Rapport - A6-0129/2005Rapport
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REPORT on patient mobility and healthcare developments in the European Union

29.4.2005 - (2004/2148(INI))

Committee on the Environment, Public Health and Food Safety
Rapporteur: John Bowis

Proċedura : 2004/2148(INI)
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on patient mobility and healthcare developments in the European Union (2004/2148(INI))

The European Parliament,

-    having regard to the communication from the Commission - "Follow-up to the high level reflection process on patient mobility and healthcare developments in the European Union" (COM(2004)0301),

-    having regard to Article 152 and Articles 5, 18, 43 and 47 of the EC Treaty,

-    having regard to the communication from the Commission to the Council, the European Parliament, the European and Social Committee and the Committee of the Regions on Modernising social protection for the development of high-quality, accessible and sustainable health care and long-term care: support for the national strategies using the "open method of coordination" (COM(2004)0304),

-     having regard to Directive 95/46/EC[1] on the protection of individuals with regard to the processing of personal data and on the free movement of such data,

-     having regard to the communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions on ‘e‑Health – making health care better for European citizens: an action plan for a European e‑Health Area’ (COM(2004)0356),

-     having regard to the communication from the Commission to the Council, the European Parliament, the European and Social Committee and the Committee of the Regions on eEurope 2002: Quality Criteria for Health related Websites (COM(2002)0667),

-     having regard to the judgments of the Court of Justice of the European Communities in Decker (C-120/95, 28 April 1998), Kohll (C-158/96, 28 April 1998), Geraets-Smits & Peerbooms (C-157/99, 12 July 2001), IKA (C-326/00, 25 February 2003) and Müller-Fauré & van Riet (C-385/99, 13 May 2003),

-     having regard to the Commission Proposal for a Directive of the European Parliament and of the Council on the recognition of professional qualifications (COM(2002)0119-COD 2002/0061),

-     having regard to the Commission Proposal for a Directive of the European Parliament and of the Council on services in the internal market (COM(2004)0002-COD 2004/0001),

-  having regard to its resolutions of 15 January 2003 and 11 March 2004 on the future of health care and care for the elderly[2] and on health care and care for the elderly[3],

-     having regard to Rule 45 of its Rules of Procedure,

-    having regard to the report of the Committee on the Environment, Public Health and Food Safety (A6‑0129/2005),

A. whereas healthcare in the EU is being transformed by developments in medicine, technology, e-health, patient awareness and law;

B.  whereas the E111 system for unplanned health treatment when temporarily in another Member State is being superseded by the European Health Card, and whereas there is a need to replace, or significantly change, the bureaucratic and restrictive E112 system for planned health treatment in another Member State;

C. whereas prevention represents a key element of a comprehensive health policy and systematic preventive measures increase life expectancy, lessen discrepancies between social groups in terms of waiting times in the health care system and stop the spread of chronic illnesses, thereby allowing reductions in treatment costs;

D. whereas European health policy is being driven in a piecemeal fashion by European Court of Justice rulings on patient mobility, and the process of enlargement will bring even more complex cases for the European Court of Justice to deal with, and whereas it is in both patients' and governments' interests that clear guidance on policy and procedures should be agreed and put in place without delay;

E.  whereas primary responsibility for the organisation, financing and delivery of health services and medical care lies with the Member States, while the European Union has a responsibility in the fields of public health, (deletion) health promotion, research and early detection and a role in cross‑border mobility;

F.  whereas further clarity is needed to enable patients, healthcare professionals and health budget holders and insurers to understand and participate in cross-border and transnational healthcare;

G. whereas there are significant logistical, administrative, cultural and clinical challenges in delivering a consistent, safe and accessible patient mobility framework for the EU;

H. whereas health care systems in the Union are founded on the principles of solidarity, equity and universality, in order to guarantee that all persons, regardless of their income, wealth and age, receive appropriate, high‑quality care in the event of sickness;

I.   whereas patient mobility is a complex issue owing to differences in national healthcare systems and traditions; whereas, however, this should not prevent efforts being made to resolve coordination and efficiency problems facing users and to improve services;

1.  Welcomes the Commission Communication on patient mobility and the ideas it outlines for structuring cooperation in healthcare;

