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The “cross-border care” directive is over, good news?

(B2)Finally several member states – Poland, Romania, Greece, Spain, Portugal in particular (but others more silently supported this position) – formed a solid blocking minority to reject the draft directive. cross-border care” at the last council of health ministers of the European Union, on December 1st. Good news. Yes, let's not be afraid of words. And let's not hide behind awkward silence. This directive was off to a bad start anyway. And I had already had the opportunity to say “all the good things” I thought about this text (Read: Why the “cross-border care” proposal is hypocritical). This text had a big flaw: mixing genres, pushing, under the pretext of patients' rights, better health, to a reorganization of health systems, to further liberalization, to a change in financial flows and solidarity. It is to make the national solidarity system support the fact that some patients prefer to be treated in the sun.

Now it's not a question of kidding ourselves either. The problem remains. It cannot be evaded any longer. There is a problem with reimbursement of care for patients who cannot obtain adequate care in their country or prefer to be treated near their loved ones. There is a fundamental information problem. There is a problem of savings to be made, research to be developed, resources to be pooled. It will also be necessary, at some point, to address the question of cross-border solidarity.

In my opinion, the question must therefore be taken up from several angles, with very distinct legal instruments, each of which has different objectives and legal and political bases, and even different timetables.

• information on patients' rights. It must actually be better assured. And a directive focusing on these aspects could be welcome. The proposal was rather welcome. And no one should be able to fundamentally object to it. It could be necessary to provide an authority, such as a mediator, easy to call to resolve cross-border problems, close to the Commission (to enable infringement procedures to be initiated) to prevent a patient from being removed from a system. or from one country to another.

• medical liability. If there is free movement of citizens, and in a certain way of patients, the question of medical liability must be considered in a European way, with a certain harmonization, at least in terms of liability insurance, patients' rights and information. This can be regulated in a directive or regulation. Other elements such as “follow-up care” (the possibility of continuing care in another country could also be regulated).

• the issue of healthcare reimbursement. It needs to be clarified. We cannot stay like this in a legal maquis. But this must be done within the framework of the “social security” regulation.

• the question of cross-border solidarity. Oh how delicate. Certain measures are already provided for in the social security regulations. They could be strengthened. But it would perhaps be necessary to provide specific measures, in this case within a new regulation.

• the question of equipment authorizations, a question arising above all from competition law, could be settled within an “exceptional” decision from the Commission, or guidelines setting out and clarifying the rules to be applied in this area .

• Finally, other questions such as cross-border research on rare diseases, centers of competence, etc. should be addressed either in a specific text or in one or other of these instruments.

This “cross-border care” package would be more complete than the one presented, and would have the advantage of clearly distinguishing each of the issues without mixing up questions of competition and patient health. And to be, all in all, more efficient.


Nicolas Gros Verheyde

Chief editor of the B2 site. Graduated in European law from the University of Paris I Pantheon Sorbonne and listener to the 65th session of the IHEDN (Institut des Hautes Etudes de la Défense Nationale. Journalist since 1989, founded B2 - Bruxelles2 in 2008. EU/NATO correspondent in Brussels for Sud-Ouest (previously West-France and France-Soir).

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