The European Court of Justice and the free movement of patients in the European Union

At present, health policy in the European Union (EU) is being developed in an extremely disconnected fashion. EU member States independently develop their own health systems, based on the goals they wish to pursue, without really considering consistency with European Community (EC) law. The impact of European integration is, in turn, mainly indirect and has emerged from European Court of Justice (ECJ) rulings. These rulings have arisen either from considerations in other sectors or through the process of addressing particular issues within single cases, leaving major issues of applicability unresolved. The evolving issue of free movement of patients is instructive. While not completely outlawing the use of a prior authorization system, recent ECJ rulings have radically restricted member States' discretion to determine their own policies by requiring that their decisions be necessary, proportional and based on objective and non-discriminatory criteria. By linking EEC Regulation 1408/71, on which cover for healthcare abroad has been traditionally based, with the free provision of services, the ECJ seems to have created difficulties and important uncertainties for the system of coordination of social security schemes.