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Preserving General Interest in Healthcare Through Secondary and Soft EU Law: The Case of the Patients’ Rights Directive

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Social Services of General Interest in the EU

Part of the book series: Legal Issues of Services of General Interest ((LEGAL))

Abstract

This chapter analyses the extent to which the Directive on the application of Patients’ Rights in Cross-border Healthcare succeeds in addressing the imbalance between the general interest objectives of healthcare systems and EU internal market objectives. It assesses the Directive’s potential impact on health systems’ financial sustainability, as well as its possible effects on accessibility to and quality of healthcare services. The Directive aims to clarify the rights and entitlements of patients to reimbursement for healthcare they receive in another EU country and thus provides legal clarity on the interpretation of the CJEU rulings regarding patient mobility. However, it does not address the deregulatory effects that could result from the application of the free movement principles to providers wishing to temporarily or permanently provide health services in another Member State. In addition, whereas the grounds to justify public measures that hinder free movement, in light of general interest, will likely continue to evolve within the jurisprudence, they are presented within the Directive as an exhaustive list of reasons. Furthermore, the Directive fails to address some of the major concerns that have driven the policy debate since the initial rulings. This concerns in particular the obligation to reimburse care from providers not integrated in the statutory system in the Member State of treatment. While the Directive does not aim to create new social rights, it can be seen to have a significant impact on access to care. Specifically patients getting access to cross-border care will have more choice of providers. This could also affect access to care domestically through policies to address long waiting times and the reimbursement of care from non-contracted providers. Finally, while Member States seemed unwilling to establish common EU level guarantees for high-quality care, they refused to automatically rely upon quality standards for healthcare providers established by the Member State of treatment.

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Notes

  1. 1.

    Directive 2011/24/EU of 9 March 2011 on the application of patients’ rights in cross-border healthcare, OJ 2011 88/45-65.

  2. 2.

    CJEU, Case C-120/95 Decker v. Caisse de Maladie des Employés Privés [1998] ECR I-1831; CJEU, Case C-158/96 Kohll v. Union des Caisses de Maladie [1998] ECR I-1931; CJEU, Case C-157/99 Geraets-Smits and Peerbooms [2001] ECR I-5473; CJEU, Case C-385/99 Müller-Fauré and Van Riet [2003] ECR I-4509; CJEU, Case C-372/04 Watts [2006] ECR I-4325; CJEU, Case C-444/05 Stamatelaki [2007] ECR I-3185.

  3. 3.

    Gekiere et al. 2010.

  4. 4.

    See also Cygan 2008.

  5. 5.

    Council of the European Union, Conclusions on patient mobility and healthcare in the Internal Market, 26 June 2002; Council Conclusions on Common values and principles in EU Health Systems, Luxembourg, 1–2 June 2006.

  6. 6.

    Proposal for a directive of the European Parliament and of the Council on services in the internal market, COM (2004) 2 final of 5 Mar 2004.

  7. 7.

    Council of the EU, Charter of Fundamental Rights of the European Union, OJ 2000, C 364/1, Article 35.

  8. 8.

    Council Conclusions on Common values and principles in EU Health Systems, Luxembourg, 1–2 June 2006.

  9. 9.

    Communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions, Modernising social protection for the development of high-quality, accessible and sustainable healthcare and long-term care: support for the national strategies using the “open method of coordination”, COM (2004) 304 final of 20 April 2004.

  10. 10.

    Donaldson and Gerard 2004, 29–52; see also Thomson et al. 2009a, 11–12.

  11. 11.

    See, for example, Maynard 2005, 256.

  12. 12.

    Communication from the Commission - Services of general interest in Europe, COM (2000) 0580 final.

  13. 13.

    Communication from the Commission, Implementing the Community Lisbon Programme: social services of general interest, COM (2006)177 final.

  14. 14.

    With regard to the exclusion of Services of General Economic Interest (SGEIs) from the Services Directive see Chap. 13 by Szyszczak.

  15. 15.

    See also Gekiere et al. 2010.

