Cross‐border health care in the European Union: recent legal implications of ‘Decker and Kohll’

In the European Union a growing number of citizens are receiving medical treatment in a country other than the one in which they are resident. This concerns migrant (frontier) workers, emergency treatment and preauthorized care. Since 1998 a ‘new category’ can be discerned of persons going abroad without prior authorization on the basis of the Decker and Kohll rulings of the EC Court of Justice. Local payers would, because of the Decker and Kohll judgements, be obliged to reimburse patients who travel abroad to circumvent the existing problems with the authorization rules. During the past years studies within specific so‐called Euregions have been performed to analyse cross‐border flows and provide some more insight in the practical and health policy consequences of the Decker and Kohll judgements. The abolishment of current preauthorization is pleaded for by many respondents in these studies. Waiting lists form an important motive (in particular in the Netherlands) to consume health care in another Member State (Belgium and Germany). The familiarity with (health care in) Belgium eases the unofficial Decker and Kohll route. However, when some parts of the health care services seem to be more expensive in the other Member State, the patient has to pay the difference. New court cases are pending before the European Court of Justice. These cases raise new issues such as the tenability of ‘benefits‐in‐kind’ systems. So far, the Decker and Kohll rulings could be seen as an incentive to enhance access to cross‐border health care in border areas.