1. Directive on patients rights in cross-border healthcare DG SANCO Unit D2 Healthcare systems

2. EU law on healthcare since early 1970s: social security Regulations - Primarily co-ordination between systems -Unplanned healthcare (EHIC) - Possibility of referral to other EU Member State (MS) (E112 / S2) -Prior authorisation system; authorisation of E112 / S2 can't be refused where "undue delay" applies -Payment dealt with between health systems

3. European Court of Justice jurisprudence 1997 - 2006 - Healthcare is a service within the meaning of the EU Treaty -If a patient is entitled to a treatment at home he or she is entitled to reimbursement for that treatment abroad - Reimbursement is up to cost of that treatment in home system -For some treatments (hospital care), health systems may require patient to seek prior authorisation

4. Provisions of Directive 1: patient entitlements - Patients have right of reimbursement when they receive healthcare in another EU MS -Level of reimbursement up to cost of treatment at home -Quality and safety standards / legislation of MS of treatment applies

5. Provisions of Directive 2: prior authorisation -Prior authorisation possible for a) overnight stay; b) highly specialised healthcare ("hospital care") -Authorisation may be refused if no "undue delay" - Authorisation processes must be reasonable, "properly reasoned"

6. Provisions of Directive 3: National Contact Points - Each MS must set up a National Contact Point (NCP) - NCPs tell outgoing patients about: rights; entitlements; reimbursement; appeal processes -NCPs tell incoming patients about: quality and safety standards and systems; complaints and redress procedure

7. Provisions of Directive 4: prices, access, information, prescriptions - Healthcare providers must provide information on: treatment options; quality and safety; prices; authorisation status; insurance / liability cover - Patients should have access to care on basis of non- discrimination; providers must apply same scale of fees as for domestic patients -Directive introduces cross-border prescriptions to help patients moving across borders

8. Summary of rules post 25 Oct 2013 - "Non-hospital care" in domestic basket of benefits: Directive without prior authorisation or apply for authorisationunder Regulations - "Hospital care" in basket of benefits: authorisation under Directive or Regulations (may be refused if no "undue delay") - Care not in basket of benefits: referral under Regulations

9. Provisions of Directive: rare diseases - Prior authorisation: may seek specialist view - Awareness-raising of EU-level diagnostic tools; possibilities for E112 / S2 referrals - Political encouragement rather than legal obligation

10. Co-operation between health systems - Recognition of prescriptions -European Reference Networks - Health Technology Assessment - eHealth

11. Thank you! Further information: http://ec.europa.eu/health/cross_border_care/policy/index_en.htm