Cross-Border Healthcare in the European Union (EU)

Spain transposes the European Cross-Border Healthcare Directive

7 February 2014. Today the Cabinet approved the Royal Decree transposing Directive 2011/24/EU on the application of patients' rights in cross-border healthcare into the Spanish legal system and amending Royal Decree 1718/2010 of 17 December on medical prescriptions and dispensing orders at the proposal of the Minister of Health, Social Services and Equality.

The Directive is the Community law on health having the greatest impact in recent years, as it will involve significant organisational adaptation in all of the Member States' health services.

According to this Directive, patients of European Union countries can go to another Member State other than their own to receive healthcare. They will have to pay in advance for the services they receive and subsequently request reimbursement in their country under certain conditions which, in the case of some kinds of treatment, will require prior authorization. The spirit of this Directive responds to the free movement of persons, goods and services in the EU.

The aims of the Royal Decree are as follows:

  1. To ensure access to safe and high-quality cross-border healthcare.
  2. To guarantee patient mobility.
  3. To facilitate cooperation on healthcare between Spain and the rest of the EU.

Up to now, EC Regulations from 2004 and 2009 have governed the healthcare of European patients in a state other than their own and guaranteed healthcare for European citizens as they moved around the European space, either temporarily through the European Health Card or on a permanent basis. Invoicing is done between the competent institutions of the States.

However, travelling to another State with the express purpose of receiving healthcare had not been regulated. That is precisely what this Directive aims to do. It has been transposed through the recently approved Royal Decree 81/2014.


According to this legislation, patients may go to another country in order to receive healthcare, which may be provided by either public or private services.

Patients will have to pay in advance, which will then be reimbursed to them through their country's competent health authority (in Spain, the regional authorities, INGESA and mutual societies for civil servants, as appropriate).

The cost of the benefits included in the National Health System's common portfolio of services and, as appropriate, in the complementary portfolio of the relevant regional authority will be reimbursed in our country. Healthcare is built in the broadest possible way and includes medicinal products and medical devices. Long-term healthcare, organ transplants and public vaccination programmes are excluded.

Reimbursement will be according to the official rates of each health service, as if the treatment had been delivered in Spain.

Royal decree also establishes the necessity of requesting prior authorisation from the regional authority, INGESA or mutual societies for civil servants in two cases:


The Royal Decree also guarantees a series of rights for patients:

  1. They may have a copy of clinical reports, diagnostic tests and therapeutic procedures.
  2. They will be ensured continuity of treatment after having received healthcare in another country.
  3. Protection of their personal data will be guaranteed.
  4. They will have all the necessary information at their disposal through the National Contact Point. The National Contact Point has already been set up at the Ministry of Health, Social Services and Equality through the Citizens' Advice Sub-Directorate.


Lastly, this Royal Decree establishes measures aimed at promoting cooperation between Spain and the rest of the European Union Member States.

Information on health professionals will be shared, main reason why the Ministry of Health, Social Services and Equality is finalizing a Royal Decree to regulate the National Registry of Health Professionals. The registry will be made available during the course of 2014.

Directive regulates the establishment of a European Reference Network, that the centres, services and units of reference of the National Health Service (currently 187 units for 42 pathologies or procedures) will join. This will be especially beneficial for people suffering from rare diseases, who will be able to attend to a specialized centre in another country.

Spain also plays an active role in the European eHealth Network. Spain leads the European Union's eHealth project, thanks to the highly successful implementation of eHealth in Spain (today 20 million Spaniards already have interoperable health records and more than 70% of prescribing and dispensing in our country is done electronically).

Spain also takes part in the European Health Technology Assessment Network, which will promote scientific information transfer between States.

Additionally, the recently approved Royal Decree amends Royal Decree 1718/2010 in order to facilitate the recognition of medical prescriptions issued in another State. Thus, medical practitioners will be able to issue valid "European prescriptions" across the Union. These prescriptions have to include the medicinal product's active substance.

To sum up, the Directive which is being transposed by the Royal Decree approved today constitutes an opportunity to strengthen and unify health criteria and requirements, safety and healthcare by ensuring equal access to healthcare to citizens of any regional authority and citizens from other Member States. Spain is one of the leading countries in matters having to do with cross-border healthcare and is at the same time taking a further step to improve the healthcare of the people needing the most specialised treatments, like the ones suffering from rare diseases.

If you want to find any information related to this website, please use the search application on the top of the page