  16. 16.

    Palm and Baeten 2011.

  17. 17.

    As argued by Thomson et al. 2010b, 1, financial sustainability should be understood as a 'policy constraint' rather than a ‘policy goal’.

  18. 18.

    See Gekiere et al. 2010. CJEU, Case C-120/95 Decker v. Caisse de Maladie des Employés Privés [1998] ECR I-1831.

  19. 19.

    CJEU, Case C-169/07, Hartlauer Handelsgesellschaft mbH/Wiener Landesregierung and Oberösterreichische Landesregierung [2009] ECR I-1721.

  20. 20.

    Kohll, cited in n. 2 supra, paras. 50–1.

  21. 21.

    Ibid., para. 41.

  22. 22.

    Watts, cited in n. 2 supra, para. 109; Müller-Fauré, cited in n. 2 supra, paras. 79–80; Geraets-Smits and Peerbooms, cited in n. 2 supra, paras. 78–9.

  23. 23.

    See also Baeten and Palm 2011.

  24. 24.

    The latter would even justify different criteria for different regions (or other relevant administrative levels) or different treatments.

  25. 25.

    Hartlauer, cited in n. 19 supra.

  26. 26.

    Proposal for a Directive on the application of patients' rights in cross-border healthcare, COM (2008) 414 of 2 July 2008, recital 7.3.

  27. 27.

    Hartlauer, cited in n. 19 supra, Opinion of the AG, fn 44.

  28. 28.

    CJEU, Case C-512/08 Commission v. France [2010] ECR I-08833.

  29. 29.

    Ibid., para. 34.

  30. 30.

    Palm et al. 2000, 99–100.

  31. 31.

    Proposal for a Directive, cited in n. 26 supra.

  32. 32.

    Geraets-Smits and Peerbooms, cited in n. 2 supra; CJEU, Case C-496/01 Commission v France [2004] ECR I-2351 and Stamatelaki, cited in n. 2 supra.

  33. 33.

    Baeten et al. 2010.

  34. 34.

    Slegers 2009.

  35. 35.

    Press release of the Council meeting Employment, Social Policy, Health and Consumer Affairs, Brussels, 30 November—1 December 2009, p. 13.

  36. 36.

    Note from the Committee of Permanent Representatives (Part I) to the Council on the Proposal for a Directive of the European Parliament and of the Council on the application of patients' rights in cross-border healthcare (LA)(*) (Legal basis proposed by the Commission: Article 95 TEC)—Political agreement, 16005/09, 25 November 2009, Article 8, 7.

  37. 37.

    Proposal for a Directive, cited in n. 26 supra.

  38. 38.

    Wörz et al. 2006.

  39. 39.

    See www.ehma.org/projects as well as Busse et al. 2006 and Wörz et al. 2006.

  40. 40.

    Regulation EC 883/2004 of 29 April 2004 on the coordination of social security systems, OJ 2004 L 314/1; Regulation EC 987/2009 of 16 September 2009 laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems, OJ 2009 L 284/1.

  41. 41.

    As for the Regulation, Regulation EC 1231/2010 of 24 November 2010 extending Regulation (EC) No 883/2004 and Regulation (EC) No 987/2009 to nationals of third countries who are not already covered by these Regulations solely on the ground of their nationality.

  42. 42.

    CJEU, Case C-56/01 Inizan [2003] ECR I-12403.

  43. 43.

    CJEU, Case 238/82 Duphar [1984] ECR 523.

  44. 44.

    Geraets-Smits and Peerbooms, cited in n. 2 supra.

  45. 45.

    CJEU, Case C-173/09 Elchinov [2010] ECR I-08889.

  46. 46.

    Garrido et al. 2008.

  47. 47.

    High Level Process on Patient Mobility and Healthcare Developments in the European Union, Outcome of the reflection process, HLPR/2003/16, 9 December 2003.

  48. 48.

