EU citizens have the right to access healthcare in any EU country and to be reimbursed for care abroad by their home country.
The EU Directive
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Directive 2011/24/EU on patients’ rights in cross-border healthcare sets out the conditions under which a patient may travel to another EU country to receive medical care and reimbursement. It covers healthcare costs, as well as the prescription and delivery of medications and medical devices. The Directive is implemented and completed by:
The Directive makes it easier to access:
The provisions strike the right balance between maintaining the sustainability of health systems, while protecting patients' right to seek treatment outside their home country. The Directive:
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The EU Regulations
Regulation (EC) No 987/2009: goal and function in cross-border health care coordination
1. Introduction: from rules to procedures
In the EU legal framework, Regulation (EC) No 883/2004 (eur-lex.europa.eu) establishes the substantive rules for coordinating social security systems among Member States (including sickness benefits, health care, maternity, etc.). But to make those rules workable in practice, a procedural “implementing” regulation was needed: that is Regulation (EC) No 987/2009, which lays down how to apply and operationalize the coordination rules. (eur-lex.europa.eu)
In other words:
2. Objectives and underlying principles
Regulation 987/2009 is underpinned by several important aims and guiding principles:
These objectives help bridge the gap between legal entitlement and effective access to cross-border health care services.
3. Key procedural mechanisms relevant to health care mobility
Below are some of the key procedural features of 987/2009 as they relate (directly or indirectly) to cross-border health care rights under coordination rules.
(a) Determination of competent institution and applicable legislationWhen a person seeks health care in a Member State other than their insured state (for example, under the “planned treatment” provisions), 987/2009 sets out clear rules to determine which institution is competent to process the application, which legislation applies, and by what schedule. (eumonitor.eu)
It also governs how information must be passed between sending and receiving institutions in such cases. (eur-lex.europa.eu)
(b) Information obligations and the persons concernedThe regulation requires that the institutions provide clear information to the persons concerned, employers, and relevant bodies about their rights and how claims should be filed. (eur-lex.europa.eu)
For example, a person requesting cross-border health care must be informed about the requirements, the process, and the timelines. (eumonitor.eu)
(c) Cooperation, exchange of data, and electronic systemsTo allow prompt handling of cross-border health care claims, 987/2009 mandates that institutions cooperate and exchange necessary personal data, subject to data protection rules. (eur-lex.europa.eu)
Importantly, the regulation provides for the maintenance of an up-to-date network of contact institutions (often via an EU-level database) to facilitate real-time access to institutional data and to ensure that Member States know which authorities to contact in cross-border cases. (eumonitor.eu)
(d) Common deadlines and procedural timeframes987/2009 introduces common procedural deadlines to ensure that claims are processed within a reasonable period. This prevents overly prolonged administrative procedures that could block effective access to cross-border health care. (eumonitor.eu)
(e) Financial settlement, reimbursement and recoveryWhere a person obtains health care outside their Member State of insurance, institutions must settle costs among themselves (e.g. through reimbursement or cross-border billing) in accordance with the coordination rules. 987/2009 lays down procedures for reimbursement, settlement, and debt recovery between institutions. (International Labour Organization)
In practice, this ensures that the patient is not unduly burdened by administrative obstacles and that cross-border providers can be paid by their home institution via institutional cooperation.
4. Benefits and challenges in practice for cross-border health care
Benefits
Challenges and areas of tension
Indeed, proposals to revise or modernize the coordination rules (including 987/2009) are ongoing, especially to address new social security challenges such as long-term care and digitally delivered health services. (eumonitor.eu)
5. Summary: role within cross-border health care legislation
1. Introduction: from rules to procedures
In the EU legal framework, Regulation (EC) No 883/2004 (eur-lex.europa.eu) establishes the substantive rules for coordinating social security systems among Member States (including sickness benefits, health care, maternity, etc.). But to make those rules workable in practice, a procedural “implementing” regulation was needed: that is Regulation (EC) No 987/2009, which lays down how to apply and operationalize the coordination rules. (eur-lex.europa.eu)
In other words:
- 883/2004 tells what rights persons moving across EU borders have under coordinated social security (including access to health care).
- 987/2009 describes how Member State institutions should cooperate, exchange information, and process claims in cross-border situations (including health care).