2.  Stresses the need, with due regard for the priority of maintaining and ensuring unrestricted and universal access to the public health service, for the European Union to develop urgently a coherent policy on patient mobility in the light of the judgements of the Court of Justice of the European Community and the report of the High Level Reflection Process on Patient Mobility and Healthcare Developments, and to agree guidelines for use by patients, health professionals and funding agencies; believes that as a minimum the patient who suffers from a life-threatening condition should have a right to seek timely treatment in another Member State, if this is not available in his/her own country or not within a reasonable period of time;

3.  Believes that further cooperation between the Member States, coordinated by the Commission where appropriate, should concentrate on the specific issues related to cross‑border health care. At the same time, particular attention should be paid to aspects of regional cooperation, and the experiences gained in border regions should be taken into account appropriately. In this way, solutions tailored to specific regions can be sought to meet people’s needs. Practical experiences can be used in the form of best practice models;

4.  Emphasises that health care services constitute services for people in need and cannot, therefore, be compared with goods offered for sale; believes, therefore, that this needs a separate Commission proposal and should not be included in the general Services Directive; however, reiterates the need for a firm and timetabled proposal for action on patient mobility and which takes into account the conclusions of the High Level Group on Health Services and Medical Care;

5.  Regrets that the Commission Communication on patient mobility does not provide a timetable for action and does not make any commitment to an integrated policy on patient mobility;

6.  Considers that the open method of coordination is an appropriate framework for dealing with patient mobility issues, without simultaneously excluding cooperation between States on matters for which Member States' health services are responsible;

7.  Believes guidelines should include procedures to obtain treatment, sources of information about health professionals and health care facilities, mechanisms for paying for care, arrangements for travel and linguistic support, arrangements for continuing care, follow up, convalescence and rehabilitation prior to or after return, complaints and other related procedures and special care for the elderly and pensioners; points out that mechanisms of payment for care should be uniform and impartial so as to avoid inequalities and the creation of disadvantages to certain patients;

8.  Considers it essential to promote cross-border cooperation in order to provide effective or urgent treatment, primarily in the case of emergencies, chronic disease, and serious illness or allergy;

9.  Welcomes the Commission Communication on extending the ‘open method of coordination’ to healthcare and long-term care and looks forward to follow-up work to provide a mechanism for structuring cooperation between Member States with specific objectives and regular reviews;

10. Calls for an overall scientific approach aimed at structuring the process of the Open Method of Coordination in the best possible way. This requires Europe‑wide data compatibility as well as a central metalevel index. It should be investigated to what extent the data already available can be integrated;

11. Welcomes the DG SANCO 2005 workplan under the Public Health Framework Programme which includes pilot proposals for cross-border co-operation in health services, to help develop co-operation and to identify potential benefits and problems associated with such co-operation;

12. Considers the lack of progress on patient information as a serious threat to the development of healthcare in the EU and in particular to the attainment of patient mobility; calls upon the Commission and Council urgently to bring forward a framework for everyday patient information;

13. Criticises the fact that a coordination of the views of the rights and duties of patients – as recommended by the Process of Reflection – has not yet been carried out, and calls on the Council and the Commission to do so without delay; calls on the Member States to adopt a patients’ law or patients’ charter in which patients are granted, among others, the following rights:

–   the right to appropriate and qualified medical care provided by qualified medical staff,

–   the right to easily understandable, expert and appropriate information and advice from the physician,

–   the right to self‑determination based on full information,

–   the right to treatment records and to inspection thereof,

–   the right to confidentiality and data protection,

–   the right to make a complaint,

–   the guarantee that no observation or medical experiments will be carried out without prior patient consent;

14. Believes that although Member States are better placed to develop clear national patient information guidance relevant to their national health systems; this should not prevent the Commission from establishing common core elements on patient information, drawing up a guide to health services and setting out the rights and duties of patients, the treatment covered and reimbursement details;

15. Calls on the Commission to consider, while respecting national rules, harmonisation of the procedures with regard to reimbursement of costs, as established by Regulation (EEC) No 1408/71 of the Council of 14 June 1971 on the application of social security schemes to employed persons and their families moving within the Community as well as by the judgments of the European Court of Justice, with a view to establishing legal certainty for patients in the area of reimbursement;

