angioedema.be 
www.angelfire.com/co3/PEKICH 
www.vved.info 

www.icpb.be 

www.ligamg.be 
www.msa-ams.be 
www.praderwillivlaanderen.be 
www.luss.be 

www.npo.bg. 

www.kuz.hr 

www.cypatient.org 

www.arcus-oc.org 

www.vzacna-onemocneni.cz 

www.danskepatienter.dk 

www.epikoda.ee 

www.cancersociety.fi 

www.leciss.org 

 
 
 
 
 
 
Study on cross-border health services: enhancing information provision to patients  

Contacted patient organisations 

MS  

Germany 

Greece 

Hungary 

Iceland 

Ireland 

Italy 

Latvia 

Lithuania 

Luxembourg 

Malta 

Netherlands 

Norway 

MS  
Poland 

Portugal 

Romania 

78 

Patient organisation 

Website  

of 

of 

patient 

patient 

patient 

patient 

patient 

coalition 

coalition 

coalition 

coalition 

advocacy 

BAG Selbsthilfe - Federal Association of 
Self-Help Organisations for people with 
disabilities  and  chronic  diseases  and 
their relatives 
(National 
organisations) 
NCDP  -  National  Confederation  of 
Disabled People  
(National 
organisations) 
BEMOSZ  -  Hungarian  Alliance  of 
Patients’ Organisations  
(National 
organisations) 
ÖBÍ  -  Organisation  of  Disabled  in 
Iceland  
(National 
organisations) 
Irish Cancer Society 
(National cancer organisation) 
Irish patients’ Association  
(National 
organisation) 
F.A.V.O.  Federazione  Italiana  delle 
Associazioni 
in 
Oncologia 
(National  coalition  of  cancer  patient 
organisations) 
SUSTENTO  -  The  Latvian  Umbrella 
Body for Disability Organization  
(National 
organisations)  
LPOAT - Council of Representatives of 
Patients’ organizations of Lithuania 
(National 
organisations) 
Patiente Vertriedung  
(National  patient  organisation  that 
offers  advice  and 
information  on 
administrative,  technical,  medical  and 
care  problems  in  the  areas  of  health 
and social security) 
MHN - Malta Health Network  
(National 
organisations) 
Patiëntenfederatie Nederland 
(National 
organisations)  
Kreft Foreningen  
(National cancer patient organisation) 

Volontariato 

coalition 

coalition 

coalition 

coalition 

patient 

patient 

patient 

patient 

of 

of 

di 

FF0  –  Norwegian  Federation  of 
Organizations of Disabled people  
(National  coalition  of  82  patient 
organisations 
with 
for 
disabilities and chronic diseases) 

people 

patient 

of 

Patient organisation 
FPP - Federation of Polish Patients 
(National 
coalition 
organisations) 
Raríssimas  
(National 
diseases) 
COPAC 
Organizations with Chronic Diseases 
(National 
coalition 
organisations) 

organisation 

for 

of 

-  Coalition  of  Patients' 

patient 

rare 

www.bag-selbsthilfe.de 

www.esaea.gr 

www.bemosz.hu 

www.obi.is 

www.cancer.ie 

www.irishpatients.ie 

www.favo.it 

www.sustento.lv/?lang=en 

www.pacientutaryba.lt 

www.patientevertriedung.lu 

maltahealthnetwork.org 

www.patientenfederatie.nl 

www.kreftforeningen.no 

http://www.ffo.no 

Website  
www.federacjapp.pl  

http://www.rarissimas.pt/index.php 

www.copac.ro 

RONARD - Romanian National Alliance 
for Rare Diseases 

www.apwromania.ro 

 
 
 
 
of 

Spain  

patient 

coalition 

Slovakia 

Slovenia 

AOPP - Association for the Protection of 
Patients' Rights 
(National 
organisations) 
Cancer Patients Association of Slovenia 
(National cancer patient organisation) 
FEP - Spanish Patients' Forum 
(National 
organisations) 
HSO - Swedish Disability Federation 
(National 
coalition 
organisations) 
Patients Association  
(National patient organisation) 
National Voices 
(National 
organisations) 
Additional patient organisations contacted on 10 November: 

United Kingdom 

Sweden 

coalition 

coalition 

patient 

patient 

patient 

of 

of 

of 

www.aopp.sk 

www.onkologija.org 

www.forodepacientes.org 

www.hso.se 

www.patients-association.org.uk 

www.nationalvoices.org.uk 

European Patients’ Forum, EPF 
International  Federation 
Bifida and Hydrocephalus 

for  Spina 

www.eu-patient.eu 
www.ifglobal.org 

Template online survey  

Patients in Cross-border Healthcare Survey 

# 

1 

2 

3 

4 

5 

Question  

How many times did you travel to another country (EU MS, Norway, Iceland or Liechtenstein) with the 
purpose of receiving medical treatment?  

