Civil Law and Cross-Border Healthcare Billing Disputes in Europe

1. Introduction

Cross-border healthcare billing disputes arise when a patient receives healthcare in one European country while being insured, resident, or financially connected with another country, and a dispute subsequently arises concerning who must pay, how much must be reimbursed, and which country's rules govern the payment.

Typical examples include:

A Belgian patient receives surgery in France and seeks reimbursement from Belgian health insurance.

A Romanian insured person receives treatment in Germany and is denied reimbursement by the Romanian insurer.

A patient pays a foreign hospital directly and later seeks reimbursement from the home-state health authority.

A hospital disputes the amount reimbursed by a foreign sickness fund.

A patient receives emergency treatment abroad and disputes a bill.

A cross-border telemedicine service generates a dispute about the applicable healthcare and billing rules.

The subject sits at the intersection of:

civil and contractual law;

EU free movement of services;

social-security coordination;

Directive 2011/24/EU on patients' rights in cross-border healthcare;

Regulation (EC) No. 883/2004;

national health-insurance law;

medical-contract law;

private international law;

consumer and patient-protection principles.

The CJEU has developed an extensive body of case law establishing that medical treatment provided across Member-State borders can fall within EU free-movement rules, while Member States retain significant authority to organise and finance their healthcare systems. (curia)

2. Meaning of Cross-Border Healthcare Billing Disputes

A cross-border healthcare billing dispute may concern:

Patient vs Health Insurer

The patient argues:

"My insurer should reimburse the treatment I obtained abroad."

Patient vs Foreign Healthcare Provider

The patient argues:

"The hospital's bill is excessive or was not properly disclosed."

Insurer vs Healthcare Provider

The insurer argues:

"The treatment is not reimbursable under the applicable tariff."

Health Authority vs Patient

The authority argues:

"Prior authorisation was required."

Healthcare Provider vs Foreign Insurer

The provider disputes:

reimbursement rates;

tariff classification;

coding;

payment delays;

eligibility;

medical necessity.

Thus, the word billing can encompass considerably more than an ordinary invoice dispute.

3. Difference Between Healthcare Cost and Healthcare Bill

Two separate financial relationships may exist.

Relationship 1

Patient → Foreign hospital

The patient may have to pay the provider.

Relationship 2

Home-state insurer → Patient

The patient subsequently seeks reimbursement.

Relationship 3

Home-state insurer → Foreign healthcare institution

Under certain social-security mechanisms, healthcare costs may be settled between institutions.

Therefore:

The amount charged by the foreign provider and the amount reimbursable by the patient's home-state system are not necessarily identical.

This distinction is central to cross-border healthcare disputes.

4. Main European Legal Framework

A. Directive 2011/24/EU

The Cross-Border Healthcare Directive establishes rules concerning patients receiving healthcare in another Member State.

It addresses:

reimbursement;

prior authorisation;

information;

quality and safety;

prescriptions;

healthcare providers;

national contact points.

5. Regulation (EC) No. 883/2004

Regulation 883/2004 coordinates social-security systems.

It is particularly relevant where an insured person:

travels temporarily;

requires necessary healthcare;

receives planned treatment abroad;

is authorised to receive healthcare in another Member State.

The Regulation and Directive 2011/24 can provide different legal routes to reimbursement.

6. Article 56 TFEU and Healthcare Services

The freedom to provide services under EU law has been central to the CJEU's healthcare jurisprudence.

The Court has repeatedly recognised that medical treatment can constitute a service even where the patient later seeks reimbursement from a national health system.

In Watts, the CJEU specifically confirmed that hospital treatment in another Member State can fall within the freedom to provide services even where the patient subsequently seeks reimbursement from the national health system. (curia)

7. Prior Authorisation

One of the most common causes of cross-border billing disputes is:

Was prior authorisation required?

The answer depends upon the nature of treatment and the legal regime being used.

Generally, EU law does not prohibit all prior-authorisation systems.

However, the authorisation system must not operate arbitrarily or disproportionately.

This principle is strongly established in Smits and Peerbooms and subsequent cases. (curia)

8. Non-Hospital Treatment

The CJEU has historically distinguished between:

non-hospital care; and

hospital or major healthcare requiring planning.

The justification for prior authorisation can be stronger for hospital treatment because Member States must be able to plan:

hospital capacity;

equipment;

financial resources;

specialist services;

healthcare availability.

The distinction is important when determining whether an insurer can lawfully refuse reimbursement.

