D5.1 – Policy report on the characteristics of patients’ mobility across Europe, the EU role and the possible gains from an increase in such mobility
Every year a small number of Europeans are treated in a country that is not their own. Some live near a border and simply find the nearest hospital on the other side of it. Some work in one country and are insured in another. Some have a rare condition treated in only a handful of specialised centres across the continent. Others choose to travel because care at home is slower, unavailable or not what they were looking for. Taken together these journeys involve only a fraction of patients, yet they raise a much bigger question: healthcare is organised nationally, so what exactly can the European Union do, and would more cross border care actually make health systems fairer and more efficient?
This report answers that question by combining a legal and an economic analysis. On the legal side it maps the division of competences under Article 168 TFEU and sets out the different routes available to patients: necessary care during a temporary stay and full coverage for cross border workers and pensioners under the social security coordination regulation (S1 form), planned care under the same regulation (S2 form), planned care under the patient mobility directive of 2011, and the additional possibilities created by bilateral agreements and national law. On the empirical side it reviews the most recent official statistics on mobility flows, showing that roughly 2.1 million people were registered under an S1 form in 2021, about 0.5 per cent of insured persons, that S2 claims amounted to some 39,500 cases worth around €131 million, and that around 200,000 patients a year use the directive, less than 0.05 per cent of EU citizens. It then draws on the health economics literature, on case studies of four border areas and on field visits to Gmünd in Austria and Furth im Wald in Germany to explain why mobility happens and what follows from it. The central message is that mobility is overwhelmingly a neighbouring country phenomenon driven by proximity, availability and cost differences rather than by quality alone, that its welfare effects are not automatically positive, and that EU action is most promising in four specific areas rather than in a general push for higher numbers.
What the deliverable contains:
- A legal map of cross border healthcare in the EU, comparing planned and unplanned care, prior authorisation requirements, reimbursement rules and the interplay between the regulation, the directive, bilateral agreements and national law
- An overview of actual mobility flows based on the latest available data on S1 and S2 forms and on reporting under the directive
- An analysis of the reasons behind mobility, covering rare diseases and European Reference Networks, border regions with four case studies, and patient driven mobility
- A review of how quality of care is defined, measured and allocated between the country of affiliation and the country of treatment, including the relevant case law
- Policy proposals in four areas, rare diseases, better use of spare hospital capacity, quality improvement through mobility and telemedicine, plus a legal option of merging the directive into the regulation to reduce complexity