Did you receive cross-border healthcare from a public or private healthcare provider? 

Did you receive cross-border care physically or through telemedicine?  

Did you apply for authorisation of the cross-border treatment with your national healthcare institution?  

Did you need authorisation from your national healthcare institution in order to receive your cross-border 
treatment? 

6  What was the reason you travelled to another country to receive medical treatment or telemedicine? 

7 

8 

Do you know about the existence of National Contact Points for Cross-border Healthcare? 

Before travelling abroad for medical treatment or telemedicine, did you already know about your right to 
receive medical treatment in another EU country and being reimbursed for that treatment by your own 
health insurance institution? 

9 

By what means did you learn about your right on reimbursable cross-border healthcare? 

10 

Prior to filling out this survey, did you know that there are two ways to receive reimbursable healthcare 
in  another  country,  more  specifically  on  the  basis  of  the  European  Directive  2011/24/EU on  patient's 
rights in cross-border healthcare and on the basis of the Social Security Regulation (EC) No 883/2004? 

11  By what means did you learn of the existence of National Contact Points for Cross-border Healthcare?  

12  Did you have contact with a National Contact Point for Cross-border Healthcare during your process of 

medical treatment abroad? 

13  With which National Contact Point for Cross-border Healthcare did you have contact during your process 

of medical treatment abroad? 

14  Did you encounter difficulties in the transfer of medical documents between your healthcare providers at 

home and the healthcare provider in the MS of treatment?  

15  Which institution did you contact or which webpage did you consult in order to obtain information with 

regard to the medical treatment or telemedicine abroad? 

16  Which public website did you consulted in order to obtain information on the cross-border treatment or 

telemedicine?  

17  Did you experience difficulties in finding information with regard to medical treatment or telemedicine 

abroad? 

18  How did you experience the level of comprehension and clarity of the information provided with regard 

to the process of medical treatment or telemedicine abroad?  

19  Did  you  experience  any  language  difficulties  in  finding  and  receiving  information  on  the  country  of 

treatment or telemedicine?  

20  Did you search for information in English on the country of treatment? 

79 

 
 
 
 
Study on cross-border health services: enhancing information provision to patients  

Patients in Cross-border Healthcare Survey 

21  Was it easy to find information in English? 

22  On which aspects of the process of cross-border treatment did you search for information? 

23  On  which  aspects  of  the  process  of  cross-border  treatment  did  you  experience  difficulties  finding  or 

understanding information? 

24 

Please  evaluate, when applicable, your experience with  information gathering on the following  topics: 
Prior  authorisation,  Reimbursement,  Quality  and  safety,  Healthcare  providers  abroad,  Accessibility  of 
hospitals  for  people  with  disabilities,  Complaint  and  redress  procedures,  Transfer  of  medical  records, 
Waiting times. 

25  Did you receive reimbursement for your medical treatment or telemedicine abroad?  

26 

27 

Please  indicate  what  is  applicable  regarding  the  reimbursement  for  your  medical  treatment  or 
telemedicine  abroad:  I  received  partial  reimbursement  for  the  cross-border  treatment,  I  received  full 
reimbursement for the cross-border treatment.  

Please  indicate  what  is  applicable  regarding  the  reimbursement  for  your  medical  treatment  or 
telemedicine  abroad:  I  received  medical  treatment  free  of  charge  at  point  of  use,  I  only  had  to  pay 
directly a small portion of the total amount of the medical treatment abroad myself, I paid the medical 
treatment  upfront  and  received  reimbursement  from  the  healthcare  insurer  in  the  MS  of  treatment,  I 
paid  the  medical  treatment  upfront  and  received  reimbursement  afterwards  from  my  own  healthcare 
insurer, “Other”.  

28  Did  you  experience  any  difficulties  with  regard  to  obtaining  reimbursement  for  your  cross-border 

treatment? 

29 

Please indicate what is applicable regarding your experience with regard to obtaining reimbursement for 
your cross-border treatment.  