2. Objectives and underlying principles
Regulation 987/2009 is underpinned by several important aims and guiding principles:
- Cooperation & administrative efficiency: It fosters closer cooperation between the social security institutions of Member States, to ensure that persons exercising free movement can access their rights smoothly and without undue delay. (eur-lex.europa.eu)
- Transparency, legal certainty, and equal treatment: The regulation introduces common procedural deadlines, duties to inform, obligations to justify decisions, and procedural safeguards to protect citizens. (eumonitor.eu)
- Use of electronic communication and real-time data exchange: To speed up cross-border procedures, the regulation mandates (where possible) electronic data exchange and a continuously updated network of national contact bodies. (eur-lex.europa.eu)
- Flexibility through simplified procedures: Member States may agree bilateral or multilateral administrative arrangements that simplify cooperation — provided that citizens’ rights are not compromised. (eur-lex.europa.eu)
- Timeliness of response: The regulation provides that institutions must respond within prescribed timeframes, ensuring that decisions on cross-border claims do not drag indefinitely. (eumonitor.eu)
These objectives help bridge the gap between legal entitlement and effective access to cross-border health care services.
3. Key procedural mechanisms relevant to health care mobility
Below are some of the key procedural features of 987/2009 as they relate (directly or indirectly) to cross-border health care rights under coordination rules.
(a) Determination of competent institution and applicable legislationWhen a person seeks health care in a Member State other than their insured state (for example, under the “planned treatment” provisions), 987/2009 sets out clear rules to determine which institution is competent to process the application, which legislation applies, and by what schedule. (eumonitor.eu)
It also governs how information must be passed between sending and receiving institutions in such cases. (eur-lex.europa.eu)
(b) Information obligations and the persons concernedThe regulation requires that the institutions provide clear information to the persons concerned, employers, and relevant bodies about their rights and how claims should be filed. (eur-lex.europa.eu)
For example, a person requesting cross-border health care must be informed about the requirements, the process, and the timelines. (eumonitor.eu)
(c) Cooperation, exchange of data, and electronic systemsTo allow prompt handling of cross-border health care claims, 987/2009 mandates that institutions cooperate and exchange necessary personal data, subject to data protection rules. (eur-lex.europa.eu)
Importantly, the regulation provides for the maintenance of an up-to-date network of contact institutions (often via an EU-level database) to facilitate real-time access to institutional data and to ensure that Member States know which authorities to contact in cross-border cases. (eumonitor.eu)
(d) Common deadlines and procedural timeframes987/2009 introduces common procedural deadlines to ensure that claims are processed within a reasonable period. This prevents overly prolonged administrative procedures that could block effective access to cross-border health care. (eumonitor.eu)
(e) Financial settlement, reimbursement and recoveryWhere a person obtains health care outside their Member State of insurance, institutions must settle costs among themselves (e.g. through reimbursement or cross-border billing) in accordance with the coordination rules. 987/2009 lays down procedures for reimbursement, settlement, and debt recovery between institutions. (International Labour Organization)
In practice, this ensures that the patient is not unduly burdened by administrative obstacles and that cross-border providers can be paid by their home institution via institutional cooperation.
4. Benefits and challenges in practice for cross-border health care
Benefits
- Practical usability of entitlements: Without procedural rules, rights under 883/2004 would remain theoretical. 987/2009 makes those rights actionable in real life.
- Harmonized approach across Member States: Citizens seeking care abroad benefit from more predictable, standardized procedures.
- Speed and clarity: Deadlines, data-sharing, and contact networks reduce delays and administrative uncertainty.
- Protection for patients: Information obligations, transparency, and procedural safeguards reduce the risk of denials due to ignorance or procedural error.
Challenges and areas of tension
- Complex national divergence: Health care systems and administrative practices differ widely across the EU; applying uniform procedural rules in such a varied context is demanding. (Official Blog of UNIO)
- Administrative burden: Institutions must maintain interoperability, data systems, and staff capacity to process cross-border claims under tight timeframes.
- Data protection tensions: Exchanging health and personal data across borders must comply with both procedural regulation and data protection laws.
- Financial and reimbursement disputes: Disagreements may arise between Member States over costs or eligibility of care, especially when national coverage policies differ.
- Keeping databases and contact networks up to date: The regulation depends on accurate institutional contact data, which requires ongoing maintenance and cooperation.
Indeed, proposals to revise or modernize the coordination rules (including 987/2009) are ongoing, especially to address new social security challenges such as long-term care and digitally delivered health services. (eumonitor.eu)
5. Summary: role within cross-border health care legislation
- Regulation 987/2009 is the “how” behind the “what” of coordination. It does not confer new health rights itself, but ensures that the health care entitlements under Regulation 883/2004 can be exercised effectively across borders.
- It ensures procedural clarity, institutional cooperation, timely processing, and reimbursement mechanisms — all of which are essential for cross-border health care to function smoothly.
- Any discussion of patient rights to seek treatment in another Member State must assume the procedural scaffolding provided by 987/2009, because without it, cross-border claims could stall or be blocked by administrative barriers.
