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Cross-border healthcare: patients’ rights

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Cross-border healthcare: patients’ rights

The freedom to receive health services throughout the European Union must be accompanied by guarantees of quality and security. In order to make an informed choice, patients must be able to access all the information they require on the conditions under which they will receive healthcare in another EU Member State and the conditions under which they will be reimbursed once they return home.


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.


This Directive makes provision for the introduction of a general framework to:

  • clarify patients’ rights with regard to accessing cross-border healthcare provision ;
  • guarantee the safety, quality and efficiency of care that they will receive in another EU Member State;
  • promote cooperation between Member States on healthcare matters.

This Directive does not concern:

  • long-term care services;
  • public vaccination programmes.

Member States’ responsibilities

Each Member State shall designate one or several national contact points for cross-border healthcare. These contact points shall consult with patient associations, healthcare providers and healthcare insurers. They are responsible for providing patients with information on their rights when they decide to take advantage of cross-border healthcare and with the contact details of the other contact points in the other Member States.

The Member State of treatment organises and provides the healthcare. They are responsible for ensuring the quality and safety of the healthcare provided, in particular by implementing control mechanisms. They also ensure the protection of personal data and equal treatment for patients who are not nationals of their country. The national contact point in the Member State of treatment shall provide patients with the necessary information.

The Member State of affiliation takes care of the reimbursement of the insured person on the condition that the treatment received is provided for under reimbursable care in their national legislation.

Procedures for reimbursing cross-border care

The Member State of affiliation shall ensure that the costs incurred by an insured person who receives cross-border care are reimbursed. The amount of the reimbursement is equivalent to the amount which could have been reimbursed by the statutory social security system if the care was provided in their country. It must not exceed the actual costs of the care.

The Member State of affiliation may reimburse related costs, such as accommodation and travel costs.

An insured person may also receive reimbursement for care services provided remotely in the form of telemedicine.

In order to avoid the risk of undermining the planning and/or financing of their health system, the State of affiliation can implement a system of prior authorisation for certain cross-border healthcare , in particular those involving at least one night in hospital or use of high-cost and highly specialised medical facilities or equipment. The State of affiliation may refuse to grant this authorisation to a patient in very specific cases however this authorisation is automatic if this healthcare cannot be provided on the patient's territory within a time limit which is medically justifiable given the state of health of the patient.

If a patient requests prior authorisation and the conditions are met, authorisation must be granted in accordance with the Regulation relating to the coordination of social security systems, except if the patient requests to be treated under the framework of this Directive.

Administrative procedures relating to the provision and reimbursement of cross-border healthcare must be based on objective and non-discriminatory criteria, which are necessary and proportionate to the objective to be achieved. They should be implemented in a transparent manner and must meet reasonable deadlines fixed by each Member State.

When processing a request for cross-border healthcare, Member States must take into account the patient’s medical condition, as well as the urgency of the specific circumstances.

Cooperation on healthcare

Member States will cooperate on the implementation of the Directive. In particular, they will support the creation of European reference networks of healthcare providers. These aim to facilitate the mobility of expertise in Europe and access to highly specialised care through the concentration and joining up of available resources and expertise.

Member States shall recognise the validity of medical prescriptions issued in other Member States if those medicines are authorised in their country. Implementing Directive 2012/52/EU of 20 December 2012 therefore set out measures to facilitate the recognition of medical prescriptions. It essentially contains a non-exhaustive list of items to include in the medical prescriptions issued in a Member State other than the Member State where the prescriptions are dispensed. The national contact points must also inform patients about these items.

Member States are also encouraged to cooperate to improve the diagnosis and treatment of rare diseases through notably using theOrphanet database, reference European networks and opportunities offered by Regulation (EC) No 883/2004 for transferring patients suffering from rare diseases to other Member States, when the diagnosis and/or treatment of an illness are not available in the Member State of affiliation.

E-health services also enable the provision of cross-border care. This Directive provides for the establishment of a network bringing together national authorities responsible for e-health, with the aim of improving the continuity of care and guaranteeing access to high quality healthcare.

Lastly, the creation of a network of authorities or bodies responsible for evaluating health technologies will facilitate cooperation between the national competent authorities in this field.


This Directive is in line with the Court of Justice jurisprudence following the Kohll and Decker judgement delivered on 28 April 1998 and which established the right of patients to be reimbursed for medical treatment received in a Member State other than their own. It does not bring into question the Regulation principles on the coordination of social security systems, in particular the principles regarding equality between resident and non-resident patients of a Member State and the European Health Insurance Card.



Entry into force

Deadline for transposition in the Member States

Official Journal

Directive 2011/24/EU



OJ L 88, 4.4.2011


Commission Implementing Directive 2012/52/EU of 20 December 2012 laying down measures to facilitate the recognition of medical prescriptions issued in another Member State [Official Journal L 356 of 22.12.2012].

Last updated: 10.04.2014