Cross-border Healthcare

General information

The organisation, management, financing and delivery of healthcare are the responsibility of the EU Member States (Art. 168 TFEU). However, several judgments of the European Court of Justice confirm that patients have in certain cases the right to access healthcare products and services in other Member States than their own, with the cost being borne by their own health system.

To clarify the situation, the European commission in 2008 adopted a proposal for a directive on the application of patients’ rights in cross-border healthcare. Directive 2011/24/EU was finally adopted on 19 January 2011 and published in the EU’s Official Journal on 9 March 2011. It will enter into application on 25 of October 2013.

EPF’s Position

EPF sees in the Cross-border Healthcare Directive the potential to reduce health inequalities for patients in access to healthcare. We believe that many aspects of the Directive can be built upon to achieve better quality care for all patients - such as stronger European cooperation in the crucial areas of quality and safety, HTA, eHealth and rare diseases. We will monitor closely the implementation of the Directive, including raising awareness in the patient communities across the EU on the new legislation and supporting patient organisations’ involvement at national level.


Cross-Border Healthcare

Key steps


EPF published a position statement on the implementation of the Cross-border Healthcare Directive. Protraying a very patchy situation in Europe, the paper draws on feedback from EPF members gathered throughout 2015. Amongst the monitoring activities, EPF conducted an online survey of its membership. Results show great discrepancies between countries and an overall lack of information about patients' rights. The statement is available here.


Following our series of Regional Conferences in 2013-2014, we released a summary report with conclusions and recommendations on Cross-Border Healthcare (see report below).

EPF continues to monitor the implementation of the Cross-Border Healthcare Directive (CBHC) with mini-workshops organised in six countries not covered by the four regional conferences held in 2013-2014. The purpose of these workshops is to raise awareness about the CBHC Directive and patients’ rights enshrined within this legislation.

  • Zagreb, Croatia – 27 January 2015
  • Madrid, Spain – 16 March 2015
  • Warsaw, Poland – 19 March 2015
  • Sofia, Bulgaria – 21 March 2015
  • Dublin, Ireland – 21 April 2015
  • Bucharest, Romania – 23 April 2015

Also in 2015, EPF publishes a document including a checklist of recommendations for National Contact Points


The EU Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare was due to be transposed by Member States into national law by 25 October 2013. As much depends on the way the Directive is implemented EPF has decided to organise a series of regional conferences on this topic to encourage national patients’ groups make full use of the opportunities.

  • First Regional Conference, 9-11 December 2013, Brussels: Around 40 patients’ organisations representatives from The Netherlands, Luxemburg, Germany, France and Belgium attended the first EPF regional conference on patients’ rights in cross-border healthcare. The conference report is available in the right-hand column. 
  • Second Regional Conference, 7-9 April 2014, Athens, Greece: Patient organisations’ representatives from Cyprus, Greece, Italy, and Malta attended the second edition of our conference. The conference report will be soon available in the right-hand column.
  • Third Regional Conference, 7-9 July 2014, Ljubljana, Slovenia: Patient organisations’ representatives from Austria, Czech Republic, Hungary, Slovakia and Slovenia will attend this conference.
  • Fourth Regional Conference, 6-8 October 2014, Tallinn, Estonia: Patient organisations’ representatives from Denmark, Estonia, Finland, Latvia, Lithuania and Sweden will attend this fourth edition of our conference.

Further conferences will be organised in 2015 in other EU countries.


We have made available online a guideline and policy recommendations with our analysis of the key issues around the Cross-Border Healthcare Directive. The guidance is designed primarily for patient organisations and decision makers, with relevance for other health stakeholders too to help them make their way through the Directive (see below).


The adoption by the Council of Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare was a major achievement. EPF had a long and intense involvement in the drafting of this Directive. Though the final document was less ambitious than EPF’s vision, it nevertheless marked a milestone for European patients. It created a legal framework for the patient’s right to seek healthcare in another Member State and to be reimbursed. It also provided a legal basis for enhanced European cooperation in key areas of healthcare – including quality and safety, HTA and eHealth, and rare diseases.

In 2011, EPF continued to liaise with the European Commission and relevant stakeholders on the implementation of the Directive. We were particularly focused on the provision of information to patients concerning their rights under the new legislation. We also developed guidance for patient organisations to support their involvement at national level, to ensure that transposition and the implementation process take patients’ needs into account.

EPF welcomed the draft Directive on cross-border healthcare, adopted on the 19th January 2011 by the European Parliament. We have had a long and intense involvement in the Draft directive, having worked closely with the Commission, the EU Presidencies, and indeed MEPs throughout the first and the second reading to ensure that a patients’ perspective was well reflected in the Parliament’s position.


EPF released a statement on the proposal adopted by the Commission for a Directive on the application of patients’ rights in cross-border healthcare (see statement below). This draft Directive went through a lengthy process with the European Parliament and Council, with failure to reach agreement during several successive EU Presidencies, before a compromise was finally agreed under the Belgian EU Presidency in the second half of 2010.


The Commission launched a consultation with all stakeholders involved in the health services sector to explore measures for a developing a Community Framework for Safe, High Quality and Efficient Health Services.