European Parliamentarians have approved controversial plans to give European Union (EU) citizens the right to seek healthcare in other EU countries more easily and be reimbursed for the costs but, they stress, this is not about the free movement of service providers.

In a 297-120 vote with 152 abstentions, Members of the European Parliament (MEPs) passed at first reading on April 24 a draft report for a directive presented by John Bowis, a UK MEP within the EPP-ED group of Christian and European Democrats. As expected, the Socialist group abstained from the vote.

The rights of EU citizens to seek treatment in member states other than their own and be reimbursed for it have been confirmed in European Court of Justice (ECoJ) judgements since 1998 but are not yet included in EU law. The report passed by Parliament follows a 2006 ECoJ ruling that the UK National Health Service (NHS) could not refuse to refund costs of treatment in another EU member state if patients waited longer than clinicians advised, even if waiting list targets were met. Mr Bowis’ draft was approved by the Parliament’s committee on environmental and public health (ENVI) at the end of March. 20 Socialist and Green MEPs boycotted that vote, claiming the proposals would lead to an “EU health service.”

However, following last week’s vote, the bill’s “shadow” drafter, UK Liberal Democrat MEP Liz Lynne, of the Alliance of Liberals and Democrats in Europe (ALDE), pointed out that cross-border healthcare “has always been around for people who can afford it. This legislation opens this opportunity up to all people irrespective of income and must now be backed by the UK government," she said.

“Why should a patient have to lose their sight waiting for a cataract operation, or spend months in agony waiting for a hip replacement when they could get treatment sooner in another member state, sometimes at a lesser cost to the country of origin? If a clinician advises treatment and this cannot be provided at home, then we need a legal framework to ensure that they can seek it elsewhere,” added Ms Lynne.

The planned directive would not require prior authorization for non-hospital care such as dental treatment and medical consultations, but it would be needed for in-patient procedures such as surgery. The draft does not cover organ transplantation and long-term care. Parliament has added special rules to it for patients with rare diseases, giving them the right to reimbursement even if the treatment in question is not provided for by the legislation of their member state, and stating that this should not be subject to prior authorisation. Moreover, special costs for people with disabilities should be reimbursed under certain conditions, and all information must be published in formats accessible to disabled people, say the MEPs.

The Standing Committee of European Doctors (CPME) has welcomed the vote, describing it as “the first step in the right direction for establishing a level playing-field in cross-border health care,” while the European Commissioner for Health, Androulla Vassiliou, said: "I am convinced that this will lead to greater confidence and knowledge for all citizens about the healthcare they receive. These are initiatives that really bring the European Union closer to its citizens."

However, progress of the plan has been marked by bitter dispute between the Parliament’s various political groupings, with those opposing it claiming that it will lead to the rise of health tourism for the wealthy and deterioration in services for the majority. There are also concerns about how much say the member state governments will have over the numbers of foreign patients using their national services and whether their prior-authorisation powers should be increased, particularly in the case of treatments which are specialized and cost-intensive.

The next stage is for European ambassadors to examine the proposed directive on May 6, and the current Czech Presidency of the EU is reportedly anxious to secure agreement over the disputed areas by early June.