9. Billing and Reimbursement Are Different Questions

Suppose:

Foreign hospital bill = €20,000

The patient's home-state reimbursement tariff may be:

€14,000

The patient may therefore face a €6,000 difference.

The dispute then becomes:

Was the treatment reimbursable?

What tariff applies?

Does EU law require additional reimbursement?

Was prior authorisation necessary?

Was the foreign price reasonable?

Is the difference payable by the patient?

10. Case Law 1 — Kohll v Union des Caisses de Maladie

Case C-158/96, CJEU, 28 April 1998

This is one of the foundational European cross-border healthcare cases. (InfoCuria)

Facts

A Luxembourg resident sought orthodontic treatment in Germany.

The Luxembourg health system required prior authorisation for reimbursement.

The authorisation was refused.

Issue

Could the requirement for prior authorisation restrict freedom to provide services?

Decision

The CJEU held that medical treatment provided by an orthodontist in another Member State constituted a service.

A prior-authorisation requirement could therefore constitute a restriction on free movement.

Importance for billing disputes

The case established that:

A national reimbursement system cannot automatically disregard treatment obtained from healthcare providers in another Member State.

Principle

Cross-border healthcare expenditure can fall within EU free-movement law.

11. Case Law 2 — Decker v Caisse de Maladie des Employés Privés

Case C-120/95, CJEU, 28 April 1998

Although Decker concerned spectacles rather than medical treatment itself, it is an important companion case to Kohll. (curia)

Facts

Mr Decker purchased spectacles from an optician in Belgium.

The Luxembourg social-security system refused reimbursement because he had not obtained prior authorisation.

Decision

The CJEU found that the prior-authorisation requirement constituted a restriction on free movement of goods.

Importance

The case demonstrates that healthcare-related expenditure can involve several EU freedoms.

Relevance

Modern healthcare billing can similarly involve:

medical products;

medical devices;

pharmaceuticals;

healthcare services.

12. Case Law 3 — Geraets-Smits and Peerbooms

Case C-157/99, CJEU, 12 July 2001

This is one of the most important cases concerning hospital treatment and reimbursement. (InfoCuria)

Facts

Ms Smits received Parkinson's treatment in Germany without prior authorisation.

Mr Peerbooms received specialised treatment in Austria.

Their Dutch sickness insurers refused reimbursement.

Issue

Could the Netherlands require prior authorisation for hospital treatment abroad?

Decision

The CJEU recognised that prior authorisation can be justified for hospital care because Member States need to maintain:

financial balance;

planning;

hospital capacity;

access to healthcare.

However, the authorisation system must operate according to objective and transparent criteria and cannot permit arbitrary refusal.

Importance

This provides the basic framework for determining whether an insurer can refuse reimbursement of foreign hospital treatment.

13. Case Law 4 — Vanbraekel and Others

Case C-368/98, CJEU, 12 July 2001

This case is particularly important for reimbursement amounts.

Facts

A Belgian insured person received hospital treatment in France after authorisation.

The issue concerned the level of reimbursement.

Decision

The CJEU examined the relationship between:

the reimbursement rules of the treatment state;

the reimbursement rules of the insurance state;

EU social-security coordination.

The Court recognised circumstances in which the insured person could be entitled to additional reimbursement where the reimbursement applicable under the competent state's system was more favourable.

Importance

The case is crucial because:

Authorisation to receive treatment abroad does not necessarily end the reimbursement dispute.

The precise amount payable can itself become the subject of litigation.

14. Case Law 5 — Müller-Fauré and van Riet

Case C-385/99, CJEU, 13 May 2003

Facts

The cases concerned Dutch insured persons who received healthcare outside the Netherlands.

The dispute involved reimbursement and prior authorisation.

Decision

The CJEU developed the distinction between:

hospital treatment;

non-hospital treatment.

It held that a general requirement of prior authorisation for non-hospital treatment could not be justified in the same manner as hospital care.

Importance

This is highly relevant to billing disputes because it affects whether an insurer can reject a reimbursement claim solely because prior approval was not obtained.

15. Case Law 6 — Watts

Case C-372/04, CJEU, 16 May 2006

Facts

Mrs Watts, a UK resident, received hip replacement treatment in France.

She had sought treatment abroad because of the waiting time in the UK.

She subsequently sought reimbursement.

Decision

The CJEU examined the UK's prior-authorisation system and circumstances in which a patient can obtain treatment abroad when treatment cannot be provided within a medically justifiable period at home.

