an eventDirective 2011/24/EU adopted, 9 March 2011

The European Parliament and the Council adopted Directive 2011/24/EU on the application of patients' rights in cross-border healthcare on 9 March 2011, signed at Strasbourg by J. Buzek for the Parliament and E. Győri for the Council. It was published in the Official Journal on 4 April 2011 at L 88/45, entered into force twenty days later, and Member States had to transpose it "by 25 October 2013". It is the only instrument in this directory that gives a patient a general right to be treated in another country and have the bill sent home.

The rule is in Article 7(1): "the Member State of affiliation shall ensure the costs incurred by an insured person who receives cross-border healthcare are reimbursed, if the healthcare in question is among the benefits to which the insured person is entitled in the Member State of affiliation." Then Article 7(4) fixes the ceiling — costs are reimbursed "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."

Read together, those two sentences describe the whole bargain. A patient may go; the home system pays what it would have paid at home; the patient carries the difference, and pays first. A right to travel is not a right to a free operation.

Governments kept one lever. Article 8 allows a prior authorisation system, restricted "to what is necessary and proportionate", and limits it to care that "involves overnight hospital accommodation of the patient in question for at least one night", "requires use of highly specialised and cost-intensive medical infrastructure or medical equipment", or presents a particular patient-safety risk. Article 8(5) then closes the obvious loophole: authorisation may not be refused when the treatment cannot be provided at home "within a time limit which is medically justifiable". The queue is written into the law.

Article 6 requires every Member State to run a national contact point, which is how a patient is supposed to find out any of this.

Inference — the directive is also the only place in this subject where a state agreed, in advance and in writing, to pay for a citizen's treatment abroad. Everything else in this directory is paid out of pocket.

The Commission's report for reference year 2022 shows what the instrument produces in practice: 23 countries reported 547,890 reimbursement requests for care that needed no prior authorisation, of which France's 300,254 and Germany's 160,647 are 84%, against 14,176 from Poland, 1,841 from Ireland, 440 from Czechia and nine from Spain. Total reimbursed was EUR 86,462,491. For care that did need prior authorisation there were 4,552 requests and EUR 7,708,041.

One instrument, one date, one jurisdiction — the directive binds the EU Member States and, through the EEA agreement and national implementations, extends unevenly beyond them. Nothing here is legal advice, and the per-country reading sits on the rule record rather than in this event.