16. Calls upon the Commission to produce a set of guidelines on core patient mobility issues by 1 January 2007; these should be supported by national guidelines produced by Member States within a further 12 months;

17. Considers that priority should be given, in the context of patient mobility, to adopting guidelines concerning access to treatments which do not exist in the patient's Member State of origin and treatments for which there is an urgent need but no possibility of immediate availability in the patient's Member State of origin;

18. Considers it essential that Member States adopt rules on prescribing, the carrying out of prescription orders, and the reimbursement of payments made for drugs by patients in another Member State with a view to further facilitating patient mobility between Member States;

19. Encourages the Commission to set deadlines for the collection and evaluation of data on existing cross‑border movement of patients and calls on the Commission to make the findings of such studies known as soon as possible; reiterates the value of evaluating and sharing the experience of cross-border agreements such as the Euregio projects;

20. Calls for a report from the Commission on the nature and prevalence of health tourism and the extent to which it is currently reimbursed by statutory agencies and by the private insurance sector or paid out of pocket;

21. Calls on the Commission and the Member States to draw up a report by June 2007 on the extent of patient mobility and the services received by visitors and residents in both the public and private sectors;

22. Calls on the Member States to present in good time the creation of a clear and transparent framework for cross‑border healthcare purchasing announced for this year as part of the ‘High-Level Group on Health Services and Medical Care’;

23. Strongly endorses efforts to improve knowledge and legislation on the movement of health and social care professionals; reminds the Commission that effective mechanisms to support high levels of patient safety must be incorporated in the Directive on the Mutual Recognition of Professional Qualifications;

24. Recognises the work being undertaken to establish an EU-wide register of doctors and other health and care professionals suspended or struck off for incompetence or malpractice; believes that this should be accessible to patients and health purchasers; and requests regular progress reports from the Commission;

25. Highlights the potential risk of a 'brain drain' from the new Member States to those offering higher salaries, with a subsequent threat to the capacity and standard of their healthcare systems; therefore encourages research into possible impacts of increased patient mobility on such movements, and research into the future demand for healthcare professionals and supply through EU higher education systems;

26. Emphasises that the free movement of patients constitutes an incentive also for national health care services to meet the highest possible standards and to encourage patients not to take the same treatment abroad by providing high quality services;

27. Welcomes efforts to move towards Centres of Reference and the potential benefits that this will bring for treatment of rare diseases; recognises that patients affected by a rare disease or condition may often require greater support in accessing such specialist care; calls for the setting up of European Centres of Reference not to be limited to rare diseases but to be extended to cover all diseases for which a special concentration of resources and expertise is available; emphasises that, in addition to treating these diseases, European Centres of Reference should also play a prominent part in obtaining second opinions and in further training for medical specialists;

28. Cautions that additional finances will be required to support a network of Centres of Reference;

29. Believes that the shared use of capacities, particularly in the case of specialised forms of care, can make an important contribution to increasing the effectiveness of health care services;

30. Notes that in a University of York study of UK patients receiving treatment abroad 87% of patients stated the prospect of waiting longer for treatment in England as their motivation; nevertheless believes that the large majority of patients prefer and will continue to prefer to be treated as close to home as possible;

31. Welcomes the Commission's commitment to upholding existing data protection law; notes the importance of providing an efficient and secure method of exchanging patient records between Member States;

32. Welcomes the Commission’s Communication setting out an ‘e-Health action plan’, recognising that information and communication technologies, in particular the Internet, can help improve access to, and the quality and effectiveness of, health services, although it may also increase inequalities as a consequence of the "digital divide"; stresses the need to apply quality criteria for health-related websites; recognises the role that telemedicine and telepsychiatry could play in improving care options for patients and reducing the need for patient mobility; account should also be taken of inequalities as regards the elderly and the illiterate;

33. Encourages the Commission to monitor the deployment of the European Health Card in Member States to ensure that Member States are providing clear and comprehensible information to the public about how the card works;

34. Asks the Commission to consider whether the European Health Card should form the basis for promoting a common approach to patient identifiers and developing new functions such as the storage of medical emergency data, in accordance with the eEurope 2005 plan approved by the Seville European Council;