30  Were you satisfied with the quality of care you received abroad? 

31  Did you search in advance for information on quality and safety of care in the country where you whished 

to receive treatment? 

32 

Please indicate what is applicable: It was easy to find information on quality and safety in the country of 
treatment, It was difficult to find any information on quality and safety in the country of treatment. 

33  Are there specific problems in information provision you have encountered during your process of medical 

treatment or telemedicine abroad that you would like to share?  

34  Are  there  specific  aspects  to  information  provision  to  patients  in  cross-border  healthcare,  which  you 

believe should be enhanced? 

35  Do you have any other remarks you would like to share? 

80 

 
ANNEX K - URLS OF THE NCP WEBSITES OF THE 28 MSS + NORWAY 

Country 

URL 

Austria 

Belgium 
Bulgaria 
Croatia 
Cyprus 
Czech 
Republic 
Denmark 

Estonia 
Finland 
France 
Germany 
Greece 
Hungary 

Ireland 
Italy 

Latvia 
Lithuania 

Luxembou
rg 
Malta 
Netherlan
ds 
Norway 
Poland 
Portugal 
Romania 
Slovakia 

Slovenia 
Spain 
Sweden 

United 
Kingdom 

https://www.gesundheit.gv.at/service/patientenmobilitaet/kontaktstelle
-patientenmobilitaet 
www.crossborderhealthcare.be 
www.nhif.bg 
www.hzzo.hr 
www.moh.gov.cy/cbh 
www.kancelarzp.cz 

http://stps.dk/da/borgere/internationalsygesikring/nationaltkontaktpunk
tfor-behandling-i-eueoes 
www.haigekassa.ee/kontaktpunkt 
www.hoitopaikanvalinta.fi 
http://www.cleiss.fr/presentation/pcn.html 
www.eu-patienten.de 
www.eopyy.gov.gr 
http://www.patientsrights.hu/ 
(http://www.eubetegjog.hu/) 
http://hse.ie/eng/services/list/1/schemes/cbd/CBD.html  
http://www.salute.gov.it/portale/temi/p2_4.jsp?lingua=english&area=h
ealthcareUE  
www.vmnvd.gov.lv  
www.lncp.lt (for information in one place) 
(http://www.vaspvt.gov.lt/en) 
(http://www.vlk.lt/vlk/en/) 
www.mediateursante.lu  
www.cns.lu 
http://health.gov.mt/en/cbhc/Pages/Cross-Border.aspx 
http://www.cbhc.nl/en-us/ 

https://helsenorge.no/norwegian-national-contact-point-for-healthcare1 
ca17@nfz.gov.pl  
diretiva.pcn@acss.min-saude.pt  
www.cnas-pnc.ro  
www.udzs-sk.sk 
http://www.nkm.sk/en_GB/web/guest/home 
http://www.nkt-z.si/wps/portal/nktz/home 
http://www.msssi.gob.es/pnc/home.htm  
www.forsakringskassan.se  
www.socialstyrelsen.se 
https://www.nhs.uk/NHSEngland/Healthcareabroad/Pages/Healthcareab
road.aspx (England) 
http://www.nhsinform.scot/ (Scotland) 
www.nhsdirect.wales.nhs.uk/travelhealth/NCPs/ (Wales) 
http://www.hscboard.hscni.net/travelfortreatment/ (Northern Ireland) 
http://www.gha.gi (Gibraltar) 

/ 

Inboun
d 
outbou
nd 
no 

no 
no 
no 
no 
no 

no 

no 
no 
no 
no 
no 
no 

no 
no 

no 
no 

yes 

no 
no 

no 
no 
no 
no 
yes 

no 
no 
yes 

no 

Nr.  of 
websit
es 

1 

1 
1 
1 
1 
1 

1 

1 
1 
1 
1 
1 
1 

1 
1 

1 
1 

2 

1 
1 

1 
1 
1 
1 
2 

1 
1 
2 

5 

 
 
 
 
 
 
Study on cross-border health services: enhancing information provision to patients  

ANNEX L – WORKSHOP PROCEEDINGS 

On 8 March 2018, a workshop/meeting of National Contact Points (NCPs) for cross-border healthcare 
was held on European Commission premises in Brussels. Below a brief overview of the proceedings 
of this workshop is presented. 

