The European Parliament has approved new legislation which clarifies that European Union (EU) citizens can be reimbursed for healthcare they receive in another member state, provided the type of treatment and costs would have normally been covered in their own country.

The long-delayed Cross-Border Health Care Directive also establishes the recognition of cross-border prescriptions in all EU member states, but permits pharmacists to refuse to dispense such prescriptions “in cases of doubt, or due to ethical concerns.”

Currently just 1% of EU citizens seek treatment in other countries, at a cost to national healthcare systems of 10 billion euros annually, and the Commission estimates that these costs will rise to no more than 30 million euros a year under the new Directive.

Nevertheless, supporters of the legislation point out that seeking healthcare abroad could particularly benefit patients seeking advanced treatments, those on long waiting lists or people who are unable to find specialist care at home. To help the latter group, MEPs have strengthened the draft’s provisions for cooperation on rare diseases.

The new rules cover only people who choose to seek treatment abroad - the European Health Insurance Card scheme will continue to apply for people who require urgent treatment while they are in another EU country. And to discourage health tourism, patients will only be reimbursed at the rates applying in their home country - if the treatment costs more in another country they must pay the difference, and travel or hotel costs cannot be claimed back. 

In cases where the treatment is very expensive or requires a stay in hospital, the patient will have to obtain prior authorisation from their national health system. A request can only be refused if the treatment could quickly be obtained in the nation where the patient lives, or if there are doubts about the physician’s qualifications.

The Directive was originally drawn up by 2008 and adopted by Parliament in April 2009, but disagreements within the European Council have delayed its progress. The version approved by the MEPs was finally agreed in Council last month, but it still failed to gain the support of Austria, Poland, Portugal and Romania, while Slovakia abstained from voting.

Opponents of the measure include Dutch MEP Kartika Liotard of the European United Left/Nordic Green Left (GUE/NGL) group in Parliament, who warns that the Directive will allow insurers to “drive patients abroad in search of cheaper treatment,” but supporters such as UK Conservative MEP Marina Yannakoudakis believe that cross-border health care can give patients choice and take pressure off national health systems in areas where there are backlogs.

Welcoming the Parliamentary vote, EU Health Commissioner John Dalli pointed to the benefits which the Directive will provide. “It will help patients who need specialised treatment, for example those who are seeking a diagnosis or treatment for a rare disease. It will bring about closer and improved health cooperation, including the recognition of prescriptions, between member states. Health experts across Europe will be able to exchange best practices and mutually benefit from innovations in Health Technology Assessment (HTA) and eHealth,” he said.

The Pharmaceutical Group of the European Union (PGEU), which represents over 400,000 community pharmacists, said it welcomed EU-wide recognition of prescriptions but stressed the challenges that lay ahead if the system is to be safe and effective.

“Pharmacists need to assess, authenticate and validate prescriptions from other member states, as they do in the case of national prescriptions,” it says.  “When authenticating a prescription, it is essential not only to identify the patient but also be able to verify and be able to contact the prescriber in order to prevent medication errors occurring. Sometimes, if patient safety is to be ensured, prescriptions need to be adjusted in cooperation with the prescriber. This presents particular difficulties when the prescriber is from a different country.”

Therefore, says the PGEU, it welcomes the principle established in the Directive that pharmacists should be able to refuse to dispense such prescriptions in cases of doubt, or due to ethical concerns, and the proposal to facilitate pharmacist/prescriber contact.”

The group also calls for medicines to be prescribed by generic name, where possible, in the cross-border context, since the names by which medicines are marketed and prescribed vary from country to country.

The Standing Committee of European Doctors (CPME) said it welcomed many of the Directive’s provisions, including the options it presents for patients affected by rare diseases and the provision on the creation of an HTA network. However, the CPME also says it is “lamentable that the evaluation of the effects of medical technology in health care focuses on the economic angle, but leaves out the important aspects of ethical dimensions.”

The draft Directive approved by MEPs must now be formally approved by the European Council, after which it should become effective by 2013. Once it is signed into law, EU member states will have 30 months to incorporate it into their national legislation.