The Court confirmed that hospital treatment abroad falls within the freedom to provide services. (curia)

Importance

The case connects:

waiting lists;

cross-border treatment;

prior authorisation;

reimbursement;

healthcare capacity.

Billing significance

A patient may argue that reimbursement cannot be denied where domestic treatment could not be provided within a medically justifiable period.

16. Case Law 7 — Elchinov

Case C-173/09, CJEU, 5 October 2010

Facts

A Bulgarian patient required hospital treatment abroad.

The Bulgarian health authority refused reimbursement because the necessary prior-authorisation requirements had not been satisfied.

Decision

The CJEU held that national legislation interpreted as completely excluding reimbursement for hospital treatment received abroad without prior authorisation could be incompatible with EU law in circumstances where the authorisation conditions were otherwise satisfied.

The case also concerned the obligation of lower national courts to follow the applicable interpretation of EU law. (InfoCuria)

Importance

The case prevents national reimbursement systems from creating an absolute barrier to cross-border healthcare reimbursement.

17. Case Law 8 — Petru v Casa Județeană de Asigurări de Sănătate Sibiu

Case C-268/13, CJEU, 9 October 2014

Facts

A Romanian patient required cardiac surgery and argued that adequate treatment was unavailable within a medically justifiable period because of serious deficiencies in the Romanian hospital system.

Issue

Could inadequate resources or conditions in the home state justify treatment abroad?

Decision

The CJEU considered the practical availability and conditions of treatment when determining whether treatment could be provided domestically within an appropriate period.

Importance

The case demonstrates that reimbursement cannot be assessed purely by asking:

"Does the treatment technically exist in the home country?"

The practical availability of the treatment is also relevant.

18. Case Law 9 — Veselības ministrija

Case C-243/19, CJEU, 29 October 2020

Subject

The case concerned cross-border healthcare reimbursement and prior authorisation under EU law.

Importance

The judgment clarified the relationship between national healthcare rules, cross-border treatment and the Directive 2011/24 framework.

It is important in determining when national systems may require authorisation and how reimbursement mechanisms should operate.

19. Case Law 10 — Casa Națională de Asigurări de Sănătate and Casa de Asigurări de Sănătate Constanța

Case C-538/19, CJEU, 6 October 2021

The case concerned reimbursement of cross-border healthcare and the interaction between EU social-security coordination and national healthcare rules.

It is particularly useful for understanding that reimbursement questions may need to be analysed under more than one EU legal instrument.

20. Case Law 11 — Casa Județeană de Asigurări de Sănătate Mureș and Others

Case C-489/23, judgment of 4 September 2025

This is a particularly recent authority.

Facts

A Romanian insured person underwent specialist cancer treatment in Germany.

After the treatment, reimbursement was sought from the Romanian health-insurance system.

The national rules made reimbursement dependent upon completion of a medical assessment and the issuance of a document authorising hospitalisation. (curia)

Issue

Could national procedural requirements significantly restrict reimbursement of cross-border healthcare?

Importance

The CJEU addressed the relationship between:

Article 56 TFEU;

Regulation 883/2004;

Directive 2011/24;

reimbursement;

prior authorisation;

national medical assessment procedures.

The judgment confirms the continuing importance of ensuring that national reimbursement mechanisms do not impose disproportionate obstacles to cross-border healthcare. (curia)

21. Case Law 12 — 2025 Telemedicine Jurisprudence

Recent CJEU jurisprudence has also clarified the treatment of cross-border telemedicine.

The Court has explained that healthcare delivered remotely by a provider established in another Member State can fall within the cross-border healthcare framework and that the "Member State of treatment" can be connected to the provider's establishment. (curia)

Importance

This is increasingly relevant to:

online consultations;

remote specialist advice;

tele-radiology;

remote diagnostics;

digital prescriptions;

cross-border medical platforms.

It introduces new billing questions:

Which country's reimbursement tariff applies to a medical consultation delivered digitally?

22. What Counts as Cross-Border Healthcare?

Cross-border healthcare may involve:

Planned treatment

The patient deliberately travels abroad.

Emergency treatment

The patient becomes ill while temporarily abroad.

Specialist treatment

The patient travels to another country because specialist expertise is available there.

Referred treatment

A doctor recommends treatment abroad.

Telemedicine

The patient remains in one country while the healthcare provider is established in another.

23. Planned Treatment

Planned treatment is particularly likely to generate reimbursement disputes.

