{
 "id": "patient-mobility",
 "names": {
  "name": "Patient mobility",
  "aliases": [
   "cross-border healthcare",
   "free movement of patients",
   "the Directive route"
  ],
  "said": "Brussels says patient mobility. It is an administrative word for a legal right, and it covers people who would never describe themselves as travellers."
 },
 "region": [
  "global",
  "europe-west",
  "europe-central",
  "europe-south",
  "europe-north",
  "europe-east"
 ],
 "etymology": {
  "root": "mobility is early 15c., \"capacity for motion, ability to move or be moved\", from Old French mobilité and Latin mobilitatem, from mobilis, movable, from movere, to move; the sociological sense arrives about 1900. Applied to patients it is a policy word, not a clinical one. What moves first in it is an entitlement; the patient moves after it.",
  "first_attested": "early 15c. for mobility; in a European Commission document title by 20 April 2004",
  "tier": "cited",
  "source": "s:etymonline-mobility",
  "note": "The only name in this glossary with a directive behind it. It describes movement inside a reimbursement scheme, not the private market most of this site describes."
 },
 "text": {
  "what": "The European Union's word for patients receiving healthcare in a member state other than the one that insures them, and being reimbursed for it at home. Two separate legal routes carry it, with different rules and different arithmetic, and a patient on the wrong one is paid on the wrong basis.",
  "story": "The court moved first. On 28 April 1998 the Court of Justice decided two Luxembourg cases on the same day: Decker, Case C-120/95, on a pair of spectacles bought in Belgium, under the free movement of goods; and Kohll, Case C-158/96, on orthodontic treatment in Germany, under the freedom to provide services. Kohll held that the Treaty precluded national rules making reimbursement of treatment provided in another member state subject to the insurer's authorisation. In Watts, Case C-372/04, decided by the Grand Chamber on 16 May 2006, the court held that authorisation could not be refused on the bare existence of a waiting list: what mattered was whether the wait exceeded \"the period which is acceptable on the basis of an objective medical assessment of the clinical needs of the person concerned\".\n\nThe administration followed, and the phrase arrives with it. The Commission's communication of 20 April 2004, COM(2004) 301 final, is titled \"Follow-up to the high level reflection process on patient mobility and healthcare developments in the European Union\", and reports a process set up after the Health Council of June 2002 which produced nineteen recommendations.\n\nThe legislature wrote it down seven years later. Directive 2011/24/EU on the application of patients' rights in cross-border healthcare was done at Strasbourg on 9 March 2011, published in the Official Journal of 4 April 2011 at L 88/45, and had to be transposed by 25 October 2013. Its recital 10 gives the word a job: the directive aims \"to ensure patient mobility in accordance with the principles established by the Court of Justice\". Its arithmetic is Article 7(4): costs \"shall be reimbursed or paid directly by the Member State of affiliation up to the level of costs that would have been assumed by the Member State of affiliation, had this healthcare been provided in its territory, without exceeding the actual costs of healthcare received\". Article 8 lets a state keep prior authorisation, limited to care involving an overnight stay, highly specialised infrastructure, particular risk, or a provider raising quality and safety concerns.\n\n*Inference —* the ceiling in Article 7(4) is the character of the whole scheme. A patient is refunded at the home state's price and never more than was actually spent, so this is a route for being treated sooner or nearer, not for buying more cheaply.",
  "how": "The older route runs on different rails. Regulation (EC) No 883/2004 of 29 April 2004 coordinates social security between member states, and its planned-treatment authorisation — the S2 route in British usage — has the treating state's public system take the patient on its own terms, with the two states settling between themselves. The directive says how the two fit: recital 30 provides that \"either this Directive applies or the Union regulations on the coordination of social security systems apply\", and recital 31 requires the affiliation state to draw a patient's attention to the regulation route where that route is more advantageous. Pay first and claim back at home rates, or seek authorisation and be treated on the host state's public terms.",
  "today": "As of 17 September 2026 the European Commission publishes annual member-state data on cross-border patient healthcare under the directive, and uses this phrase for the series. The administrative vocabulary is not always careful with its own citations: the 2004 communication footnotes the Kohll judgment twice as Case C-155/96."
