Observations

• Author: European Court of Auditors
• Pages: 17-33

17

Observations

The Commission has ensured that the EU Cross-Border

Healthcare Directive has been put into practice

22 In order to oversee the implementation of the Directive, the Commission needs

to monitor and enforce its transposition by the Member States through completeness

and compliance checks. The Commission also has to report on the operation of the

Directive and appropriately guide the National Contact Points responsible for provision

of information to patients on cross-border healthcare.

The Commission has monitored and enforced transposition of the

Directive

23 Following the Directive’s transposition deadline of 25 October 2013 and the

Commission’s completeness checks of the transposition by the Member States, the

Commission opened 26 infringement procedures for late or incomplete notification of

transposition measures. In addition, the Commission initiated 21 infringement

procedures on late or incomplete transposition of the Implementing Directive on the

recognition of medical prescriptions issued in another Member State17. After all

Member States provided complete notifications of transposition measures, the

Commission closed these procedures by November 2017.

24 The Commission checks Member States’ legislation to establish whether they had

correctly transposed the Directive’s provisions. In order to target these checks, the

Commission identified four priority areas that act as barriers to cross-border patients:

reimbursement systems, the use of prior authorisation, administrative requirements

and the charging of incoming patients. Following these checks, the Commission

opened 11 own-initiative infringement cases, four of which had been closed by

November 2018, after Member States amended national transposition measures.

25 We consider that the Commission’s checks has led to improvements in the

systems and practices employed by the Member States.

17 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 (OJ L 356, 22.12.2012, p. 68).

18

The Commission has reported on the operation of the Directive in a

timely manner

26 The Commission is required to draw up a report every three years, starting in

2015, on the operation of the Directive18. These reports should include information on

patient flows and the costs associated with patients’ mobility. While the Directive does

not oblige Member States to collect data on patients’ flows, it specifies that they shall

provide the Commission with assistance and all available information for preparing the

report. In 2013, Member States agreed to provide specific data to the Commission on

an annual basis.

27 The majority of Member States were late in the adoption of the national

transposition measures (see paragraph 23) and this delayed their provision of data to

the Commission in 2015. In 2017, 26 Member States provided it but for six of them,

data was incomplete. In addition, data was not comparable from one country to

another as some Member States reported all reimbursements without specifying

whether they were granted under the Directive or the Regulation on the coordination

of social security systems. The Commission recognised the limited accuracy of data

included in the reports. For example, the overview of patient flows was incomplete.

Table 1 shows that four Member States did not provide data on outgoing patient flows

in 2016.

28 Despite these challenges, the Commission met its reporting obligation on time. It

adopted its recent report in September 2018 and presented an overview of patient

flows and of the financial impact of cross-border healthcare under the Directive.

The Commission guided the National Contact Points in improving the

information on cross-border healthcare

29 The Commission supports and guides the National Contact Points with the aim of

providing clear and comprehensive information on patients’ rights to cross-border

healthcare. To do that the Commission published a number of relevant studies19. Prior

18 Article 20 of the Directive.

19 These studies include: 2012 Study on a best practice based approac h to National Contact

Point websites with recommendations to Member States and the Comm ission on how to

provide the appropriate information on various essential aspects of cross-border healthcare

through NCPs; 2014 Study on the impact of information on patients’ choice within the

context of the Directive; 2015 Evaluative study on the operation of the Directive containing

inter alia a review of NCP websites.