The patient may need to determine:

whether prior authorisation is necessary;

whether the treatment is covered;

which reimbursement tariff applies;

whether the foreign provider is recognised;

whether the treatment is medically necessary.

24. Emergency Treatment

Emergency situations raise different concerns.

A patient generally cannot be expected to obtain lengthy prior authorisation before emergency care.

Therefore, a reimbursement system that categorically refuses payment because prior authorisation was impossible may be problematic under EU law.

The CJEU has emphasised this point in its healthcare jurisprudence, including Elchinov and later cases. (curia)

25. Healthcare Provider Billing

A foreign healthcare provider may issue a bill directly to the patient.

The dispute may concern:

whether the patient consented to treatment;

price transparency;

medical necessity;

additional procedures;

room charges;

professional fees;

diagnostic charges;

medication;

emergency fees.

This is a more traditional civil-law dispute.

26. Patient-Insurer Reimbursement

A different dispute arises when:

Foreign hospital → €30,000 bill

Home insurer → €20,000 reimbursement

The patient asks:

"Who is responsible for the remaining €10,000?"

The answer depends upon:

applicable EU law;

national reimbursement tariffs;

authorisation;

treatment classification;

contractual/insurance terms.

27. Reimbursement Ceiling

European law does not generally mean:

"Every patient must receive unlimited reimbursement for treatment abroad."

Reimbursement can be subject to legally defined limits.

The CJEU has recognised that reimbursement may be limited according to the amount that would have been assumed under the patient's competent national system, subject to the applicable EU rules. (curia)

Therefore:

Foreign treatment cost ≠ automatically reimbursable amount.

28. Medical Necessity

A central issue is whether treatment was medically necessary.

The insurer may argue:

"Equivalent treatment was available at home."

The patient may argue:

"The foreign treatment was medically justified because domestic treatment was unavailable within an appropriate period."

Smits-Peerbooms, Watts, Elchinov and Petru demonstrate how important medical necessity and practical availability can be in reimbursement disputes.

29. Waiting Lists

Waiting lists can become legally significant.

Suppose:

Home-state waiting time = 18 months

while:

Foreign treatment availability = 2 months

If the patient's medical condition makes an 18-month wait unacceptable, EU law may require a more careful assessment of whether domestic treatment is genuinely available within a medically justifiable period.

Watts is particularly important here.

30. Hospital vs Non-Hospital Treatment

This distinction is extremely important.

Non-hospital treatment

Prior authorisation is generally more difficult to justify.

Hospital treatment

Prior authorisation may be justified because healthcare planning and financial sustainability can require advance control.

The distinction appears throughout the CJEU case law beginning with Kohll, Smits-Peerbooms and Müller-Fauré.

31. Applicable Law

A cross-border healthcare billing dispute may involve several laws simultaneously.

Law of patient's country

May govern:

insurance entitlement;

reimbursement;

national healthcare benefits.

Law of treatment country

May govern:

healthcare provider obligations;

professional standards;

hospital billing;

medical liability.

EU law

May govern:

cross-border access;

free movement;

reimbursement;

prior authorisation.

Thus:

One dispute can legitimately involve multiple legal systems.

32. Private International Law

Where the dispute is genuinely contractual or tortious, private international law may become important.

Questions include:

Where was the healthcare contract concluded?

Where was treatment provided?

Where did injury occur?

Where is the insurer domiciled?

Which law governs the provider-patient relationship?

Which court has jurisdiction?

Brussels I Recast and Rome I/Rome II may therefore become relevant depending on the nature of the claim.

33. Healthcare Provider vs Patient

Suppose a German hospital treats a French patient.

The hospital sends a €50,000 bill.

The patient disputes €15,000.

Potential questions:

Was the treatment authorised?

Was the price disclosed?

Was there a valid contract?

Was emergency treatment involved?

Was the treatment medically necessary?

Does French or German law govern the billing contract?

Which court has jurisdiction?

Is there a statutory healthcare tariff?

34. Health Insurer vs Foreign Provider

A foreign provider may claim:

"The insurer must pay the full amount."

The insurer may respond:

"Our reimbursement obligation is limited by the applicable tariff."

The court may then need to distinguish:

provider's contractual price

from

statutory reimbursement obligation.

35. Medical Tariffs

Healthcare reimbursement may be calculated according to:

national tariff;

diagnosis-related group;

treatment code;

professional fee schedule;

insurance contract;

statutory reimbursement rate.

A cross-border billing dispute may therefore become a technical question of tariff classification.

36. Telemedicine Billing

Telemedicine introduces new questions.

