Hard road for EU health reforms

It may sound like a brave new world for healthcare in the EU, but the latest blueprint is bound to face substantial changes before it is agreed by governments.

As far as funding operations abroad is concerned, the UK Department of Health has already made it clear that the National Health Service (NHS) will decide what it will pay for and what it will not.

The problem for the commission is that it has had to respond to court rulings telling EU governments they had to fund treatment abroad if the patient was facing an undue delay.

Indeed, the commission points out that it was EU health ministers themselves who asked for a draft directive.

But some governments may argue that Brussels has overstepped the mark.

They are likely to include countries such as the Irish Republic, Italy and Spain, which provide direct government funding for health services.

The commission's argument is that the cost for governments would be marginal as the money would have been spent on the patient in any case.

Health tourism

Dental tourism already exists in some parts of the EU, but would the patient's home country be willing to fund it?

The commission is careful to include only treatments that the patient is already entitled to at home.

So, if your provider does not allow plastic surgery, you would still have to pay.

The European Commission and the UK are agreed that the number of people these proposals are likely to affect will not be high.

More than 90% of patients are treated by their home system.

It is generally accepted that most patients would rather have care close to their homes and carried out by people who speak their language.

The remainder tend to receive their care via co-operation agreements.

Many agreements are on a small scale between neighbouring countries.

But the European Health Insurance Card (EHIC) provides emergency care across the EU for patients who fall ill while abroad.

Big ambitions

The health commissioner, Markos Kyprianou, says he has big ambitions but his most significant hurdle will be in persuading some EU countries to accept that the commission has the right - the competence - to produce directives on public health.

As it stands, the EU has no competence when it comes to health care funding or public health systems.

The area starts to become grey because the European Court of Justice has ruled that health is an economic activity and therefore part of the internal market.

In other words, the competence of member states in health matters may already have been affected.

And there do appear to be aspects of the commission's proposals that make the patient a consumer with the right to call in for treatment anywhere in the EU.

If something goes wrong with the treatment, a patient would have guaranteed redress.

Some critics may see similarities to the controversial Services Directive which was approved by member states a year ago after a stormy ride from ministers and MEPs alike.

But the commission will argue that these proposals merely clarify patients' rights and do not give them new ones.

The importance, it says, is in ensuring safety and quality of health care across borders.