    CJEU, Case C-368/98 Vanbraekel [2001] ECR I-5363 and Watts, cited in n. 2 supra; However, the Court denied the application of this additional reimbursement bonus for unscheduled care during a temporary stay in another Member State, basically since in those cases a patient—given the urgency of treatment—could not actually choose between treatment at home or in the country of stay and therefore no hindrance to the principle of free provision of services can be found (CJEU, Case C-211/08 Commission v. Spain [2010] ECR I-5267).

  49. 49.

    Rosenmoller et al. 2006.

  50. 50.

    Baeten et al. 2010.

  51. 51.

    This was introduced after the Pierik rulings (CJEU, Case 117/77 Bestuur van het Algemeen Ziekenfonds Drenthe-Platteland v. Pierik [1978] ECR 825; CJEU, Case 182/78 Bestuur van het Algemeen Ziekenfonds Drenthe-Platteland v. G. Pierik [1979] ECR 1977) and was further strengthened after the Müller-Fauré Case (Müller-Fauré, cited in n. 2 supra).

  52. 52.

    Baeten et al. 2010.

  53. 53.

    European Commission (2007). Cross-border health services in the EU. Analytical report. Flash Eurobarometer, 210 (May):1–42.

  54. 54.

    Stamatelaki, cited in n. 2 supra.

  55. 55.

    Legido-Quigley et al. 2008, 17, 35.

  56. 56.

    Communication from the Commission—A Community framework on the application of patients' rights in cross-border healthcare, SEC (2008) 2183, COM (2008) 415 final, 2 July 2008.

  57. 57.

    Council Recommendation of 9 June 2009 on patient safety, including the prevention and control of healthcare associated infections,OJ 2009 C 151/1.

  58. 58.

    European Commission, Minutes of the Patient Safety and Quality of Care Working Group meeting of 2 February 2010 approved by the Group, HLG/PSQCWG/2010/01, 26 January 2011.

  59. 59.

    Council of the European Union, Outcome of proceedings, Working Party on Public Health at Senior Level on 28 May 2010, Brussels, 3 June 2010.

  60. 60.

    Council of the European Union, Quality of Healthcare—Presentation by the Commission, from: General Secretariat of the Council to: Working Party on Public Health at Senior Level, Brussels, 9366/1/10 21 May 2010.

  61. 61.

    Nys and Goffin 2011.

  62. 62.

    Council of the European Union, Proposal for a Directive of the European Parliament and of the Council on the application of patients' rights in cross-border healthcare (second reading)—Approval of the European Parliament’s amendments—Statements, 6590/11 ADD 1 REV 2, Brussels, 23 February 2011.

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Authors and Affiliations

  1. European Social Observatory, 13, Rue P. E. Janson, 1050, Bruxelles, Belgium

    Rita Baeten

  2. European Observatory of Health Systems and Policies, Rue de l’Autonomie 4, 1070, Bruxelles, Belgium

    Willy Palm

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  1. Rita Baeten
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  2. Willy Palm
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Correspondence to Rita Baeten .

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Editors and Affiliations

  1. , Faculty of Law, University of Copenhagen, Studiestræde 6, Copenhagen K, 1455, Denmark

    Ulla Neergaard

  2. , School of Law, University of Leicester, University Road, Leicester, LE1 7RH, United Kingdom

    Erika Szyszczak

  3. , Faculty of Law, Radboud University, Comeniuslaan 4, Nijmegen, 6525 HP, Netherlands

    Johan Willem van de Gronden

  4. , Fachbereich Rechtswissenschaft, Universität Erlangen-Nürnberg, Schillerstraße 1, Erlangen, 91054, Germany

    Markus Krajewski

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Baeten, R., Palm, W. (2013). Preserving General Interest in Healthcare Through Secondary and Soft EU Law: The Case of the Patients’ Rights Directive. In: Neergaard, U., Szyszczak, E., van de Gronden, J., Krajewski, M. (eds) Social Services of General Interest in the EU. Legal Issues of Services of General Interest. T.M.C. Asser Press, The Hague, The Netherlands. https://doi.org/10.1007/978-90-6704-876-7_15

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