Factsheet – A long journey to care, or why it’s time for an ambitious EU framework for a cross-border healthcare
FACTSHEET
A long journey to care, or why it’s time for an ambitious EU framework for a cross-border healthcare
Adam is a 76-year-old Polish citizen who
suffers from the late-stage Alzheimer and
travels once a month to Germany for an
advanced treatment. This treatment,
which is not available in his country allow
him to respond better to the
environment, carry on a conversation
with his family, and at least partially to
control his movement.
He is one of 200,000 patients (0.05% of
the EU population) who every year seek
healthcare abroad under the framework
of the Cross-border Healthcare Directive
(Directive 2011/24/EU), principally in a
neighbouring Member State to their
country of residence. In 2019, 290,890
patients sought healthcare in another
Member State.
The Directive aims to guarantee EU patients’
right of access to safe and high-quality
healthcare across national borders within the
EU/EEA, their rights to be reimbursed for such
care, and to facilitate the cross-border
exchange of and access to patients’ data.
The Directive’s contributions to improve the
treatment of rare disease patients is well
recognised. The 24 European Reference
Networks (ERNs) have had a positive impact for
patients by facilitating the exchange of
knowledge and best practices across the EU,
although they could be further improved and
expended.
In fact, the Directive has delivered a limited
positive impact for many patients. Such was the
conclusion of the European Court of Auditors in
2019 and of many citizens who received
healthcare under the Directive.
Patients are required to deal with a complex
system of lengthy administrative procedures to
determine whether their treatments are eligible
and often have to seek prior authorisation, for
which national procedures differ widely.
Patients must also bear the upfront cost of their
treatment and may not be reimbursed its full
cost, excluding many European citizens from
the equality of access that Europe strives to
achieve in healthcare.
The Directive is an essential tool for Europe to improve patients’ access to
specialised treatments such as advanced therapy medicinal products
(ATMPs) and orphan medicines for whom cross-border treatment is often
the only available solution.
These innovative treatments, based on
genes, tissues, or cells, are the next
generation of care and build on Europe’s
excellence in research and innovation.
Unlike many current medicines, they offer
the prospect of curing diseases like
Alzheimer’s for the first time or effectively
treating cancers with single or small
number of treatments. Yet, ATMPs require
a level of expertise and infrastructure,
including manufacturing, processing, and
healthcare delivery that is not available in
all 27 EU countries, and will never be viable
to do so, particularly for rare diseases.
As such, patients often need to seek crossborder
care through the Coordination of
Social Security Regulations, an equally
complex and restrictive system, due to the
necessity to request prior authorisation,
that does not provide reimbursement for
all costs associated with the treatment,
such as travel and accommodation further
adding to patients’ burdens.
All these administrative complexities added
to different national rules and procedures
for eligibility of treatments only delay
patients access to life-saving treatments
and increase the burden on themselves
and their families.
As the European Commission finalises its
first evaluation of the Cross-Border
Healthcare Directive after more than 10
years, it has the opportunity to strive for an
ambitious and future-ready Directive. A
revision can address shortcomings linked
to ease and equality of access, and patient
empowerment through a well-functioning
and integrated EU cross-border healthcare
framework which harnesses Europe’s
clinical excellence. Harmonised and
simplified administrative procedures,
including for payment and
reimbursements, expanded and better
integrated ERNs, and easier access to
cross-border clinical trials are objectives
that can be achieved by revising the
Directive.
If the European Health Union born out of
the COVID-19 pandemic is to succeed, it
needs to bring real benefits to citizens
across Europe. Guaranteeing simpler and
wider access to care, in particular for
innovative treatments, is where the EU can
excel and bring significant added value
from integration and collaboration.