Example:

Patient in France

receives a remote consultation from

Doctor established in Germany.

Questions include:

Where is the service legally provided?

Which healthcare standards apply?

Which reimbursement tariff applies?

Is the provider authorised?

Which insurer pays?

Is the consultation covered?

Which data-protection rules apply?

Recent CJEU jurisprudence has specifically addressed the cross-border nature of telemedicine under the EU healthcare framework. (curia)

37. Medical Records and Evidence

Billing disputes often require:

medical records;

invoices;

treatment codes;

prescriptions;

referrals;

authorisation documents;

diagnostic reports;

proof of payment;

insurer correspondence.

Cross-border cases may require translation and certification of documents.

GDPR also becomes relevant because medical records contain sensitive personal data.

38. Currency and Payment Issues

Cross-border healthcare billing can involve different currencies.

Although many EU countries use the euro, not all do.

Disputes may concern:

exchange rates;

date of conversion;

bank charges;

payment deadlines;

interest;

late-payment penalties.

39. Reimbursement Time Limits

National systems may establish deadlines for submitting reimbursement claims.

A dispute may arise where:

the patient submits the claim late;

the insurer delays processing;

medical documents are missing;

the patient was not adequately informed of the procedure.

A procedural deadline should not, however, be assessed in isolation from EU effectiveness requirements.

40. Refusal of Reimbursement

Common grounds for refusal include:

No prior authorisation.

Treatment not covered.

Treatment not medically necessary.

Equivalent domestic treatment available.

Provider not recognised.

Documentation incomplete.

Claim submitted late.

Treatment outside statutory benefits.

Amount exceeds applicable reimbursement tariff.

Each reason must be tested against the applicable EU and national framework.

41. Remedies

A patient may seek:

Reimbursement

Payment of eligible healthcare costs.

Additional reimbursement

Where EU law requires it.

Interest

For delayed payment where legally available.

Declaration

A court may determine entitlement to reimbursement.

Annulment of refusal

A national authority's refusal may be challenged.

Damages

Potentially available under applicable civil or administrative law, depending on the legal basis.

42. Administrative and Civil Enforcement

Cross-border healthcare disputes frequently involve an administrative element.

The patient may first challenge:

Health-insurance decision → administrative appeal → national court

But there may also be a civil dispute:

Patient → hospital → billing claim

Therefore, the legal route depends upon the identity of the defendant and the nature of the obligation.

43. Importance of Prior Information

Patients need clear information about:

reimbursement rights;

prior authorisation;

provider status;

costs;

treatment conditions;

complaint procedures.

Lack of information can itself become relevant where the patient argues that the reimbursement system was not transparent or accessible.

44. Case-Law Comparison

45. Most Important Six Cases for Examination

If the question specifically asks for six case laws, use these:

1. Kohll — C-158/96

Cross-border medical services and prior authorisation.

2. Smits and Peerbooms — C-157/99

Hospital treatment and justified prior authorisation.

3. Müller-Fauré — C-385/99

Non-hospital treatment and reimbursement.

4. Vanbraekel — C-368/98

Level of reimbursement and additional reimbursement.

5. Watts — C-372/04

Waiting lists and hospital treatment abroad.

6. Elchinov — C-173/09

Reimbursement and unlawful absolute barriers to cross-border hospital treatment.

For a more current answer, add Petru, Veselības ministrija, and Casa Județeană Mureș.

46. Practical Hypothetical

Facts

A Romanian resident is insured in Romania.

She has a serious medical condition.

A German specialist clinic can provide treatment within two months.

The Romanian system can provide the treatment after one year.

She travels to Germany without obtaining prior authorisation.

The German hospital charges:

€40,000

The Romanian insurer refuses reimbursement completely.

Legal analysis

Step 1

The patient is insured in Romania.

Step 2

Healthcare was provided in Germany.

Step 3

This is cross-border healthcare.

Step 4

Determine whether the treatment is hospital or major healthcare.

Step 5

Determine whether prior authorisation could legitimately be required.

Step 6

Assess whether treatment was available in Romania within a medically justifiable period.

Step 7

Apply the relevant rules under Directive 2011/24 and Regulation 883/2004.

Step 8

Calculate the reimbursement legally available.

Step 9

Determine whether the insurer can lawfully refuse reimbursement completely.

Step 10

If the insurer's decision is challenged, national courts may need to apply the CJEU's interpretation of EU law.

The reasoning in Watts, Elchinov, Petru and the later CJEU jurisprudence becomes particularly relevant.

