Ministers reject proposal on cross-border healthcare

Today's failure to reach an agreement on the cross-border directive is just the latest twist in more than a decade of debate about patients' rights in the EU.

The story began in the mid 1990s when a Luxembourgois citizen asked the family's health insurer to pay for his daughter's visit to an orthodontist in Trier, Germany. The insurance company refused and the Kholl family went to court. The case made it to the European Court of Justice, which ruled in 1998 in Kholl and Decker (a similar case concerning spectacles) that patients had the right to be reimbursed for some healthcare in another EU country. In 1999 the Smits/Peerbooms case established that no healthcare system could be exempt from the EU treaty. Patients' rights were given a further boost by the case of Watts in 2006, when the court ruled that a health care system could not refuse to refund patients who had gone abroad because they faced waiting times at home that exceeded clinical advice.

EU member states began debating cross-border healthcare in late 2003, but sensitivities over national governments' control over health services have always been strong. An early attempt to legislate at EU level stalled:  healthcare was removed from the EU directive to liberalise services, the controversial ‘Bolkestein' directive that was agreed in 2006. Then the draft law on cross-border healthcare was bogged down in the European Commission for months in internal battles and countless re-drafts before finally appeared in July 2008.

Whether to revive the proposal will be one of the big decisions for John Dalli, the designated European commissioner for health.