 },
 "kin": [
  {
   "to": "eu-directive-2011-24",
   "as": "The instrument this word carries, with its dates and its articles.",
   "rel": "rule"
  },
  {
   "to": "s2-route",
   "as": "The other rail: authorisation first, then treatment on the host state's public terms.",
   "rel": "rule"
  },
  {
   "to": "tariff",
   "as": "The home-state schedule a reimbursement is capped at.",
   "rel": "term"
  },
  {
   "to": "prior-authorisation",
   "as": "The gate Article 8 allows a member state to keep, and the four grounds for it.",
   "rel": "term"
  },
  {
   "to": "medical-travel",
   "as": "The wider name for the same movement outside any reimbursement scheme.",
   "rel": "contrast"
  },
  {
   "to": "eu-national-contact-points",
   "as": "The network the directive created to answer the questions this word raises.",
   "rel": "org"
  }
 ],
 "sources": [
  "s:etymonline-mobility",
  "s:eu-directive-2011-24",
  "s:com-2004-301",
  "s:ecj-decker-1998",
  "s:ecj-kohll-1998",
  "s:ecj-watts-2006",
  "s:eu-reg-883-2004",
  "s:nhs-s2-route",
  "s:ec-crossborder-2022"
 ],
 "provenance": {
  "default": {
   "tier": "cited"
  }
 },
 "confidence": "high",
 "schema": 1,
 "type": "term",
 "updated": "2026-09-17",
 "facets": {
  "letter": "P"
 },
 "blurb": "The European Union's word for patients receiving healthcare in a member state other than the one that insures them, and being reimbursed for it at home.",
 "region_terms": [
  {
   "key": "global",
   "name": "Everywhere",
   "note": "use for a node that belongs to no one country — a standard, a word, a risk"
  },
  {
   "key": "europe-west",
   "name": "Western Europe",
   "note": "Germany, France, Belgium, the Netherlands, Ireland, the UK, Switzerland, Austria"
  },
  {
   "key": "europe-central",
   "name": "Central Europe",
   "note": "Poland, Czechia, Hungary, Slovakia, Slovenia, Croatia"
  },
  {
   "key": "europe-south",
   "name": "Southern Europe",
   "note": "Spain, Portugal, Italy, Greece, Cyprus, Malta"
  },
  {
   "key": "europe-north",
   "name": "Northern Europe",
   "note": "the Nordics and the Baltics"
  },
  {
   "key": "europe-east",
   "name": "Eastern Europe",
   "note": "Romania, Bulgaria, Serbia, Ukraine, Moldova, Albania, North Macedonia"
  }
 ],
 "kin_out": [
  {
   "to": "eu-directive-2011-24",
   "type": "rule",
   "name": "Directive 2011/24/EU on patients' rights in cross-border healthcare",
   "as": "The instrument this word carries, with its dates and its articles.",
   "rel": "rule"
  },
  {
   "to": "s2-route",
   "type": "rule",
   "name": "The S2 route",
   "as": "The other rail: authorisation first, then treatment on the host state's public terms.",
   "rel": "rule"
  },
  {
   "to": "tariff",
   "type": "term",
   "name": "Tariff",
   "as": "The home-state schedule a reimbursement is capped at.",
   "rel": "term"
  },
  {
   "to": "prior-authorisation",
   "type": "term",
   "name": "Prior authorisation",
   "as": "The gate Article 8 allows a member state to keep, and the four grounds for it.",
   "rel": "term"
  },
  {
   "to": "medical-travel",
   "type": "term",
   "name": "Medical travel",
   "as": "The wider name for the same movement outside any reimbursement scheme.",
   "rel": "contrast"
  },
  {
   "to": "eu-national-contact-points",
   "type": "org",
   "name": "EU National Contact Points for cross-border healthcare",
   "as": "The network the directive created to answer the questions this word raises.",
   "rel": "org"
  }
 ],
 "source_list": [
  {
   "id": "s:etymonline-mobility",
   "kind": "dictionary",
   "title": "mobility (n.), mobile (adj.) — etymology",
   "publisher": "Online Etymology Dictionary, compiled by Douglas Harper",
   "url": "https://www.etymonline.com/word/mobility",
   "accessed": "2026-09-17",
   "note": "early 15c. / late 15c."