35. Calls on the Commission to draw up a proposal for recording on the European Health Card, with the consent of the parties concerned, not only insurance details but also medical data relating to patients, thereby facilitating their mobility between Member States and likewise ensuring appropriate access to the care and treatment that their state of health requires;

36. Requests that the Commission consider how the European Health Card can better relate to the needs of pensioners from one Member State temporarily residing or staying in another Member State;

37. Notes, however, that there must be a high level of data protection in relation to any new functions of the European Health Card and that data stored on it and information exchanged between competent authorities must take account of existing provisions on data protection;

38. Welcomes the establishment of the High Level Group on Health Services and Medical Care in the Commission as well as the establishment of a Health Working Group meeting at official level in the Council; requests that the Parliament receive regular updates from the Commission and from the Council on the Groups’ activities; requests also that the Parliament receive a report from the High Level Group every six months;

39. Believes that patient safety is critical to the development of effective health policy in the EU; recognises the need to work closely with the WHO World Alliance for Patient Safety; strongly encourages the High Level Group on Health Services and Medical Care to bring forward proposals for an EU Patient Safety Network as soon as possible in 2005;

40. Stresses that healthcare and patient safety considerations must be taken into account in the planning and implementation of policies in other areas; regrets the occasional friction between internal market and healthcare objectives; believes that the health of its citizens is a prerequisite to Europe's economic performance and competitiveness;

41. Emphasises that the focal point of the whole system is the patient, who has a natural interest in his or her own health and in the quality and accessibility of health care, who is the recipient of care and who pays for the care he or she receives, whether directly or through health insurance or taxation. Therefore, patients are fully entitled to be kept completely informed about their treatment and their state of health and are fully entitled to be involved in decision‑making with regard to health care consumption;

42. Believes there is a need for a network of relevant information accessible to patients, health professionals and managers throughout the EU; welcomes, therefore, the establishment by the Commission of an EU Health Portal, and hopes that the Portal will be online by the end of 2005 as planned;

43. Agrees that there is a need to provide citizens with legal certainty and a clear overview of their rights and duties as patients with regard to access to healthcare and reimbursement of costs incurred in another Member State;

44. Considers it essential to draw up a Charter of Patients' Rights, which should cover, inter alia, matters relating to their mobility;

45. Calls on the Commission to develop guidelines to clearly define issues such as “without undue delay”, "standard practices", "comparable cost", "hospital care", "major out-patient care" and "minor out-patient care", and to ensure maximum uniformity between Member States on prior authorisation requirements and on the interpretation of "a medically justifiable time-limit";

46. Stresses that cross-border healthcare should not become an automatic activity but only be delivered where necessary or in the event of temporary unacceptable delays in treatment; believes the responsibility remains with Member States to ensure the existence of a public health service based on the principle of universal and unrestricted access that will make large-scale patient mobility unnecessary;

47. Is concerned that the terms of treatment should not discriminate against low-income patients so that, for example, they do not have to pay the full cost of treatment before reimbursement;

48. Instructs its President to forward this resolution to the Council, Commission and the governments and parliaments of the Member States.


"La science ne connaît pas de frontière parce que la connaissance appartient à l’humanité et que c’est la flamme qui illumine le monde." Louis Pasteur 1876

("Science recognises no borders, because knowledge belongs to humanity,

and is the torch which illuminates the world.")

The new rights for patients conferred by the European Court of Justice in its sequence of judgements are potentially good news for patients but a substantial headache for health service budget holders and insurers. So far the pace has been set by the courts and patient pressure. If we are happy to leave it to the courts to decide policy and spending priorities, the European Union need do nothing, except to prepare to pay heavy and unpredictable bills, whenever patient probing and legal opinions are delivered.

That is no way to run a Country, much less the venture that is New Europe. Our electors like the idea of patient mobility as an option; but they want and expect it to be properly managed and they want and expect to be offered sound guidance on policy and procedures. Some Member States may prefer to think that, if they delay long enough, the issue will go away and that healthcare delivery is the exclusive preserve of Member States under the Treaties. Yet it is exactly those Treaties that have provided the ECJ with its judgements and have set in motion a process which has the potential to empower patients and enhance the health of Europe’s citizens.