Welcome and Introductory remarks 

The Commission welcomed all attendees, and the agenda was adopted. The Commission introduced 
the representative of the European Court of Auditors who attended the workshop exceptionally on 
this occasion. The forum was briefed on the ongoing performance audit on cross-border healthcare 
within the framework of Directive 2011/24/EU. The audit would focus on the functioning of NCPs, e-
Health strategies and rare disease patient policies. It was explained that a number of Member States 
were selected for in-depth visits and these would be contacted by the Court of Auditors in due course. 

Then, the Study on Cross-border Health services: Enhancing Information Provision to Patients was 
introduced. On behalf of the project team, the moderator introduced the team in charge of the study 
consisting of KU Leuven, GfK and Ecorys. Additionally, the aim and objective of the workshop were 
discussed,  as  well  as  the  focus  of  the  day:  "feeding  back  and  learning  from  each  other".  The 
objectives of the study were three-fold: (i) to identify the information needs of patients; (ii) to assess 
how the NCPs collect the information and provide it to patients; and (iii) to propose practical tools 
and guiding principles to improve the information provision by the NCPs.  

Results of NCP Website Analysis (Work Package 2) 

On behalf of the project team, Ecorys presented the preliminary results of Work Package 2: Website 
Analysis. One NCP (Ireland) gave an overview of developments in their Member State related to their 
approach to ensuring a good website for the National Contact Point function. The main issues that 
were touched upon include amongst others: difficulties in providing reimbursement information on 
the website, the requirement of the availability of information in both native and English language, 
and continuous improvement of the websites so that the end-user perspective can be enhanced.  

Results of NCP Pseudo-Patient Investigation (Work Package 3) 

On behalf of the project team, GfK presented the methodology and preliminary results of the pseudo-
patient  investigation  conducted  between  August  and  October  2017.  In  a  nutshell,  55%  of  NCPs 
responded to at least half of the questions in the email or telephone inquiries, on average. 24% of 
NCPs were able to respond to the majority of questions, on average. 10% of NCPs were not able to 
provide any information to the pseudo-patients. 

With regards to the evaluation of the replies received, the project team informed that the assessment 
of the replies was built on a series of binary values indicating whether the answers were provided or 
not. They did not investigate whether the answers provided to the pseudo-patients by each NCP were 
right or wrong. GfK further confirmed that in some cases, pseudo-patients were told by the NCPs 
that they were not allowed or were unable to give a certain piece of information. 

Issues that were touched upon by the NCPs were amongst others: case management by NCPs, legal 
restrictions of the NCPs and the use of Social Media to inform patients.  

Draft Toolbox and Training Material including Guiding Principles (Work Package 4) 

The  KU  Leuven  representative  presented  the  draft  toolbox,  draft  training  material  and  the  eleven 
draft Guiding Principles for good NCP conduct. To facilitate the discussion, the NCPs were asked to 
express their opinions on each draft guiding principle via an interactive voting tool. The NCPs were 
able  to  vote  (yes  or  no)  on  whether  they  agree  with  the  overall  principles  and  the  preliminary 
underlying guidelines and indicators. The voting tool then showed the results on screen in a real-
time setting. 

In  general,  the  draft  guiding  principles  underpinning  the  guidelines  were  not  as  queried  as  the 
preliminary  guidelines  and  indicators  supporting  them.  In  light  of  the  detailed  feedback  received 
during and further to the workshop, KU Leuven proposed to revise the draft guidelines and indicators 
and resubmit them via written consultation in spring 2018 to the NCPs. 

82 

 
 
Looking  Ahead:  Interactive  Session  on  Implementation  of  the  Draft  Toolbox  and  Next 
Steps 

No  NCP  representative  queried  the  intrinsic  value  of  good  NCP  conduct  and  the  added  value  of 
streamlining  information  provision  in  the  interest  of  patients.  None  questioned  the  choice  of  the 
present methodology and its roll-out as a vehicle to map the current state of play on the ground.  

NCPs were thus invited to share their views on the draft guidelines and toolbox with the consortium 
on the last mile before the study finalisation. It was requested to take into account, in the assessment 
of NCPs' functioning, national specificities and the diverse ways in which NCPs are organised. 

Wrap-up of the day 

The  Commission  and  the  project  team  thanked  participants  for  their  attendance  and  views  and 
announced  that  the  timeline  for  publication  of  the  study  on  enhancing  information  provision  to 
patients would be summer/ early autumn.  

83 

 
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doi:10.2875/87869 
ISBN 978-92-79-80263-8