  },
  {
   "id": "s:eu-directive-2011-24",
   "kind": "web",
   "title": "Directive 2011/24/EU on the application of patients' rights in cross-border healthcare",
   "publisher": "Official Journal of the European Union",
   "year": 2011,
   "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32011L0024",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:com-2004-301",
   "kind": "regulation",
   "title": "Communication from the Commission — Follow-up to the high level reflection process on patient mobility and healthcare developments in the European Union, COM(2004) 301 final, 20 April 2004",
   "publisher": "European Commission, via EUR-Lex (CELEX 52004DC0301)",
   "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:52004DC0301",
   "accessed": "2026-09-17",
   "note": "the phrase patient mobility appears fifteen times in the English text; footnotes 1 and 2 mis-cite the Kohll judgment as Case C-155/96"
  },
  {
   "id": "s:ecj-decker-1998",
   "kind": "ruling",
   "title": "Case C-120/95, Nicolas Decker v Caisse de maladie des employés privés, judgment of 28 April 1998, ECR 1998 I-1831",
   "publisher": "Court of Justice of the European Communities, via EUR-Lex (CELEX 61995CJ0120)",
   "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:61995CJ0120",
   "accessed": "2026-09-17",
   "note": "spectacles bought in Belgium; decided under the free movement of goods"
  },
  {
   "id": "s:ecj-kohll-1998",
   "kind": "ruling",
   "title": "Case C-158/96, Raymond Kohll v Union des caisses de maladie, judgment of 28 April 1998, ECR 1998 I-1931",
   "publisher": "Court of Justice of the European Communities, via EUR-Lex (CELEX 61996CJ0158)",
   "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:61996CJ0158",
   "accessed": "2026-09-17",
   "note": "orthodontic treatment in Germany; decided under the freedom to provide services"
  },
  {
   "id": "s:ecj-watts-2006",
   "kind": "ruling",
   "title": "Case C-372/04, The Queen (on the application of Yvonne Watts) v Bedford Primary Care Trust and Secretary of State for Health, Grand Chamber judgment of 16 May 2006",
   "publisher": "Court of Justice of the European Communities, via EUR-Lex (CELEX 62004CJ0372)",
   "url": "https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:62004CJ0372",
   "accessed": "2026-09-17"
  },
  {
   "id": "s:eu-reg-883-2004",
   "kind": "statute",
   "title": "Regulation (EC) No 883/2004 on the coordination of social security systems, Article 20 (as adopted)",
   "publisher": "The National Archives, legislation.gov.uk",
   "url": "https://www.legislation.gov.uk/eur/2004/883/article/20/adopted",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:nhs-s2-route",
   "kind": "web",
   "title": "The Planned Treatment Scheme (S2 funding route)",
   "publisher": "NHS",
   "url": "https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/planned-treatment-s2-funding-route/",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:ec-crossborder-2022",
   "kind": "report",
   "title": "Member State data on cross-border patient healthcare following Directive 2011/24/EU — reference year 2022",
   "publisher": "European Commission, DG Health and Food Safety, Unit B.3; written by PredictBy Research and Consulting and Baltic Media; Publications Office of the European Union",
   "url": "https://health.ec.europa.eu/document/download/69e33702-c7cc-4f0e-afc0-f3cf13e127ab_en?filename=crossborder_2022_patient-healthcare_data_en.pdf",
   "license": "CC BY 4.0",
   "accessed": "2026-09-16",
   "note": "final version January 2024, ISBN 978-92-68-14858-7. 23 countries reported 547,890 reimbursement requests for care not needing prior authorisation in 2022, of which France 300,254 and Germany 160,647 are 84%; Poland 14,176, Slovakia 13,904, Ireland 1,841, Romania 889, Czechia 440, Croatia 192, Lithuania 131, Greece 56, Cyprus 44, Portugal 27 (all refused), Spain 9. Total reimbursed EUR 86,462,491. For care needing prior authorisation, 4,552 requests and EUR 7,708,041. Belgium and Hungary could not report; Czechia, Cyprus, Latvia, Lithuania, the Netherlands, Finland, Sweden and Norway run no prior-authorisation system; only Denmark and Romania have a mechanism to limit inflow."
  }
 ],
 "tiers": {
  "text.what": {
   "tier": "cited"
  },
  "text.story": {
   "tier": "cited"
  },
  "text.how": {
   "tier": "cited"
  },
  "text.today": {
   "tier": "cited"
  },
  "etymology": {
   "tier": "cited"
  }
 },
 "primary_image": null,
 "tag_facts": [],
 "recognition_facts": [],
 "acclaim": 0,
 "kin_in": [
  {
   "from": "john-connell",
   "type": "person",
   "name": "John Connell",
   "as": "The other word for the same movement, preferred by the people who regulate it.",
   "rel": "term"
  },
  {
   "from": "directive-2011-24-adopted",
   "type": "event",
   "name": "Directive 2011/24/EU adopted, 9 March 2011",
   "as": "The word Brussels uses for this, and why it is not the word the trade uses.",
   "rel": "term"
  },
  {
   "from": "medical-tourism",
   "type": "term",
   "name": "Medical tourism",
   "as": "The European administrative word for the same movement, with a directive behind it.",
   "rel": "term"
  },
  {
   "from": "medical-travel",
   "type": "term",
   "name": "Medical travel",
   "as": "The administrative version, for patients moving inside a reimbursement scheme.",
   "rel": "term"
  },
  {
   "from": "medical-visa",
   "type": "term",
   "name": "Medical visa",
   "as": "The scheme where no visa is needed at all, because the border is already open.",
   "rel": "contrast"
  },
  {
   "from": "prior-authorisation",
   "type": "term",
   "name": "Prior authorisation",
   "as": "The European scheme with its own prior approval, which does cross a border.",
   "rel": "term"
  },
  {
   "from": "tariff",
   "type": "term",
   "name": "Tariff",
   "as": "The European scheme that refunds a patient at the home state's tariff, not the foreign one.",
   "rel": "term"
  },
  {
   "from": "the-word-itself",
   "type": "story",
   "name": "The word itself",
   "as": "Brussels administrative language for an entitlement, with a directive behind it.",
   "rel": "term"
  }
 ]
}