The answer to Member States that prefer that their citizens should use their national health and care services is to ensure that these services match the best that is available within the Union. Most patients and their families would certainly prefer to use local services; but, if the quality is poor or the delays are unacceptable, some at least will be prepared to travel, knowing that the bill will be paid by their home country.

Following the ECJ judgements there has been an urgent need to agree the procedures for patients, their doctors, advocacy and support groups and health services and insurers. That led to the setting up of the High Level Reflection Group. The subsequent Communication is welcome and of high quality in confirming the constitutional setting and reality of patient mobility rights and setting out the issues and procedures that need to be agreed. It is not absolutely clear however that it recognises the need to take these forward with a sense of urgency, if the matters are not to go back to the courts. It is also not clear why other parts of the Commission have been allowed to tinker with health services in the draft General Services Directive. It would be better from patients’, professionals’ and policymakers’ points of view to deal separately and comprehensively with the issues of patient and professional mobility.

To come down to basics: if I am waiting for treatment of a painful, uncomfortable or life-threatening disease or disorder, I want to know my options. Where could I go; how can I be sure of the professional competence and standards of care and treatment; how do I or my family or specialist doctor know where there is capacity in hospital or clinic and in professional diaries; what forms do I need to complete and under what circumstances will my application be agreed; what does “undue delay” mean in relation to my personal condition; what financial cover is provided for the operation, for other medical and care costs, for travel and convalescence, and for family accompanying or visiting; if the cost is too high, can I top up above the set limit and who is to set such limits; are there complications if I travel from a Euro to a non-Euro zone or vice versa; what if something goes wrong or I have a complaint – what complaints systems will there be and will there be a cross-Europe register of professionals guilty of malpractice. These are but some of the individual’s questions.

Those of budget holders will start from the question of how I am to be reimbursed for unplanned expenditure resulting from this new patients’ freedom and they and governments will want to know how they are to set local or national priorities for treatment, if these are to be unpredictably affected by impatient patients. The truth is that we are very unlikely to see more than a trickle of patients going to other Member States; that the incentive to avoid even this by raising the standards of local services is a likely and beneficial outcome; and that the concept of money following patients is not a bad one, if managed sensibly, as many governments already do in managing the transfer of patients to other health districts, to the voluntary and private sector and by bilateral agreement with hospitals in other countries to reduce waiting lists.

The urgency is real; the perceived fear of large numbers or vast costs is not – or not unless courts, rather than politicians, are allowed to determine policy.



Patient mobility and healthcare developments in the European Union

Procedure number


Basis in Rules of Procedure

Rule 45

Committee responsible
  Date authorisation announced in plenary



Committee(s) asked for opinion(s)
  Date announced in plenary






Not delivering opinion(s)
  Date of decision





Enhanced cooperation
  Date announced in plenary






Motion(s) for resolution(s) included in report




  Date appointed

John Bowis


Previous rapporteur(s)



Discussed in committee






Date adopted


Result of final vote







Members present for the final vote

Georgs Andrejevs, Liam Aylward, Irena Belohorská, Johannes Blokland, John Bowis, Frederika Brepoels, Hiltrud Breyer, Dorette Corbey, Chris Davies, Avril Doyle, Mojca Drčar Murko, Anne Ferreira, Karl-Heinz Florenz, Françoise Grossetête, Satu Hassi, Mary Honeyball, Marie Anne Isler Béguin, Dan Jørgensen, Christa Klaß, Eija-Riitta Korhola, Holger Krahmer, Urszula Krupa, Peter Liese, Jules Maaten, Riitta Myller, Dimitrios Papadimoulis, Frédérique Ries, Dagmar Roth-Behrendt, Guido Sacconi, Karin Scheele, Carl Schlyter, Richard Seeber, Kathy Sinnott, Jonas Sjöstedt, María Sornosa Martínez, Antonios Trakatellis, Thomas Ulmer, Anja Weisgerber, Åsa Westlund, Anders Wijkman

Substitutes present for the final vote

Danutė Budreikaitė, Christofer Fjellner, Milan Gaľa, Genowefa Grabowska, Vasco Graça Moura, Erna Hennicot-Schoepges, Miroslav Mikolášik, Renate Sommer, Robert Sturdy, Phillip Whitehead

Substitutes under Rule 178(2) present for the final vote


Date tabled – A6