With recommendations to the Commission on Modernised rules for patients’ rights in cross-border healthcare

(2025/2206(INL))

The European Parliament,

–having regard to Articles 114, 168, and 225 of the Treaty on the Functioning of the European Union,

–having regard to articles 26, 34, 35, 41, 45 and 47 of the Charter of Fundamental Rights of the European Union,

–having regard to its resolution of 12 February 2019 on the implementation of the Cross-Border Healthcare Directive (2018/2108(INI)),

–having regard to the opinion of the Committee on Legal Affairs on the proposed legal basis,

–having regard to Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients' rights in cross-border healthcare,

–having regard to Regulation (EU) 2025/327 of the European Parliament and of the Council on the European Health Data Space,

–having regard to the Regulation (EC) No 883/2004 on the coordination of social security systems and Regulation (EC) No 987/2009 laying down the procedure for implementing Regulation (EC) No 883/2004,

–having regard to the European Pillar of Social Rights, in particular Principle 16 on healthcare,

–having regard to the UN Convention on the Rights of Persons with Disabilities, ratified by the EU,

–having regard to the European Patients’ Forum report on access to healthcare (2016),

–having regard to the judgments of the Court of Justice of the European Union in cases C-120/95 Decker, C-158/96 Kohll, C-157/99 Smits and Peerbooms, C-385/99 Müller-Fauré and Van Riet, and C-372/04 Watts,

–having regard to the European Court of Auditors Special Report No 07/2019 entitled “EU actions for cross-border healthcare: significant ambitions but improved management required”,

–having regard to Rules 47 and 55 of its Rules of Procedure,

–having regard to the report of the Committee on Public Health (A10-0000/2026),

A.whereas health is a fundamental human right, not a privilege;

B.whereas, on the basis of the conclusions of the European Court of Auditors, Directive 2011/24/EU, has failed to eliminate structural barriers to access, including advance payment requirements, opaque prior authorisation procedures, inadequate reimbursement frameworks and the fragmented information;

C.whereas cross-border healthcare must complement strong, universal and publicly funded national healthcare systems;

D.whereas the European Reference Networks (ERNs) sustainability is endangered by precarious funding, inadequate legal recognition and uneven participation across Member States, and ERNs must be significantly strengthened and placed on a permanent, adequately resourced footing;

E.whereas National Contact Points (NCPs), are chronically under-staffed, inconsistently structured and too often practically inaccessible to patients with lower digital literacy, disabilities or language barriers;

Revision and Strengthening of the Legislative Framework

1.Calls on the Commission to present a modernised legislative framework on cross-border healthcare, also mobilising financial instruments, aimed at guaranteeing equitable and timely access to quality healthcare services throughout the Union, reducing administrative and financial barriers between regions and Member States, and ensuring that all patients have access to high quality care regardless of where they live;

2.Stresses that patient organisations must be formally involved in the operation and governance of National Contact Points (NCPs) to ensure that the information provided meets the real-life needs of patients; stresses the importance of ensuring sustainable, objective and transparent public funding for patients’ organisations to enable their presence in the public sphere and governance structures, and to provide them with financial independence;

Equity and Patient-Centric Care

3.Stresses that healthcare must remain a public good based on solidarity and equitable access; Calls on the Commission and Member States to introduce robust safeguards, including by addressing barriers like the upfront payments with the aim of ensuring equitable access to cross-border healthcare services for all, regardless of nationality, socioeconomic status, disability, gender identity or place of residence;

4.Stresses the need to eliminate regional disparities while accessing to diagnosis, treatment and specialised expertise, including through strengthened European Reference Networks;

Prior Authorisation: Transparency, Fairness and Accountability

5.Calls on the Commission and Member States to reform the prior authorisation system to ensure it serves patients' needs rather than acting as an administrative gatekeeping mechanism;

6.Calls on Member States to replace broad, vague categories with explicitly detailed public lists of the specific treatments subject to prior authorisation;

7.Calls on the Commission to establish minimum European standards for patients’ rights, including the right to timely treatment, informed consent and non-discrimination as well as seamless cross-border access to electronic medical records through the mandatory implementation of the European Health Data Space (EHDS);