47. Relationship Between Healthcare Contract and Insurance Contract

There may actually be two separate contracts/relationships:

Healthcare relationship

Patient ↔ Foreign healthcare provider

Insurance relationship

Patient ↔ Home-state insurer

The first governs:

treatment;

provider charges;

medical obligations.

The second governs:

reimbursement;

eligibility;

tariffs;

authorisation.

Confusing these two relationships can lead to incorrect legal analysis.

48. Civil-Law Principles

A. Good Faith

Parties should act honestly in contractual and reimbursement relationships.

B. Transparency

Patients should understand the financial consequences of treatment.

C. Proportionality

Restrictions on cross-border treatment must be proportionate to legitimate healthcare objectives.

D. Legitimate Expectations

Patients may rely upon clear information provided by health authorities or insurers.

E. Restitution

Where a party has wrongly received or withheld money, restitution may become relevant.

F. Damages

Where legally available, a patient may claim compensation for losses resulting from unlawful conduct.

49. Key Enforcement Problems

1. Different reimbursement tariffs

The treatment country may charge considerably more than the insurance country reimburses.

2. Prior authorisation

Disputes frequently arise over whether authorisation was actually required.

3. Medical necessity

Insurers may challenge the necessity or classification of treatment.

4. Emergency care

The patient may have had no realistic opportunity to obtain authorisation.

5. Waiting lists

The home state may technically provide treatment but not within a medically appropriate period.

6. Different legal systems

The patient and hospital may be subject to different national laws.

7. Telemedicine

It can be difficult to determine the location of healthcare provision.

8. Documentation

Medical records and invoices may need cross-border verification.

50. Exam-Oriented Legal Framework

For an examination answer, follow this sequence:

1. Identify the parties

Patient, insurer, hospital, doctor or health authority.

2. Identify the cross-border element

Residence, insurance, treatment or provider establishment.

3. Identify the type of treatment

Hospital, non-hospital, emergency or telemedicine.

4. Determine the legal regime

Consider:

Directive 2011/24;

Regulation 883/2004;

Article 56 TFEU;

national healthcare law.

5. Examine prior authorisation

Was it required?

6. Examine medical necessity

Could treatment reasonably be provided at home?

7. Calculate reimbursement

What tariff or reimbursement method applies?

8. Examine the bill

What did the foreign provider actually charge?

9. Determine jurisdiction and applicable law

Consider the appropriate EU private-international-law rules where a civil dispute exists.

10. Determine remedy

Reimbursement, additional payment, interest, damages, or judicial review.

51. Ultra-Basic Keywords

Cross-border healthcare billing =

Patient → Foreign hospital → Treatment → Bill → Insurance → Authorisation → Reimbursement → Tariff → EU law → Dispute → Court → Enforcement

Must-remember terms

Cross-border healthcare

Patient mobility

Healthcare provider

Health insurer

Reimbursement

Prior authorisation

Hospital treatment

Non-hospital treatment

Emergency treatment

Medical necessity

Waiting list

Healthcare tariff

Directive 2011/24/EU

Regulation 883/2004

Article 56 TFEU

Free movement of services

Social-security coordination

Telemedicine

Medical records

Foreign hospital

Additional reimbursement

Civil liability

Contractual liability

Jurisdiction

Applicable law

Interest

Damages

Conclusion

Cross-border healthcare billing disputes in Europe are fundamentally about reconciling patient mobility and freedom to provide healthcare services with the Member States' responsibility to organise and finance their healthcare systems. The CJEU's jurisprudence beginning with Decker and Kohll established that healthcare and related expenditure can fall within EU free-movement principles. Smits and Peerbooms, Müller-Fauré, Vanbraekel, Watts, Elchinov and Petru subsequently developed the rules on prior authorisation, hospital versus non-hospital treatment, reimbursement levels, waiting times and practical availability of treatment. (curia)

The more recent Casa Județeană de Asigurări de Sănătate Mureș (C-489/23) decision shows that these issues remain current: national reimbursement procedures and medical-assessment requirements must be assessed against the EU framework and cannot disproportionately obstruct reimbursement of legitimate cross-border healthcare. (curia)

The central rule for revision is:

A patient does not automatically acquire a right to unlimited reimbursement simply by obtaining treatment abroad, but a Member State cannot use reimbursement rules, prior-authorisation requirements or procedural barriers in a manner that unjustifiably or disproportionately restricts EU rights to cross-border healthcare.