ECJ rulings on health care services and their effects on the freedom of cross-border patient mobility in the EU

Patient mobility and cross-border medical care are significant issues of the actual discussion about the future development of the health care systems of the Member States of the European Union. New rights for patients were defined by the European Court of justice in its sequence of judgements (e. g. Kohll, Muller-Faure, Watts) referring to Regulation (EEC) 1408/71 on the social security of migrant workers. The Court's rulings also provoked considerable effects in national governments, insurance institutions, care providers and medical professionals. In its communication of April 2005 the European Commission proposed a new health and consumer protection strategy, of which the scope of facilitating utilisation of cross-border health care is a striking aspect. Discussions are based on the existence of two categories of health care systems within the EU: social insurance systems and national health systems both varying in organisation, financing and benefits. As regards individual rights before going abroad the patients in certain cases have to be aware of the need of prior authorisation by the competent authority. In terms of the Court's reasoning the question will be how the freedom to choose one's doctor and hospital can be realised without endangering the system's financial balance and what restrictions are necessary to provide a balanced medical and hospital service accessible to all, which is indispensable for the maintenance of an essential treatment facility or medical service on national territory. The Court's most important rulings on these issues are introduced. In the light of these rulings and the increasing mobility of patients, especially retired persons, the paper reflects financial and institutional effects on the national health care systems within the EU.