Financial Accessibility and EU Solidarity Mechanisms

8.Calls on Member States to implement mechanisms for a direct financial compensation between competent institutions across borders, applying the payment models used under the Social Security Coordination Regulations (Regulation (EC) No 883/2004) to pay treatments covered by Directive 2011/24/EU, in order to avoid that patients are forced to forfeit the broader freedoms of this Directive to circumvent upfront costs;

9.Calls on the Commission to propose targeted amendments to Article 7(4) of Directive 2011/24/EU to simplify and streamline the administrative procedures for patients claiming other related costs, such as travel and accommodation expenses, based on income eligibility; stresses, in this regard, the need to establish clear and fast-track mechanisms for the reimbursement of additional costs, ensuring procedures do not impose disproportionate administrative burdens;

European Reference Networks: Sustainable Funding

10.Encourages the reinforcement and sustainable financing of ERNs as central engines of cross-border clinical cooperation; urges the Commission, in this regard, to propose a framework granting ERNs a distinct legal status to enable them to directly apply for EU funding, sign contracts, and effectively working as unified entities within national health systems;

Digital Health and the European Health Data Space

11.Stresses that robust, patient-centric mechanisms for the secure exchange of health-related data and best practices across Union health systems must be prioritised within the regulatory framework, including through the mandatory expansion of the MyHealth@EU infrastructure, to ensure that patients moving between Member States receive high-standard healthcare;

Rights of Persons with Disabilities, Rare and complex diseases

12.Stresses the need for multiannual, renewable cross-border care authorisations for patients with chronic, long-term or progressively deteriorating health conditions who require ongoing treatment, replacing the current practice of requiring repeated individual authorisations for each treatment episode, which places an unacceptable administrative burden on the most vulnerable patients;

13.Calls on the Commission and Member States to formally recognise in the revised legislative framework that rare and complex diseases require, by their very nature, highly specialised expertise, multi-disciplinary care coordination, and access to cutting-edge research and innovation that cannot be equitably or consistently delivered within national borders alone; and to formally recognise that, accordingly, access to cross-border healthcare for patients with rare and complex diseases must be treated not as an exception but as a structural feature of the Union's healthcare system, deserving of dedicated legal provisions, guaranteed funding, and proactive facilitation by Member States;

14.Calls on the Commission to extend the scope of EU cross-border healthcare legislation to explicitly cover participation in clinical trials for rare and complex diseases, including early-phase trials, recognising that, for conditions in which low-intervention trials form part of standard treatment and experimental therapies offer a second chance to patients with relapsed or refractory malignancies, access to research conducted in selected centres across Europe is an essential, rather than optional, component of care.

Special Protection and Prioritisation for Children

15.Calls on the Commission and Member States to establish child-specific provisions within the cross-border healthcare framework guaranteeing priority access to paediatric specialist care and, expedited authorisation procedures, and amending Article 7(4) of Directive 2011/24/EU to ensure the mandatory reimbursement of travel and accommodation costs for both the child and their accompanying parents or guardians, in recognition of children's particular vulnerability and the inseparability of family support from effective paediatric care;

16.Calls on the Commission and Member States to recognise the specific medical, social and emotional needs of children with rare and complex diseases and to require each Member State to establish national cross-border navigator services providing personalised, cost-free guidance for young patients, their families and their caregivers throughout the entire cross-border care pathway, thereby reducing the disproportionate administrative burden placed on families navigating fragmented health systems;

17.Calls on the Commission and Member States to provide dedicated, multi-annual infrastructure funding to strengthen and expand existing cross-border networks in rare and complex disease areas, including the European Reference Networks established under Directive 2011/24/EU, with a view to fostering specialist capacity across the Union and reducing geographic disparities to access to expertise;

Continuous coordination and Safety of Care

18.Stresses the necessity of fully implementing the European Health Data Space (EHDS), the MyHealth@EU infrastructure and the European electronic health record exchange format to ensure the seamless cross-border transfer of patient summaries and discharge reports;

19.Requests that the Commission submit, by the end of 2027, on the basis of Articles 114 and 168 of the Treaty on the Functioning of the European Union, a proposal for a revision of the Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients' rights in cross-border healthcare, following the recommendations set out in the Annex hereto;

20.Considers that the financial implications of the requested proposal should be covered by existing budgetary allocations;

21.Instructs its President to forward this resolution and the accompanying recommendations to the Commission and the Council.